Brain networks alterations in cocaine use and gambling disorders during emotion regulation.

Background: Cocaine use disorder (CUD) and gambling disorder (GD) share clinical features and neural alterations, including emotion regulation deficits and dysfunctional activation in related networks. However, they also exhibit differential aspects, such as the neuroadaptive effects of long-term drug consumption in CUD as compared to GD. Neuroimaging research aimed at disentangling their shared and specific alterations can contribute to improve understanding of both disorders. Methods: We compared CUD (N = 15), GD (N = 16) and healthy comparison (HC; N = 17) groups using a network-based approach for studying temporally coherent functional networks during functional magnetic resonance imaging (fMRI) of an emotion regulation task. We focused our analysis in limbic, ventral frontostriatal, dorsal attentional (DAN) and executive networks (FPN), given their involvement in emotion regulation and their alteration in CUD and GD. Correlations with measures of emotional experience and impulsivity (UPPS-P) were also performed. Results: The limbic network was significantly decreased during emotional processing both for CUD and GD individuals compared to the HC group. Furthermore, GD participants compared to HC showed an increased activation in the ventral frontostriatal network during emotion regulation. Finally, networks' activation patterns were modulated by impulsivity traits. Conclusions: Functional network analyses revealed both overlapping and unique effects of stimulant and gambling addictions on neural networks underpinning emotion regulation.

Unpacking common and distinct neuroanatomical alterations in cocaine dependent versus pathological gambling.

Pathological gambling and cocaine dependence are highly pervasive disorders. Functional neuroimaging evidence implicates aberrant activity of prefrontal striatal pathways in both disorders. It is unclear if the neuroanatomy of these areas is also affected. Participants with pathological gambling (n = 18), cocaine dependence (n = 19) and controls (n = 21) underwent high-resolution structural MRI scan and cognitive assessments. In line with emerging functional neuroimaging findings, we hypothesised (i) lower volumes of corticostriatal areas ascribed to decision-making/inhibitory control, craving and reward processing (i.e., orbitofrontal cortex, inferior frontal gyrus, amygdala, striatum, insula) in both pathological gamblers and cocaine dependent participants versus controls; (ii) selected dopaminergic/glutamatergic pathways directly taxed by cocaine (i.e., superior, dorsolateral and anterior cingulate cortices) would be altered in cocaine dependent versus control participants only. Analyses were conducted with a bonferroni correction. Our results showed that both pathological gambling and cocaine dependent participants, compared to controls, had larger volumes of the right inferior frontal gyrus (ps <.01, ds = 0.66 and 0.62). Cocaine dependent participants had lower nucleus accumbens and medial orbitofrontal cortex volumes than pathological gamblers (ps <.05, ds = 0.51 and 0.72), with the latter being predicted by higher negative urgency scores. Inferior frontal gyrus volume may reflect common alterations of cocaine and gambling addictions, whereas cocaine dependence may be uniquely associated with reduced volume in dorsolateral and middle frontal regions. Cocaine's supra-physiological effects on mesolimbic neurons may explain reduced accumbens-orbitofrontal structure compared to gambling.

The neural interface between negative emotion regulation and motivation for change in cocaine dependent individuals under treatment.

BACKGROUND: Emotion regulation is important for cocaine addiction treatment success, particularly during early abstinence. In addition, the neural underpinnings of emotion processing overlap with those of motivation and goal-directed behavior. We examined if the neural underpinnings of emotion maintenance and its regulation correlate with cocaine treatment motivation. METHODS: Forty-five cocaine dependent individuals (CDIs) starting outpatient treatment in a public specialized addiction treatment clinic in Granada (Spain) underwent fMRI scans while performing a Reappraisal task, and completed the University of Rhode Island Change Assessment Scale (URICA), to measure treatment motivation. We conducted correlation analyses to examine the association between emotion maintenance and regulation related brain activation and URICA's Readiness to Change scores. We also explored links between Emotional reports during the fMRI reappraisal task, duration of abstinence, and anxiety and depression symptoms. RESULTS: Readiness to Change scores were positively correlated with activations in the right dorsolateral prefrontal and right parietal cortices, the midbrain (p ≤ 0.001, cluster extents ≥109 voxels), and basolateral amygdala (PFWE-SVC<0.05), while negatively with emotion maintenance related activation in the same cortical areas and activations in the dorsomedial frontal cortex, the nucleus accumbens and the left fusiform gyrus. Emotional reactivity negatively correlated with right dorsolateral prefrontal cortex reappraisal related activation (r= -0.40, p = 0.007), and the Regulate score positively correlated with the left fusiform gyrus emotion maintenance related activation (r = 0.31, p = 0.04). CONCLUSIONS: Emotional related activation in frontoparietal, accumbens, fusiform, amygdala and midbrain regions engaged during emotion regulation and its maintenance correlate with early treatment motivation in CDIs.

Questionnaire of core beliefs related to drug use and craving for assessment of relapse risk. / Cuestionario de creencias nucleares relacionadas con el consumo de drogas y el craving, para la valoración del riesgo de recaída.

This study was aimed at designing a questionnaire for the assessment of addiction-related core beliefs and craving. The sample comprised 215 patients (85.8% males and 14.2% females) in treatment for dependence to alcohol (40%), cocaine (36.3%) and cannabis (23.7%). Descriptive statistics were used to characterize the sample. Variance, regression and factorial analyses were conducted to study the questionnaire structure and its relation with variables such as abstinence and craving. Items about drug-related beliefs yielded a four-factor structure: what patient think that they could not do without drug use, lack of withdrawal, conditions required to use drugs again, and use of drugs as the only way to feel good. Items related to craving yielded three factors: negative emotions as precipitants of drug use, positive emotions, and difficulties attributed to coping with craving. Furthermore, beliefs were more important to predict craving than abstinence time. The present questionnaire allows to assess a set of significant factors to design prevention relapse programs.

El objetivo de la investigación fue diseñar un cuestionario para la evaluación de creencias nucleares en torno al consumo de drogas y el craving. La muestra estuvo compuesta por 215 pacientes, de los que el 85.8% eran hombres y el 14.2% mujeres en tratamiento por su adicción al alcohol (40%), cocaína (36.3%) y cánnabis (23.7%). Se realizó un análisis descriptivo de la muestra, análisis de varianza, de regresión y análisis factorial con la finalidad de indagar en la estructura del cuestionario y su relación con variables como la abstinencia o deseo de consumo. El apartado de creencias relacionadas con las drogas mostró una estructura de cuatro factores: lo que la persona cree que no podrá realizar en ausencia del consumo de drogas, la falta de renuncia al consumo, las condiciones que deben darse para volver a consumir y el consumo como única vía para sentirse bien. El apartado relacionado con el craving mostró tres factores: las emociones negativas como precipitantes del consumo, las emociones positivas y las dificultades atribuidas al afrontamiento del deseo. A su vez, se constata que las creencias tienen más peso en la predicción del deseo en comparación al tiempo de abstinencia. El cuestionario permite evaluar un conjunto de creencias que muestras factores significativos para el diseño de programas de prevención de recaídas.

Cuestionario de creencias nucleares relacionadas con el consumo de drogas y el craving, para la valoración del riesgo de recaída / Questionnaire of core beliefs related to drug use and craving for assessment of relapse risk

El objetivo de la investigación fue diseñar un cuestionario para la evaluación de creencias nucleares en torno al consumo de drogas y el craving. La muestra estuvo compuesta por 215 pacientes, de los que el 85.8% eran hombres y el 14.2% mujeres en tratamiento por su adicción al alcohol (40%), cocaína (36.3%) y cánnabis (23.7%). Se realizó un análisis descriptivo de la muestra, análisis de varianza, de regresión y análisis factorial con la finalidad de indagar en la estructura del cuestionario y su relación con variables como la abstinencia o deseo de consumo. El apartado de creencias relacionadas con las drogas mostró una estructura de cuatro factores: lo que la persona cree que no podrá realizar en ausencia del consumo de drogas, la falta de renuncia al consumo, las condiciones que deben darse para volver a consumir y el consumo como única vía para sentirse bien. El apartado relacionado con el craving mostró tres factores: las emociones negativas como precipitantes del consumo, las emociones positivas y las dificultades atribuidas al afrontamiento del deseo. A su vez, se constata que las creencias tienen más peso en la predicción del deseo en comparación al tiempo de abstinencia. El cuestionario permite evaluar un conjunto de creencias que muestras factores significativos para el diseño de programas de prevención de recaídas

This study was aimed at designing a questionnaire for the assessment of addiction-related core beliefs and craving. The sample comprised 215 patients (85.8% males and 14.2% females) in treatment for dependence to alcohol (40%), cocaine (36.3%) and cannabis (23.7%). Descriptive statistics were used to characterize the sample. Variance, regression and factorial analyses were conducted to study the questionnaire structure and its relation with variables such as abstinence and craving. Items about drug-related beliefs yielded a four-factor structure: what patient think that they could not do without drug use, lack of withdrawal, conditions required to use drugs again, and use of drugs as the only way to feel good. Items related to craving yielded three factors: negative emotions as precipitants of drug use, positive emotions, and difficulties attributed to coping with craving. Furthermore, beliefs were more important to predict craving than abstinence time. The present questionnaire allows to assess a set of significant factors to design prevention relapse programs

Self-deception as a mechanism for the maintenance of drug addiction / El autoengaño como mecanismo de mantenimiento de la adicción a las drogas

BACKGROUND: This study was aimed at: (I) examining levels of selfdeception in substance dependent individuals following addiction treatment, and (II) examining the association between participants' levels of self-deception and (a) personality disorders, (b) addiction-related beliefs, (c) duration of abstinence, and (d) estimates of craving. METHOD: We administered self-report questionnaires of self-deception and mixtification, and core beliefs related to addiction and craving. The sample comprised 79 outpatients who were consecutively recruited at the Centro Provincial de Drogodependencias in Granada: 87.3% were males and the mean age was 37.68 years old. Thirty-four percent of participants were diagnosed with comorbid personality disorders. RESULTS: Results showed that individuals with substance dependence exhibit elevated scores of selfdeception, particularly in the domains of active denial, selective amnesia, projection, and confabulation. Individuals with comorbid personality disorders display greater levels of self-deception compared to individuals without dual diagnosis. CONCLUSIONS: Moreover, there is a significant association between levels of self-deception and addiction-related beliefs and craving. In addition, there is a negative association between levels of self-deception and duration of abstinence

ANTECEDENTES: los objetivos de este estudio fueron: (I) conocer el nivel de autoengaño de drogodependientes en tratamiento por su adicción, y (II) estudiar la relación del autoengaño con (a) los trastornos de personalidad, (b) las creencias, (c) la abstinencia y (d) el craving en estos pacientes. MÉTODO: se utilizaron los cuestionarios de autoengaño y mixtificación (IAM) y de creencias relacionadas con el consumo de drogas y craving. La muestra estaba compuesta por 79 pacientes atendidos de forma consecutiva en el Centro Provincial de Drogodependencias de Granada. El 34.5% de los pacientes presentaban un trastorno de la personalidad. RESULTADOS: los resultados mostraron que los drogodependientes obtienen puntuaciones elevadas en autoengaño, especialmente en los factores negación, amnesia selectiva, proyección y pensamiento fantaseado. Además, los pacientes con trastornos de la personalidad presentan niveles de autoengaño más elevados en comparación a los que no presentan este tipo de psicopatología, observándose una relación significativa entre las creencias nucleares relacionadas con el consumo y con el craving con el nivel de autoengaño. CONCLUSIONES: se constata igualmente que el nivel de autoengaño se relaciona de forma negativa con el tiempo de abstinencia, lo que convierte al autoengaño en una diana terapéutica para mejorar el pronóstico

[Differential aspects of treatment dropout risk in cocaine dependent patients with and without personality disorders]. / Aspectos diferenciales del riesgo de abandono al inicio del tratamiento de la adicción a la cocaína en pacientes con trastornos de la personalidad.

The aim of this study was to examine the link between psychosocial adjustment, impulsivity and comorbid Axis II psychopathology, and the risk of treatment dropout in cocaine dependent patients. The sample consisted of 95 cocaine dependent participants, 53.7% of whom had been diagnosed with Axis II personality disorders. We utilised a descriptive methodology, which allowed us to examine correlations between the different variables, group differences in these variables, and their ability to predict different dimensions associated with the risk of dropout. Results show that the risk of dropout during the first two months of treatment is not associated with the existence of comorbid personality disorders. With regard to the cognitive profiles of personality disorders, we show that the antisocial profile is associated with higher risk of dropout. The profile of patients at higher risk of treatment dropout is characterised by lower levels of perceived quality of life and elevated levels of impulsivity, especially the experience of strong impulses under positive affect. Therefore, the presence of psychological dimensions tightly associated with emotions, affects and subjective feelings are the more relevant to estimate the risk of treatment dropout in cocaine dependent patients. This study stresses the variables that need to be specifically addressed during early phases of cocaine addiction treatment, since they are associated with higher risk of treatment dropout.

Prefrontal Gray Matter and Motivation for Treatment in Cocaine-Dependent Individuals with and without Personality Disorders.

Addiction treatment is a long-term goal and therefore prefrontal-striatal regions regulating goal-directed behavior are to be associated with individual differences on treatment motivation. We aimed at examining the association between gray matter volumes in prefrontal cortices and striatum and readiness to change at treatment onset in cocaine users with and without personality disorders. Participants included 17 cocaine users without psychiatric comorbidities, 17 cocaine users with Cluster B disorders, and 12 cocaine users with Cluster C disorders. They completed the University of Rhode Island Change Assessment Scale, which measures four stages of treatment change (precontemplation, contemplation, action, and maintenance) and overall readiness to change, and were scanned in a 3 T MRI scanner. We defined three regions of interest (ROIs): the ventromedial prefrontal cortex (including medial orbitofrontal cortex and subgenual and rostral anterior cingulate cortex), the dorsomedial prefrontal cortex (i.e., superior medial frontal cortex), and the neostriatum (caudate and putamen). We found that readiness to change correlated with different aspects of ventromedial prefrontal gray matter as a function of diagnosis. In cocaine users with Cluster C comorbidities, readiness to change positively correlated with gyrus rectus gray matter, whereas in cocaine users without comorbidities it negatively correlated with rostral anterior cingulate cortex gray matter. Moreover, maintenance scores positively correlated with dorsomedial prefrontal gray matter in cocaine users with Cluster C comorbidities, but negatively correlated with this region in cocaine users with Cluster B and cocaine users without comorbidities. Maintenance scores also negatively correlated with dorsal striatum gray matter in cocaine users with Cluster C comorbidities. We conclude that the link between prefrontal-striatal gray matter and treatment motivation is modulated by co-existence of personality disorders.

Decision-making impairment predicts 3-month hair-indexed cocaine relapse.

RATIONALE: One of the key outstanding challenges in cocaine dependence research is determining who is at risk of relapsing during treatment. OBJECTIVES: We examined whether cognitive decision-making profiles predict objectively (hair) indexed cocaine relapse at 3-month follow-up. METHODS: Thirty-three cocaine-dependent patients commencing outpatient treatment in a public clinic performed baseline decision-making assessments with the original and variant versions of the Iowa Gambling Task, and provided a 3-cm hair sample 3 months afterwards. Based on Iowa Gambling Tasks' performance cut-offs, 5 patients had intact decision-making skills, 17 patients showed impaired sensitivity to reward or punishment (impairment in one of the tasks), and 9 patients showed insensitivity to future consequences (impairment in both tasks). Based on a 0.3 ng/mg cocaine cut-off, 23 patients were classified as relapsers and 10 as non-relapsers at the 3-month follow-up. RESULTS: Eighty percent of patients with intact decision-making were abstinent at follow-up, whereas 90% of patients with insensitivity to future consequences had relapsed. The two subgroups (relapsers and non-relapsers) showed no significant differences on drug use, comorbidities, or psychosocial function, and significantly differed on verbal but not performance IQ. A regression model including decision-making scores and verbal IQ predicted abstinence status with high sensitivity (95%) and moderately high specificity (81%). CONCLUSION: These preliminary findings demonstrate that decision-making profiles are associated with cocaine relapse. Moreover, combined decision-making and IQ assessments provide optimal predictive values over stimulant relapse, yielding significant opportunities for clinical translation.

Aspectos diferenciales del riesgo de abandono al inicio del tratamiento de la adicción a la cocaína en pacientes con trastornos de la personalidad / Differential aspects of treatment dropout risk in cocaine dependent patients with and without personality disorders

El objetivo de este trabajo fue conocer el riesgo de abandono del tratamiento de pacientes en tratamiento por su adicción a la cocaína en función de variables como la psicopatología en el Eje II, el nivel de gravedad del ajuste psicológico o la impulsividad. La muestra estaba compuesta por 95 pacientes, de los que el 53.7 % presentaba un trastorno de la personalidad. Se utilizó una metodología descriptiva que nos permitió conocer las correlaciones entre diferentes variables, su capacidad predictiva y las diferencias entre grupos con respecto a variables relacionadas con el abandono del tratamiento. Este trabajo muestra que el riesgo de abandono durante los dos primeros meses no viene determinado por la presencia de un trastorno de la personalidad. En relación a los perfiles cognitivos de personalidad se comprueba que el antisocial presenta más riesgo de abandono. El perfil de paciente con más riesgo de abandono del tratamiento al iniciar el tratamiento presenta un menor nivel de calidad de vida autopercibida y niveles más elevados de impulsividad, en especial la experiencia de fuertes impulsos bajo condiciones de afectos positivos. Se ha comprobado que la presencia de sentimientos adversos como afectos, emociones, sensaciones y sentimientos que afectan al paciente es la dimensión que tiene un papel más destacado en el análisis del riesgo de abandono del tratamiento. Este trabajo permite poner de relieve las variables que deben atenderse con más especificidad desde el inicio del tratamiento porque se han relacionado más claramente con un mayor riesgo de abandono del tratamiento

The aim of this study was to examine the link between psychosocial adjustment, impulsivity and comorbid Axis II psychopathology, and the risk of treatment dropout in cocaine dependent patients. The sample consisted of 95 cocaine dependent participants, 53.7% of whom had been diagnosed with Axis II personality disorders. We utilised a descriptive methodology, which allowed us to examine correlations between the different variables, group differences in these variables, and their ability to predict different dimensions associated with the risk of dropout. Results show that the risk of dropout during the first two months of treatment is not associated with the existence of comorbid personality disorders. With regard to the cognitive profiles of personality disorders, we show that the antisocial profile is associated with higher risk of dropout. The profile of patients at higher risk of treatment dropout is characterised by lower levels of perceived quality of life and elevated levels of impulsivity, especially the experience of strong impulses under positive affect. Therefore, the presence of psychological dimensions tightly associated with emotions, affects and subjective feelings are the more relevant to estimate the risk of treatment dropout in cocaine dependent patients. This study stresses the variables that need to be specifically addressed during early phases of cocaine addiction treatment, since they are associated with higher risk of treatment dropout

Cocaine users with comorbid Cluster B personality disorders show dysfunctional brain activation and connectivity in the emotional regulation networks during negative emotion maintenance and reappraisal.

Cocaine dependence often co-occurs with Cluster B personality disorders. Since both disorders are characterized by emotion regulation deficits, we predicted that cocaine comorbid patients would exhibit dysfunctional patterns of brain activation and connectivity during reappraisal of negative emotions. We recruited 18 cocaine users with comorbid Cluster B personality disorders, 17 cocaine users without comorbidities and 21 controls to be scanned using functional magnetic resonance imaging (fMRI) during performance on a reappraisal task in which they had to maintain or suppress the emotions induced by negative affective stimuli. We followed region of interest (ROI) and whole-brain approaches to investigate brain activations and connectivity associated with negative emotion experience and reappraisal. Results showed that cocaine users with comorbid personality disorders had reduced activation of the subgenual anterior cingulate cortex during negative emotion maintenance and increased activation of the lateral orbitofrontal cortex and the amygdala during reappraisal. Amygdala activation correlated with impulsivity and antisocial beliefs in the comorbid group. Connectivity analyses showed that in the cocaine comorbid group the subgenual cingulate was less efficiently connected with the amygdala and the fusiform gyri and more efficiently connected with the anterior insula during maintenance, whereas during reappraisal the left orbitofrontal cortex was more efficiently connected with the amygdala and the right orbitofrontal cortex was less efficiently connected with the dorsal striatum. We conclude that cocaine users with comorbid Cluster B personality disorders have distinctive patterns of brain activation and connectivity during maintenance and reappraisal of negative emotions, which correlate with impulsivity and dysfunctional beliefs.

Drogodependientes vs. usuarios de salud mental con trastornos de personalidad: su relación con la calidad de vida, la psicopatología en Eje I, el ajuste psicológico y dinámica familiar / Addicts vs mental health users with personality disorders: its relation to quality of life in Axis I psychopathology, psychological adjustment and family dynamics

El objetivo de este estudio ha sido analizar algunas variables de gran relevancia en el tratamiento de los trastornos de la personalidad como son la calidad de vida, el nivel de gravedad de ajuste psicológico, la concomitancia con psicopatología del Eje I y la percepción de dinámica familiar de estos pacientes. La muestra la componen 68 pacientes que presentan un trastorno de la personalidad de los que el 57.4 % son drogodependientes en tratamiento en un centro ambulatorio de atención a las drogodependencias y el 42.6 % son usuarios de un centro ambulatorio de salud mental que no presenta trastornos adictivos. Los resultados muestran que no existen diferencias significativas en calidad de vida ni gravedad de ajuste psicológico entre los pacientes en función de la drogadicción. Las diferencias parecen estar vinculadas a la concomitancia de psicopatología en el Eje I, porque los que no la presentan cuentan con un nivel de calidad de vida más elevado y mejor ajuste psicológico. Esto indica que la presencia de psicopatología en el Eje I, en pacientes con trastornos de la personalidad, incrementa la dificultad asociada al tratamiento de estos pacientes. En relación a la dinámica familiar se ha podido constatar que mientras el apego influye negativamente en la calidad de vida de estos pacientes, los recursos familiares la mejoran. Todo parece indicar que la calidad de vida autopercibida en pacientes con trastornos de la personalidad, drogodependientes o usuarios de salud mental, está determinada por la presencia concomitante de otra psicopatología en el Eje I. Esta concomitancia debe convertirse en objetivo de intervención terapéutica (AU)

The aim of this study was to analyze some variables of great relevance in the treatment of personality disorders such as quality of life, the severity level of psychological adjustment, the concomitant Axis I psycho-pathology and perception of family dynamics of these patients. The sample is composed of 68 patients with a personality disorder of which 57.4% are drug addicts undergoing treatment in an outpatient drug addiction center and 42.6% are users of a mental health clinic has not addictive disorders. The results showed no significant differences in life quality or severity of psychological adjustment among patients on the basis of drug addiction. The differences appear to be linked to the concomitance of psychopathology on Axis I, because for those who do not have a quality of life higher and better psychological adjustment. This indicates that the presence of Axis I psychopathology, in patients with personality disorders, increases the difficulty associated with treating these patients. In terms of family dynamics has been shown that while the attachment has a negative impact on quality of life of these patients, family resources the better. It seems that the perceived quality of life in patients with personality disorders, drug or mental health consumers, is determined by the concomitant presence of other psychopathology on Axis I. This concomitant should be targeted for therapeutic intervention (AU)

Negative urgency, disinhibition and reduced temporal pole gray matter characterize the comorbidity of cocaine dependence and personality disorders.

BACKGROUND: Individuals with cocaine dependence and co-occurring personality disorders are more likely to have increased impulsivity, dysfunctional beliefs, executive dysfunction and brain structural abnormalities by virtue of the conjoint impact of both pathologies. METHODS: We recruited 32 cocaine dependent patients with comorbid Cluster B personality disorders, 44 cocaine dependent patients without comorbidities and 34 non-drug-using controls. They completed the UPPS-P impulsivity scale, the Personality Belief Questionnaire, and executive function tests of working memory, attention/response inhibition and shifting. A subsample (n=61) was also scanned using Magnetic Resonance Imaging. We used univariate ANOVAs for group comparisons, and tested the association between impulsivity, executive control and personality dysfunction and diagnoses using correlation and multivariate logistic regression analyses. RESULTS: Cocaine dependent patients with personality disorders had elevated negative urgency and borderline beliefs, decreased inhibition and attention regulation, and reduced temporal pole gray matter with respect to the rest of the sample. Trait and cognitive measures correctly classified 73% of comorbid patients (60% sensitivity and 82% specificity). CONCLUSION: The co-occurrence of cocaine dependence and personality disorders is associated with negative-mood impulsivity and beliefs, executive dysfunction and temporal pole attrition.

Frontal systems related symptoms in cocaine dependent patients with comorbid personality disorders.

RATIONALE: The co-occurrence of cocaine dependence and personality disorders may contribute to frontal systems-related behavioral symptoms in cocaine users. OBJECTIVE: This study aims to characterize apathy, disinhibition, and dysexecutive symptoms in cocaine users with comorbid personality disorders. METHODS: Thirty-nine participants meeting criteria for cocaine dependence and personality disorders, 35 participants meeting criteria for cocaine dependence without comorbidities, and 29 controls matched for age, education, and IQ completed the Frontal Systems Behavior Scale (FrSBe), which provides present and retrospective assessments (of the period preceding cocaine use) about apathy, disinhibition, and dysexecutive symptoms. Additionally, relatives of cocaine patients (34 relatives from comorbid patients and 31 relatives from noncomorbid patients) completed the informant version of the FrSBe. We used one-way ANOVAs to investigate present-moment differences between the groups and related samples t tests to quantify changes between pre-disorder and present-moment symptoms. RESULTS: Cocaine users with personality disorders self-reported higher present-moment apathy and disinhibition symptoms than noncomorbid users and controls. Informant ratings showed that comorbid users exhibited pre-disorder elevations in apathy, disinhibition and dysexecutive symptoms, and that these symptoms did not significantly change between the pre-disorder and the present-moment assessments. In contrast, noncomorbid users exhibited increased apathy, disinhibition, and dysexecutive symptoms at present-moment compared with pre-disorder measures. CONCLUSIONS: The co-occurrence of cocaine dependence and personality disorders is associated with elevated frontal systems-related behavioral symptoms. Comorbid and noncomorbid users differ in frontal symptoms' trajectories, with the former showing pre-disorder stable elevations and the latter showing lower baseline symptoms but greater addiction-related elevations.

Evolución de las creencias nucleares relacionadas con la adicción en drogodependientes con y sin trastornos de personalidad / Changes in core beliefs associated with addiction among substance-dependent patients with vs. without comorbid personality disorders

Los objetivos de este estudio fueron: 1) Estimar la capacidad predictiva de las creencias sobre el craving y los consumos de alcohol; y 2) Examinar la evolución a lo largo de nueve meses de las creencias nucleares relacionadas con la adicción en función de la comorbilidad con trastornos de personalidad. Participaron 65 pacientes con dependencia de alcohol de los que el 56.4% presentaban TP comórbidos. Se administró el Cuestionario de Creencias relacionadas con la adicción y con el craving, y se recogieron como medidas de resultado el número de consumos de alcohol durante el tratamiento y el grado de ajuste psicológico. La relación entre los ítems del cuestionario y las variables de resultado se exploraron mediante regresiones lineales y la evolución de las creencias a lo largo del tratamiento se analizó con pruebas t para muestras relacionadas. Los resultados indican que es posible medir de manera fiable un conjunto de creencias adictivas, que el nivel de identificación con estas creencias permite predecir el craving, los consumos de alcohol durante el tratamiento y el ajuste psicológico global, y que el curso de dichas creencias durante el tratamiento difiere en función de la presencia de comorbilidad con TP; los pacientes con TP comórbido presentan una evolución mucho más irregular de su identificación con las creencias relacionadas con la adicción (AU)

The aims of this study were: 1) To evaluate the predictive ability of cognitive beliefs about craving and alcohol use during treatment; and 2) To examine the course of cognitive beliefs, over a nine-month follow-up, as a function of comorbidity with personality disorders (PDs). Participants in the study were sixty-five alcohol-dependent patients initiating treatment at the Provincial Drug-Dependence Centre in Granada (Spain), 56.4% of whom had comorbid personality disorder. We administered the “Questionnaire on beliefs related to addiction and craving”, taking number of alcohol-use episodes during treatment and degree of psychological adjustment as outcome variables. We used linear regression models to analyze the relation between questionnaire items and outcome variables, and related-samples t-tests to examine the course of beliefs throughout the follow-up. Results indicate that it is feasible to reliably measure a range of dysfunctional beliefs associated with addiction, that the degree of identification with these beliefs significantly predicts craving and alcohol use during treatment, and that the course of identification with these beliefs is considerably more irregular in alcohol-dependent individuals with comorbid PDs (AU)

[Changes in core beliefs associated with addiction among substance-dependent patients with vs. without comorbid personality disorders]. / Evolución de las creencias nucleares relacionadas con la adicción en drogodependientes con y sin trastornos de personalidad.

The aims of this study were: 1) To evaluate the predictive ability of cognitive beliefs about craving and alcohol use during treatment; and 2) To examine the course of cognitive beliefs, over a nine-month follow-up, as a function of comorbidity with personality disorders (PDs). Participants in the study were sixty-five alcohol-dependent patients initiating treatment at the Provincial Drug-Dependence Centre in Granada (Spain), 56.4% of whom had comorbid personality disorder. We administered the "Questionnaire on beliefs related to addiction and craving", taking number of alcohol-use episodes during treatment and degree of psychological adjustment as outcome variables. We used linear regression models to analyze the relation between questionnaire items and outcome variables, and related-samples t-tests to examine the course of beliefs throughout the follow-up. Results indicate that it is feasible to reliably measure a range of dysfunctional beliefs associated with addiction, that the degree of identification with these beliefs significantly predicts craving and alcohol use during treatment, and that the course of identification with these beliefs is considerably more irregular in alcohol-dependent individuals with comorbid PDs.

Comparison of impulsivity and working memory in cocaine addiction and pathological gambling: Implications for cocaine-induced neurotoxicity.

BACKGROUND: The aim of this study was to compare the cognitive performance of cocaine dependent individuals (CDI) with that of pathological gamblers (PG). Cocaine dependence and pathological gambling share neurobiological vulnerabilities related to addiction, but PG are relatively free of the toxic consequences, such that any additional deficits observed in CDI may be interpreted as pertaining to specific drug effects. METHODS: We used a case-control observational design contrasting multiple measures of impulsivity (UPPS-P trait impulsivity, delay discounting) and executive measures of response inhibition (Stroop) and working memory performance (N-back) between groups of CDI (n=29), PG (n=23), and healthy controls (n=20). We conducted one-way ANOVAs, followed by planned pairwise tests and calculations of Cohen's d to estimate significant differences between the groups. RESULTS: CDI, as compared to PG, had elevated scores on UPPS-P Negative Urgency and poorer performance on working memory (2-back). PG had steeper delay-discounting rates. Both groups had elevated Positive Urgency and poorer Stroop inhibition compared to controls. Peak amount of cocaine use was negatively correlated with working memory and response inhibition performance. CONCLUSION: We found cocaine-related specific elevations in Negative Urgency and working memory deficits, putatively identified as cocaine neurotoxicity effects. Other aspects of impulsivity (Positive Urgency, Stroop inhibition) were increased across CDI and PG groups and may reflect vulnerability factors for addiction.

Estudio longitudinal sobre calidad de vida, craving y ajuste psicológico en pacientes dependientes del alcohol: variaciones en función de los trastornos de la personalidad / Longitudinal study on quality of life, craving and psychological adjustment in alcohol-dependent patients: variations depending on the personality disorders

El objetivo de este estudio fue conocer la evolución de variables como la calidad de vida, el craving o el ajuste psicológico a lo largo del tratamiento en una muestra de 65 pacientes con un trastorno por dependencia del alcohol, de los que el 56,3% presentaba un trastorno de la personalidad (TP). Se realizaron cinco mediciones a lo largo del tratamiento con un intervalo de tres meses entre cada una de ellas. El análisis de tendencias de la variables craving, calidad de vida y ajuste psicológico a lo largo de los cinco momentos en que fueron evaluados los pacientes ponen de manifiesto que el tratamiento cognitivo-conductual influye de distinta manera en cada una de estas variables: estableciéndose una relación cuadrática y cúbica para el craving; para la calidad de vida en sus distintas escalas se da una relación lineal, cuadrática y cúbica según los distintos momentos temporales; y para el ajuste psicológico existe una relación lineal y cuadrática. Al final del tratamiento los pacientes evaluados presentan niveles de calidad de vida significativamente mayores en comparación al inicio del mismo, pero los resultados muestran que aunque los pacientes con TP mejoran su percepción de calidad de vida a los tres meses, es menor a lo largo de todo el tratamiento con respecto al nivel de los pacientes que no presentan TP. También se ha constatado que la calidad de vida y el craving al iniciar el tratamiento predicen el consumo de alcohol durante los tres primeros meses. Se discuten las implicaciones de estos resultados cara a la intervención psicológica con pacientes dependientes del alcohol (AU)

The goal of this study was to determine the evolution of variables such as quality of life, craving, or psychological adjustment during treatment in a sample of 65 patients with alcohol-dependence disorder, 56.3% of whom also presented a personality disorder (PD). Five measurements were taken over the course of the treatment, at 3-month intervals. The analysis of tendencies of the variables craving, quality of life, and psychological adjustment assessed at the five assessment points revealed that the cognitive-behavioral treatment influences each one of these variables differently: a quadratic and cubic relation was identified for craving, whereas for quality of life there were linear, quadratic and cubic relationships in its diverse scales depending on the time point in question, and for psychological adjustment there were linear and quadratic relationships. At the end of treatment, the patients assessed presented significantly higher levels of quality of life than at the beginning, but the results showed that, although the patients with PD had better perceived quality of life at three months, it was lower over the entire course of the treatment compared to patients without PD. It was also found that quality of life and craving at the start of the treatment predicted alcohol use during the first three months. The implications of these results are discussed with a view to psychological intervention with alcohol-dependent patients (AU)

[Longitudinal study on quality of life, craving and psychological adjustment in alcohol-dependent patients: variations depending on the personality disorders]. / Estudio longitudinal sobre calidad de vida, craving y ajuste psicológico en pacientes dependientes del alcohol: variaciones en función de los trastornos de la personalidad.

The goal of this study was to determine the evolution of variables such as quality of life, craving, or psychological adjustment during treatment in a sample of 65 patients with alcohol-dependence disorder, 56.3% of whom also presented a personality disorder (PD). Five measurements were taken over the course of the treatment, at 3-month intervals. The analysis of tendencies of the variables craving, quality of life, and psychological adjustment assessed at the five assessment points revealed that the cognitive-behavioral treatment influences each one of these variables differently: a quadratic and cubic relation was identified for craving, whereas for quality of life there were linear, quadratic and cubic relationships in its diverse scales depending on the time point in question, and for psychological adjustment there were linear and quadratic relationships. At the end of treatment, the patients assessed presented significantly higher levels of quality of life than at the beginning, but the results showed that, although the patients with PD had better perceived quality of life at three months, it was lower over the entire course of the treatment compared to patients without PD. It was also found that quality of life and craving at the start of the treatment predicted alcohol use during the first three months. The implications of these results are discussed with a view to psychological intervention with alcohol-dependent patients.

Drogodependencias y trastornos de la personalidad: variables relevantes para su tratamiento / No disponible

Se sabe que el tratamiento de pacientes con patología dual debe hacerse desde un modelo integral que aborde simultáneamente la adicción y la psicopatología concomitante. El tratamiento de drogodependientes con trastornos de la personalidad ha sido objeto de muchas investigaciones a lo largo de los últimos años, gracias a las cuales hoy podemos disponer de algunas evidencias para llevar a cabo tratamientos efectivos. El artículo hace una revisión de diversas investigaciones sobre el tratamiento de la drogadicción en pacientes con trastorno de la personalidad, destacando la importancia de variables como la adherencia al tratamiento, la evolución del trastorno de personalidad, los patrones de consumo, la vinculación entre el trastorno del Eje II y la droga, la evaluación, la especificidad del tratamiento con respecto a otros casos que no presentan esta psicopatología, el impacto del Eje II en la evolución del tratamiento y evaluación de resultados. El tratamiento cognitivo-conductual es un tratamiento efectivo para el tratamiento de estos casos, si bien es cierto que el paciente debe permanecer en tratamiento el tiempo suficiente (AU)

There is agreement on the notion that the treatment of substance dependent individuals with dual diagnosis has to be conducted froma comprehensive model that is able to address both addiction and concurrent psychopathology. In recent years several research studies have focused on the treatment of substance dependent individuals with personality disorders, thus providing increasing evidence on how to carry out effective interventions for these patients. This paper reviews a number of research studies about addiction treatment in the case of patients with personality disorders. This review underscores and discusses the relevance of key variables for treatment in dual diagnosed patients, including treatment retention, evolution of personality disorders, drug using patterns, the link between the Axis II diagnosis and drug use, assessment, the need of tailored interventions with respect to other cases without comorbid psychopathology, and the impact of Axis II diagnosis on the evolution of treatment and the evaluation of treatment outcomes. Cognitive behavioral therapy is an effective intervention for the treatment of substance dependent individuals with dual diagnosis, provided that the patients stay in treatment long enough (AU)