[Prefrontal Symptoms Inventory (PSI): ecological validity and convergence with neuropsychological measures]. / Inventario de sintomas prefrontales (ISP): validez ecologica y convergencia con medidas neuropsicologicas.

INTRODUCTION: The Prefrontal Symptoms Inventory (PSI) is a self-reported questionnaire, created in Spain, which asks about cognitive, emotional and behavioural alterations in activities of daily living and which can be applied in both the general population and in multiple clinical populations. There is a shorter 20-item version (PSI-20) with excellent psychomotor properties for screening. AIM: To study the convergent and divergent validity of the PSI and PSI-20, by analysing how their scales reflect the day-to-day consequences of real deficits found in neurological assessment performed by means of performance tests. PATIENTS AND METHODS: A sample of 52 persons undergoing treatment for substance addiction (31 males and 21 females) were administered the PSI together with an abbreviated neuropsychological examination battery focused on describing attentional, mnemonic and executive processes. RESULTS: Both versions of the PSI present optimal psychometric properties (0.78 > alpha > 0.94 for the complete 46-item version and 0.7 > alpha > 0.89 for the abbreviated 20-item version). The results confirm the hypotheses regarding their validity: the performance problems scale is related with the capacity to resolve tests that supposedly rate the executive functions of a prefrontal origin (convergent validity), whereas the scales of problems in emotional control and problems with social behaviour are not related with those cognitive capabilities (discriminant validity). CONCLUSIONS: The PSI is a test that is clinically useful, psychometrically valid and applicable in multiple clinical populations.

TITLE: Inventario de sintomas prefrontales (ISP): validez ecologica y convergencia con medidas neuropsicologicas.Introduccion. El inventario de sintomas prefrontales (ISP) es un cuestionario autoinformado creado en España que interroga sobre alteraciones cognitivas, emocionales y comportamentales en las actividades de la vida diaria y que resulta aplicable tanto en poblacion general como en multiples poblaciones clinicas. Existe una version abreviada de 20 items (ISP-20) con excelentes propiedades psicometricas para el cribado. Objetivo. Estudiar la validez convergente y divergente del ISP e ISP-20, analizando como sus escalas reflejan las consecuencias cotidianas de deficits reales hallados en evaluacion neuropsicologica mediante pruebas de ejecucion. Pacientes y metodos. Se estudiaron 52 personas con adiccion a sustancias en tratamiento (31 varones y 21 mujeres) a las que se administro el ISP junto con una bateria de exploracion neuropsicologica abreviada centrada en describir procesos atencionales, mnemicos y ejecutivos. Resultados. Ambas versiones del ISP presentan optimas propiedades psicometricas (0,78 > alfa > 0,94 para la version completa de 46 items y 0,7 > alfa > 0,89 para la version abreviada de 20 items). Los resultados confirman las hipotesis sobre su validez: la escala de problemas en la ejecucion se relaciona con la capacidad para resolver tests que presumiblemente valoran funciones ejecutivas de origen prefrontal (validez convergente), mientras que las escalas de problemas en el control emocional y problemas en la conducta social no se relacionan con dichas capacidades cognitivas (validez discriminante). Conclusiones. El ISP es una prueba clinicamente util, psicometricamente valida y aplicable en multiples poblaciones clinicas.

Outcomes of a multicomponent intervention on occupational performance in persons with unilateral acquired brain injury.

Complications after unilateral acquired brain injury (ABI) can affect various areas of expertise causing (depending on the location of the lesion) impairment in occupational performance. The aim of this study was to analyze and compare the concepts of occupational performance and functional independence, both before and after a multicomponent intervention including occupational therapy, in persons with unilateral brain damage. This was a longitudinal quasi-experimental pretest post-test study in a sample of 58 patients with unilateral brain injury (28 with traumatic brain injury and 30 with ischemic stroke). The patients' level of independence was measured using the short version of the International Classification of Functioning, Disability and Health. We also measured quality of performance using the Assessment of Motor and Process Skills. The findings of this study showed that patients with injury in the right hemisphere improved more than those with left hemisphere damage (p<0.001). All the patients with ABI, especially those with right-sided injury, derived benefit from the multicomponent intervention, except in the area of motor skills. More research is needed on the specific techniques that might address such skills.

[Neurocognitive screening in substance addicts: the Montreal Cognitive Assessment]. / Cribado neurocognitivo en adictos a sustancias: la evaluacion cognitiva de Montreal.

INTRODUCTION: The detection of neurocognitive disorders in addicts would allow subjects with functional impairment to be assigned to cognitive rehabilitation programmes. The Montreal Cognitive Assessment (MoCA) is a screening test that can be a valuable aid with this kind of patient. AIMS: To use the MoCA with a sample of subjects with addictions who are receiving treatment and to compare the results with the criteria proposed for the general population, mild cognitive impairment and early dementias. It also intends to examine the concurrent validity with global execution tests and the relationship with socio-demographic variables and others related to addiction. PATIENTS AND METHODS: The MoCA and the Allen Cognitive Level Screen-5 (ACLS-5) test were administered to a sample of 79 patients with addiction who were beginning treatment in a specific centre. RESULTS: Only 29.1% of the participants presented normal performance in terms of the criteria proposed by the authors. The others achieved scores below the cut-off point, many of them displaying an alarmingly low score, even when compared with criteria for mild cognitive impairment and early dementias. The MoCA showed concurrent validity with the ACLS-5 and correlation with academic level, but not with variables related to addiction. CONCLUSIONS: The MoCA is a test that is quick and simple to administer and correct. It allows the detection of subjects with extremely low cognitive performance that require neuropsychological and occupational interventions for cognitive rehabilitation, which increases treatment compliance and the benefits to be gained from other interventions with important cognitive demands, such as relapse prevention psychotherapy.

Propuesta de un protocolo para la evaluación neuropsicológica de las adicciones / A proposal for a protocol of neuropsychological assessment for use in addictions

Introducción. El interés por los procesos cerebrales implicados en la instauración, el mantenimiento y el abandono de las adicciones ha desencadenado que, en los últimos años, se hayan planteado algunos modelos neurocognitivos con un sustancial apoyo empírico. Sin embargo, existe la necesidad de un consenso en cuanto a las pruebas de valoración clínica que se pueden administrar y por qué hacerlo. El presente trabajo pretende recoger algunos de los tests neuropsicológicos más útiles para valorar a individuos adictos, así como las escalas de sintomatología cotidiana y pruebas de desempeño ocupacional que se han validado en castellano para esta población. Desarrollo. Los subprocesos cognitivos abordados en este trabajo, que han demostrado ser útiles en el diagnóstico sindrómico de las adicciones, son la velocidad de procesamiento, la atención selectiva y sostenida, la atención alternante y dividida, la amplitud atencional y el ejecutivo central, la memoria, la flexibilidad cognitiva y la fluidez, la inhibición de respuestas, la planificación, la abstracción, la toma de decisiones y, por último, la teoría de la mente. Se propone un protocolo en dos sesiones de 50 minutos, en el que la segunda sesión es opcional en función de la necesidad y la oportunidad en cada caso. Conclusión. El presente protocolo proporciona algunas ventajas importantes para los clínicos, como la sistematización, la posibilidad de replicación y convergencia entre evaluadores o la delimitación de los subprocesos susceptibles de evaluación compartiendo un mismo esquema, y, todo ello, en sesiones asequibles en cuanto a duración para casi todos los servicios que se dedican a atender a adictos que solicitan tratamiento (AU)

Introduction. Interest in the brain processes involved in establishing, maintaining and overcoming addictions has led to the development, in recent years, of a number of neurocognitive models with a substantial amount of empirical support. However, agreement still needs to be reached regarding the clinical evaluation tests that can be administered and the reason for doing so. The aim of this work is to outline some of the most useful neuropsychological tests for evaluating addicts, as well as the scales of day-to-day symptoms and occupational performance tests that have been validated in Spanish for this population. Development. The cognitive sub-processes addressed in this work, which have proved to be useful in the syndromic diagnosis of addictions, are processing speed, selective and sustained attention, alternating and divided attention, attentional amplitude and central executive, memory, cognitive flexibility and fluency, response inhibition, planning, abstraction, decision-making and, lastly, theory of mind. A protocol involving two 50-minute sessions is proposed, where the second session is optional depending on the needs and suitability in each case. Conclusions. This protocol offers several important advantages for physicians, including systemisation, the possibility of replication and convergence among evaluators or delimitation of the sub-processes that can be evaluated by sharing the same scheme. Moreover, it can all be carried out in sessions that are short enough to allow them to be offered by nearly all services that attend to addicts who request treatment (AU)

[Prevalence of attention-deficit hyperactivity disorder in substance addiction: from screening to diagnosis]. / Prevalencia del trastorno por deficit de atencion/hiperactividad en adictos a sustancias: del cribado al diagnostico.

INTRODUCTION: There is a rich body of literature on the coexistence of diagnostic criteria for attention deficit hyperactivity disorder (ADHD) and substance abuse/dependence. Prevalence, however, varies considerably from one work to another. AIMS: To apply an algorithm that takes into account all the criteria needed to reach an adequate diagnosis and to explore the conditions associated with false positives. PATIENTS AND METHODS: The diagnostic algorithm was applied using several tests in the different phases, i.e. the Attention Deficit Hyperactivity Disorder Self-Report Scale was used for screening, the Wender-Utah Rating Scale and the Parents' Rating Scale were administered for the retrospective diagnosis, and the self-administered Spanish version of the frontal behaviour scale and the perceived stress scale were used to study false positives. Symptoms of other axis I disorders were also explored and a battery of classic neuropsychological tests was administered. All this was carried out with a sample of 696 subjects whose treatment began in a care centre for drug addicts. RESULTS: The final prevalence was found to be 6.89%. The symptoms of the false positives in the screening test prior to consumption were similar to those of the true negatives, but in that moment those symptoms were similar to those of the true positives, with whom no differences were found in the neuropsychological performance. Generalised anxiety disorder was the one that showed the highest relation with false positives. CONCLUSIONS: The diagnostic category of ADHD is usually utilised indiscriminately to classify subjects with early-onset neurological disorders and those who present similar manifestations following the phase of active addiction to substances. There is a need for a neurological and neuropsychological study that goes beyond the mere symptoms so as to be able to carry out a suitable characterisation and treatment of a set of similar symptomatic manifestations, but with a very wide range of developmental and aetiopathogenic components.

[Cognitive remediation in addictions treatment]. / Rehabilitacion cognitiva en el tratamiento de las adicciones.

More recent theories of addiction suggest that neurocognitive mechanisms, such as attentional processing, cognitive control, and reward processing play a key role in the development or maintenance of addiction. Ultimately, the addiction (with or without substances) is based on the alteration of brain decision-making processes. The neurosciences, particularly those responsible for behavior modification, must take into account the neurobiological processes underlying the observable behavior. Treatments of addiction usually do not take into account these findings, which may be at the base of the low retention rates and high dropout rates of addicted patients. Considered as an alteration of brain functioning, addiction could be addressed successfully through cognitive rehabilitation treatments used in other clinical pathologies such as brain damage or schizophrenia. Although there are few studies, it is suggest that intervention to improve patients' cognitive functioning can improve the efficiency of well-established cognitive-behavioral therapies, such as relapse prevention. This paper reviews the available evidence on cognitive rehabilitation in treating addiction as well as in other pathologies, in order to formulate interventions that may be included in comprehensive rehabilitation programs for people with addictive disorders.

Rehabilitación cognitiva en el tratamiento de las adicciones / Cognitive remediation in addictions treatment

Las más recientes teorías sobre la adicción sugieren que los mecanismos neurocognitivos, como el procesamiento atencional, control cognitivo y procesamiento de la recompensa, desempeñan un papel clave en el desarrollo y mantenimiento de la adicción. En último término, la adicción (con o sin sustancias) se sustenta en la alteración de los procesos cerebrales de toma de decisiones. Las neurociencias, y en especial aquéllas encargadas de la modificación de la conducta, han de tener en cuenta los procesos neurobiológicos que subyacen a los comportamientos observables. Los tratamientos de las conductas adictivas habitualmente no toman en cuenta estos hallazgos, lo que quizá esté en la base de las bajas tasas de retención y altas tasas de abandono de los pacientes adictos. Considerada como una alteración del funcionamiento cerebral, la adicción podría abordarse satisfactoriamente mediante tratamientos de rehabilitación cognitiva utilizados en otras patologías, como el daño cerebral o la esquizofrenia. Aunque aún son pocos, diversos estudios sugieren que la intervención para mejorar el funcionamiento cognitivo de los pacientes adictivos puede mejorar su aprovechamiento de terapias de eficacia bien establecida, como la de prevención de recaídas. El presente trabajo revisa la evidencia disponible sobre la rehabilitación cognitiva en el tratamiento de la adicción, así como en otras patologías, de cara a la formulación de intervenciones que puedan incluirse en los programas globales de rehabilitación de personas con problemas adictivo (AU)

More recent theories of addiction suggest that neurocognitive mechanisms, such as attentional processing, cognitive control, and reward processing play a key role in the development or maintenance of addiction. Ultimately, the addiction (with or without substances) is based on the alteration of brain decision-making processes. The neurosciences, particularly those responsible for behavior modification, must take into account the neurobiological processes underlying the observable behavior. Treatments of addiction usually do not take into account these findings, which may be at the base of the low retention rates and high dropout rates of addicted patients. Considered as an alteration of brain functioning, addiction could be addressed successfully through cognitive rehabilitation treatments used in other clinical pathologies such as brain damage or schizophrenia. Although there are few studies, it is suggest that intervention to improve patients’ cognitive functioning can improve the efficiency of well-established cognitive-behavioral therapies, such as relapse prevention. This paper reviews the available evidence on cognitive rehabilitation in treating addiction as well as in other pathologies, in order to formulate interventions that may be included in comprehensive rehabilitation programs for people with addictive disorders (AU)

[Frontal symptoms in substance abusers under treatment using the Spanish version of the Frontal System Behaviour Scale]. / Sintomatología frontal en adictos a sustancias en tratamiento mediante la versión española de la escala de comportamiento frontal.

INTRODUCTION AND AIMS: There are different studies that suggest a relationship between frontal symptoms and substance addiction. The Frontal System Behavior Scale is a questionnaire used to consider the manifestations of three frontal syndromes: executive dysfunction, apathy and lack of inhibition. SUBJECTS AND METHODS: The Spanish version of the Frontal System Behavior Scale (FrSBe-Sp) is administered to 215 addicted individuals starting treatment and to 267 nonclinical participants. The FrSBe-Sp is a self-administered questionnaire of 46 items that evaluate the three syndromes afore- mentioned, in an estimation of baseline (before substance use) and in a present estimation (after substance consumption). RESULTS: The questionnaire shows suitable psychometric properties and convergent validity with another similar questionnaire (DEX-Sp). Statistically significant differences appear between the scores of the addicted individuals compared with the group control at the baseline, as well as, specially, the present time. CONCLUSIONS: The results point out the fact that possibly the alterations of frontal character were previous. Maybe they acted as some kind of risk factors at the beginning of substance use. Also, they have significantly increased during the phase of active substance use. The FrSBe-Sp seems to be a good instrument to explore, both synchronically and diachronically, symptoms of frontal type related to addictive behaviors. New hypotheses of special relevance for treatment of addictive behaviors are suggested.

Sintomatología frontal en adictos a sustancias en tratamiento mediante la versión española de la escala de comportamiento frontal / Frontal symptoms in substance abusers under treatment using the spanish version of the frontal system behaviour scale

Introducción y objetivo. Existen diferentes estudios que sugieren la relación entre sintomatología de tipo frontal y la adicción a sustancias. La escala de comportamiento frontal es un cuestionario diseñado para estimar las manifestaciones de tres síndromes frontales: disfunción ejecutiva, apatía y desinhibición. Sujetos y métodos. Se administra la versión española de la escala de comportamiento frontal (FrSBe-Sp) a 215 adictos que inician tratamiento y a 267 participantes no clínicos. La FrSBe-Sp es un autoinforme de 46 ítems que valoran los tres síndromes mencionados, en una estimación de línea base (antes del consumo) y en una estimación actual (tras la fase de consumo). Resultados. El cuestionario muestra adecuadas propiedades psicométricas y validez convergente con otro cuestionario similar (DEX-Sp). Aparecen diferencias estadísticamente significativas entre las puntuaciones de los adictos comparados con el grupo control, tanto en la estimación de línea base como, especialmente, en la actual. Conclusiones. Los resultados apuntan al hecho de que las alteraciones de carácter frontal posiblemente eran previas, y en tal medida predisponentes, al inicio del consumo, y se han agravado significativamente durante la fase de consumo activo. La FrSBe-Sp parece un buen instrumento para explorar, tanto sincrónica como diacrónicamente, la sintomatología de tipo frontal asociada a las conductas adictivas. Se sugieren nuevas hipótesis de especial relevancia de cara a la clínica de los trastornos adictivos. (AU)

Introduction and aims. There are different studies that suggest a relationship between frontal symptoms and substance addiction. The Frontal System Behavior Scale is a questionnaire used to consider the manifestations of three frontal syndromes: executive dysfunction, apathy and lack of inhibition. Subjects and methods. The Spanish version of the Frontal System Behavior Scale (FrSBe-Sp) is administered to 215 addicted individuals starting treatment and to 267 nonclinical participants. The FrSBe-Sp is a self-administered questionnaire of 46 items that evaluate the three syndromes afore- mentioned, in an estimation of baseline (before substance use) and in a present estimation (after substance consumption). Results. The questionnaire shows suitable psychometric properties and convergent validity with another similar questionnaire (DEX-Sp). Statistically significant differences appear between the scores of the addicted individuals compared with the group control at the baseline, as well as, specially, the present time. Conclusions. The results point out the fact that possibly the alterations of frontal character were previous. Maybe they acted as some kind of risk factors at the beginning of substance use. Also, they have significantly increased during the phase of active substance use. The FrSBe-Sp seems to be a good instrument to explore, both synchronically and diachronically, symptoms of frontal type related to addictive behaviors. New hypotheses of special relevance for treatment of addictive behaviors are suggested (AU)

Terapia Ocupacional en la rehabilitación de la disfunción ejecutiva en adictos a sustancias / Occupational Therapy in the rehabilitation of dysexecutive function in substance-addicted patients

Objetivos. La investigación más reciente está aportando un gran caudal de datos a la relación entre la adicción y los sustratos neurológicos en los que se sustenta, así como las funciones cerebrales implicadas en el proceso adictivo. Una de las principales líneas de investigación vincula la adicción al funcionamiento del lóbulo frontal, en especial a los componentes ejecutivos del comportamiento. Diversos trabajos previos encuentran deterioro significativo en el funcionamiento ejecutivo de los adictos a sustancias, que afecta, especialmente, a su desempeño en tareas cotidianas. La Terapia Ocupacional es una disciplina que estudia el desempeño ocupacional de las personas y su utilización como instrumento rehabilitador. El presente trabajo explora las alteraciones debidas a la disfunción ejecutiva y plantea una intervención terapéutica desde la perspectiva ocupacional para los pacientes adictos a sustancias que solicitan tratamiento. Material y métodos. Se revisaron los trabajos que exploran las alteraciones en funciones ejecutivas en adictos a sustancias y las técnicas y programas de rehabilitación desarrolladas por la Terapia Ocupacional en el ámbito del daño cerebral adquirido. Resultados. Se propone un modelo de intervención desde la Terapia Ocupacional que pueda ser incluido en los programas multidisciplinares de tratamiento de las adicciones. Conclusiones. La experiencia acumulada por la Terapia Ocupacional en pacientes con daño cerebral puede facilitar la comprensión de las alteraciones neurológicas en adictos, y su tratamiento, ya sea favoreciendo la adaptación o la restauración de las funciones alteradas, y potenciando el trabajo rehabilitador en otras áreas (por ejemplo, médica, psicológica o educativa)

Objectives. The most recent research has been contributing much data on the relationship between addition and the underlying neurological substrates as well as the brain functions involved in the addictive process. One of the main research lines links addiction to frontal lobe operation, especially to the executive components of behavior. Several previous studies have found a significant impairment in the executive functions of substance-addicted patients, that mainly affect their performance of daily tasks. Occupational Therapy is a discipline that studies the occupational performance of people and its use as a rehabilitating instrument. The present work examines the alterations due to executive dysfunction and poses a therapeutic intervention from the occupational perspective for addicted patients demanding treatment. Material and methods. Studies examining alterations in the executive functions of substance-addicts and the techniques and programs of rehabilitation performed by Occupational Therapy in the scope of the acquired cerebral damage were reviewed. Results. An intervention model is proposed using Occupational Therapy that can be included in multi-disciplinary addition treatment programs. Conclusions. The accumulated experience of Occupational Therapy in patients with brain damage can facilitate the understanding of neurological alterations in addicts, and its treatment, whether favoring the adaptation or the restoration of altered functions, and strengthening the rehabilitating work in other areas (medical, psychological or educative) (AU)

[Dysexecutive symptoms in substance abusers under treatment using the Spanish version of the dysexecutive questionnaire (DEX-Sp)]. / Sintomatología disejecutiva en adictos a sustancias en tratamiento mediante la versión española del cuestionario disejecutivo (DEX-Sp).

INTRODUCTION AND AIMS: Dysexecutive syndrome has traditionally been related to alterations affecting the functioning of the frontal lobes of the brain. Different studies suggest that this syndrome is present in addicts to substances and, hence, the use of a brief questionnaire has been put forward as a way of carrying out an initial screening for the condition, prior to a thorough assessment of the executive functions by a neuropsychologist. SUBJECTS AND METHODS: The Spanish version of the dysexecutive questionnaire (DEX-Sp) was administered to 176 addicts who were beginning treatment and to 213 non-clinical (control) participants. The DEX is a 20-item self report that evaluates a wide range of dysexecutive symptoms. RESULTS: Statistically significant differences appeared between the scores of addicts and those obtained by the control group. Whereas males showed differences in the types of symptoms they reported, female addicts displayed more intense dysexecutive clinical features, which affected all the areas under frontal control. No significant differences were observed as regards the main drug of abuse. CONCLUSIONS: It can be established that a total score of 24 points or more on the complete DEX-Sp scale suggests the existence of dysexecutive symptoms that are clinically relevant. Likewise, scores of 33 points or more indicate a probable moderate or severe dysexecutive syndrome. The DEX seems to be an instrument that is sensitive, fast and easy to apply in the initial assessment of addicts who are seeking treatment.

Sintomatología disejecutiva en adictos a sustancias en tratamiento mediante la versión española del cuestionario disejecutivo (DEX-Sp) / Dysexecutive symptoms in substance abusers under treatment using the Spanish version of the dysexecutive questionnaire (DEX-Sp)

Introducción y objetivo. El síndrome disejecutivo se relaciona tradicionalmente con alteraciones en el funcionamiento de los lóbulos frontales del cerebro. Existen diferentes estudios que sugieren la presencia de dicho síndrome en adictos a sustancias y, por ello, se plantea el uso de un cuestionario breve como cribado inicial de la sintomatología, previo a la evaluación exhaustiva de las funciones ejecutivas por un neuropsicólogo. Sujetos y métodos. Se administra la versión españoladel cuestionario disejecutivo (DEX-Sp) a 176 adictos que inician tratamiento y a 213 participantes no clínicos. El DEX es un autoinforme de 20 ítems que valoran un amplio espectro de síntomas disejecutivos. Resultados. Aparecen diferencias estadísticamentesignificativas entre las puntuaciones de los adictos comparados con el grupo control. Mientras que los varonespresentan diferencias en los tipos de síntomas referidos, las mujeres adictas muestran una sintomatología disejecutiva más intensa, que afecta a todas las áreas de competencia frontal. No se observan diferencias significativas en función de la drogaprincipal de abuso. Conclusiones. Se puede establecer que una puntuación total de 24 puntos o más en la escala completa delDEX-Sp sugiere la existencia de sintomatología disejecutiva relevante para la clínica. Asimismo, puntuaciones de 33 puntos o más indican un probable síndrome disejecutivo moderado o grave. El DEX parece ser un instrumento sensible, rápido y fácilde aplicar en la evaluación inicial de los adictos que solicitan tratamientos

Introduction and aims. Dysexecutive syndrome has traditionally been related to alterations affecting the functioning of the frontal lobes of the brain. Different studies suggest that this syndrome is present in addicts to substances and, hence, the use of a brief questionnaire has been put forward as a way of carrying out an initial screening for the condition, prior to athorough assessment of the executive functions by a neuropsychologist. Subjects and methods. The Spanish version of thedysexecutive questionnaire (DEX-Sp) was administered to 176 addicts who were beginning treatment and to 213 non-clinical (control) participants. The DEX is a 20-item self report that evaluates a wide range of dysexecutive symptoms. Results. Statistically significant differences appeared between the scores of addicts and those obtained by the control group. Whereas males showed differences in the types of symptoms they reported, female addicts displayed more intense dysexecutive clinicalfeatures, which affected all the areas under frontal control. No significant differences were observed as regards the main drug of abuse. Conclusions. It can be established that a total score of 24 points or more on the complete DEX-Sp scale suggests the existence of dysexecutive symptoms that are clinically relevant. Likewise, scores of 33 points or more indicate a probable moderate or severe dysexecutive syndrome. The DEX seems to be an instrument that is sensitive, fast and easy to apply in theinitial assessment of addicts who are seeking treatment