Gloria García-Fernández

Contingency management is effective across cocaine-dependent outpatients with different socioeconomic status

Contingency management (CM) has demonstrated its efficacy for treating cocaine dependence, but there is still some controversy with regard to its dissemination. Understanding how individual differences affect CM outcomes is important for detecting barriers to its dissemination. The aim of this study is to examine the impact of socioeconomic variables in cocaine-dependent outpatients on the effectiveness of CM in a community setting. Cocaine-dependent outpatients (N=118) were randomized to community reinforcement approach (CRA) treatment or a CRA plus vouchers program. The impact of baseline economic variables, alone and in combination with treatment conditions, on abstinence and retention outcomes after 6 months of treatment was assessed. Results showed that income had no effect on retention or abstinence outcomes after 6 months of treatment in either treatment condition. The addition of a CM component was beneficial for individuals with any socioeconomic status. These results support the generalizability of CM strategies with patients of different socioeconomic status in community settings.

Motivation for change and barriers to treatment among young cannabis users.

Background/Aims: Despite cannabis use among adolescents has shown to be related to psychosocial and mental health problems, the demand from adolescents for professional help is very low, and determinants of motivation for change among nonclinical populations remain unknown. The purpose of this study was to assess motivation for change among young cannabis users and to identify determinants of intention to change and self-change, as well as perceived barriers to seeking professional help. Methods: 261 cannabis users aged 16–21 participated in a computerized survey in Spain. Results: Data from this cross-sectional study indicated that few users intend to stop taking the drug. Determining factors of intention to change were the following: having more drug-related problems, paranoid symptomatology and greater concern about the consequences of use. Self-change was facilitated by lower use of cannabis, and could be hindered by tobacco smoking and cannabis dependence. Lack of awareness of the problems and the desire to solve one’s problems alone constitute the main barriers to seeking professional help. Conclusions: Adolescent cannabis users show low motivation for change though experiencing more problems associated with its use emerges as a determinant of increased motivation. Several barriers impede this motivation from turning into treatment demand.

Community reinforcement approach plus vouchers among cocaine-dependent outpatients: twelve-month outcomes.

The aims of this study were to assess the effectiveness of the Community Reinforcement Approach (CRA) plus vouchers treatment in a cohort of Spanish cocaine-dependent outpatients, and to examine the maintenance of treatment effects after the voucher intervention was discontinued. Sixty-four adult outpatients were randomly assigned to one of two treatment conditions, CRA plus vouchers or standard care. The vouchers program was implemented from weeks 1 to 24. Among patients assigned to the CRA plus vouchers condition, 65.5% completed 12 months of treatment versus 28.6% of those assigned to the standard care condition (p = .003). At the 12-month assessment, 58.6% of patients assigned to the CRA plus vouchers condition were abstinent, compared with 25.7% in the standard care condition (p = .008); furthermore, 34.5% of patients assigned to the CRA plus vouchers condition achieved twelve months of continuous cocaine abstinence, versus 17.1% in the standard care condition. Those treated in the CRA plus vouchers condition also achieved greater improvements in psychosocial functioning than those treated in the standard care condition. Overall, these results reveal an extension of the effectiveness of the CRA plus vouchers treatment to a community sample of cocaine-dependent outpatients, while also supporting the maintenance of treatment effects for 6 months after completion of the voucher program.

Screening of cannabis-related problems among youth: the CPQ-A-S and CAST questionnaires.

BackgroundCannabis use among young people is a significant problem, making particularly necessary validated screening instruments that permit secondary prevention. The purpose of this study was to analyze and compare the psychometric properties of the CAST and CPQ-A-S questionnaires, two screening instruments specifically addressing the youth population.MethodsInformation was obtained on sociodemographics, frequency of substance use, psychopathological symptoms and cannabis-use problems, and the CPQ-A-S and CAST were applied, as well as an infrequency scale for discarding responses made randomly. The sample was made up of 144 young people aged 16 to 20 that had used cannabis in the last month, of which 71.5% were boys. Mean age of the sample was 17.38 years (SD = 1.16).ResultsThe results show that from the psychometric point of view both the CAST and the CPQ-A-S are good screening instruments.ConclusionsThe CAST is shorter and presents slightly better internal consistency than the CPQ-A-S. Both instruments show high sensitivity and specificity in the detection of young people dependent on cannabis according to the DSM IV-TR criteria. The CPQ-A-S appears to show greater capacity for detecting psychopathological distress associated with use. Both questionnaires yield significant odds ratios as predictors of frequent cannabis use and of the DSM IV-TR abuse and dependence criteria. In general, the CPQ-A-S emerges as a better predictor than the CAST.

Long-term benefits of adding incentives to the community reinforcement approach for cocaine dependence.

Background: The community reinforcement approach (CRA) with vouchers is a well-established program developed for the treatment of cocaine addiction. It involves an incentive program in which patients earn vouchers that can be exchanged for goods or services contingent upon abstinence from cocaine use. Aim: To examine the contributions of incentives to retention, abstinence, and psychosocial outcomes in the CRA + vouchers program at the 12-month follow-up. Methods: 58 cocaine addicts were randomly assigned to CRA treatment with or without an added incentive program in a community setting for cocaine dependence in Spain. Results: 65.5% of patients in the group with vouchers completed 12 months of treatment, versus 48.3% in the no-voucher group. In the CRA + vouchers group, mean percentage of cocaine-negative samples was 95.76%, versus 79.31% in the group without vouchers. There were significant improvements in psychosocial functioning in both treatments, but when differences were observed, they supported CRA with vouchers over CRA alone. Conclusion: Combining CRA with incentives improves treatment outcomes in cocaine-dependent outpatients. Additive benefits of vouchers remain 6 months after the incentive program ends.

Contingency management improves outcomes in cocaine-dependent outpatients with depressive symptoms.

Despite depressive symptoms being very common among patients seeking treatment for cocaine dependence, few studies have examined the effects of depressive symptoms on cocaine outpatient treatment outcomes, and there is even less research in the context of Contingency Management (CM). The purpose of this study was to assess the main and interactive effects of co-occurring depressive symptoms on CM outcomes. Cocaine-dependent individuals (N = 108) were randomized to Community Reinforcement Approach (CRA) or CRA plus CM in two outpatient community clinical settings. Participants were categorized according to depression symptoms, self-reported by means of the BDI at treatment entry. Outcome measures included treatment retention and documented cocaine abstinence over a 6-month treatment period. Depressive symptoms were more commonly found in females and in unemployed participants, and were associated with more drug-related, social, and psychiatric problems at treatment entry. Individuals with baseline depressive symptoms had poorer treatment outcomes than patients without depressive symptoms. The addition of CM to CRA made the program more effective than with CRA alone, regardless of depressive symptoms. CM was associated with better abstinence treatment outcomes, while the interaction between unemployment and depressive symptoms was associated with negative retention treatment outcomes. This study supports the efficacy of CM for cocaine-dependent outpatients with and without depressive symptoms, and highlights its importance for improving treatment for unemployed and depressed cocaine-dependent individuals.

Adding voucher-based incentives to community reinforcement approach improves outcomes during treatment for cocaine dependence.

This study compares the efficacy of the Community Reinforcement Approach (CRA) with and without an incentive program for cocaine-dependent patients in Spain. A total of 58 patients were randomly assigned to the CRA or CRA plus vouchers condition. In the CRA plus vouchers group, mean percentage of cocaine-negative samples was 97.07%, versus 79.76% in the no-voucher group. Those treated in the CRA plus vouchers condition also achieved greater improvements in psychosocial functioning than those treated in the CRA condition. The present results show that treatment outcome is better if incentives are delivered contingent upon the submission of cocaine-free urine specimens. 

Adaptación y validación española del Adolescent-Cannabis Problems Questionnaire (CPQ-A)

El cannabis es una sustancia cuyo consumo esta altamente extendido entre jovenes y adolescentes. Sin embargo, la demanda de ayuda y tratamiento en esas edades sigue siendo baja. En estas condiciones resulta esencial el desarrollo de instrumentos especialmente disenados para la deteccion precoz de los problemas asociados al consumo de cannabis en esa poblacion. El proposito de este trabajo es adaptar y validar en poblacion espanola el CPQ-A (Adolescent- Cannabis Problems Questionnaire) como herramienta de screening. La muestra utilizada esta formada por 144 jovenes (71,4% chicos), con edades comprendidas entre 16 y 20 anos (M = 17,12; DT = 1,17), que habian consumido cannabis en el ultimo mes, y que se encontraban cursando algun tipo de formacion en diversos centros educativos de Asturias. El analisis factorial del CPQ-A en esta muestra apunta a una solucion unidimensional, con un Alfa de Cronbach de 0,86 para el total del cuestionario. Las evidencias de validez convergente de la prueba son buenas. La puntuacion en el CPQ-A permite discriminar entre consumidores de cannabis moderados y excesivos en el ultimo mes, esta positivamente relacionada con el CAST (Cannabis Abuse Screening Test) y presenta una sensibilidad y especificidad adecuadas para determinar casos de abuso y dependencia del cannabis segun los criterios del DSM IV-TR. Ademas, es sensible al grado de preocupacion que genera en los jovenes el consumo de cannabis y los efectos psicopatologicos asociados al consumo. Los resultados obtenidos permiten afirmar que es una prueba util para el screening de jovenes consumidores de cannabis con problemas.

Community Reinforcement Approach (CRA) for cocaine dependence in the Spanish public health system: 1 year outcome.

INTRODUCTION AND AIMS The development and dissemination of effective treatments for cocaine dependence is an important public health priority in Europe, and especially in Spain, given the increase in treatment demand over recent years. The aim of this study was to determine the effectiveness of the Community Reinforcement Approach (CRA) for cocaine dependents at an outpatient clinic within the Spanish public health system. DESIGN AND METHODS A total of 82 cocaine-dependent patients were randomly assigned to one of two treatment conditions: Standard Treatment (n = 35) or CRA (n = 47). Dependent variables were treatment retention, cocaine abstinence and composite scores from the European version of the Addiction Severity Index at 12 month follow up. RESULTS Of the patients who received CRA, 55% completed 6 months of treatment, versus 40% who received Standard Treatment. At the 12 month follow up, patients assigned to the CRA condition achieved higher rates of abstinence (95.2%) by comparison with Standard Treatment (69.2%). In the CRA group, 27% of the patients achieved continuous cocaine abstinence, versus 21% in the Standard Treatment group. The CRA group also obtained lower scores than the Standard Treatment group in all Addiction Severity Index composite scores. DISCUSSION AND CONCLUSIONS This study showed that CRA is a feasible treatment for cocaine addiction in a public community setting in Spain.

Tratamiento de la adicción a la cocaína mediante terapia de incentivos

Resumen El Programa de Reforzamiento Comunitario (CRA) mas Terapia de Incentivos es un tratamiento psicologico para el abordaje de la adiccion a la cocaina que integra un programa de entrenamiento en habilidades (CRA) y un componente de manejo de contingencias, en el que los pacientes reciben incentivos a cambio de resultados negativos en analiticas de orina. Este programa cuenta con amplia evidencia cientifica, pero la mayoria de estudios empiricos se han realizado en contextos experimentales en Estados Unidos. Durante los ultimos anos se han llevado a cabo estudios controlados para evaluar la adaptabilidad y la eficacia del programa en contextos comunitarios en Espana. El objetivo de este trabajo es describir los principales hallazgos de la aplicacion del programa CRA mas incentivos en Espana. Estos resultados respaldan el uso de este programa especifico para la adiccion a la cocaina en dispositivos asistenciales en Espana, debido a su adaptabilidad y eficacia. No obstante, se requieren estudios de seguimiento mas largos y con un numero mayor de participantes.