Luis Villalobos-Gallegos

Co-Occurring Disorders: A Challenge for Mexican Community-Based Residential Care Facilities for Substance Use

ABSTRACT Objective: In Mexico, specialized treatment services for people with co-occurring disorders are limited within public health services, while private options are deemed too costly. More than 2,000 community-based residential care facilities have risen as an alternative and are the main source of treatment for individuals with substance use disorders; however, suboptimal practices within such facilities are common. Information on the clinical characteristics of patients receiving care in these facilities is scarce and capacity to provide high-quality care for co-occurring disorders is unknown. The aims of this study were to examine the prevalence of co-occurring disorders in patients receiving treatment for substance use in these community-based residential centers and to assess whether the presence of co-occurring disorders is associated with higher severity of substance use, psychiatric symptomatology, and other health risks. Methods: This study was conducted with 601 patients receiving treatment for substance use disorders at 30 facilities located in five Mexican states, recruited in 2013 and 2014. Patients were assessed with self-report measures on substance use, service utilization, suicidality, HIV risk behaviors, psychiatric symptomatology, and psychiatric disorder diagnostic criteria. Results: The prevalence of any co-occurring disorder in this sample was 62.6%. Antisocial personality disorder was the most prevalent (43.8%), followed by major depressive disorder (30.9%). The presence of a co-occurring disorder was associated with higher severity of psychiatric symptoms (aB = .496, SE = .050, p < .05); more days of substance use (aB = .219, SE = .019, p < .05); current suicidal ideation (aOR = 5.07, 95% CI [2.58, 11.17]; p < .05), plans (aOR = 5.17 95% CI [2.44, 12.73]; p < .05), and attempts (aOR = 6.43 95% CI [1.83, 40.78]; p < .05); more sexual risk behaviors; and more contact with professional services (aOR = 1.77, 95% CI [1.26, 2.49], p < .05). Conclusions: Co-occurring disorders are highly prevalent in community-based residential centers in Mexico and are associated with significantly increased probability of other health risks. This highlights the need to develop care standards for this population and the importance of clinical research in these settings.

Characteristics of a Treatment-Seeking Population in Outpatient Addiction Treatment Centers in Mexico

Background: Baseline patients’ characteristics are critical for treatment planning, as these can be moderators of treatment effects. In Mexico, information on treatment seekers with substance use disorders is scarce and limited to demographic characteristics. Objective: This paper presents and analyses demographic characteristics, substance use related problems, clinical features, and addiction severity in a sample of treatment seekers from the first multi-site randomized clinical trial implemented in the Mexican Clinical Trials Network on Addiction and Mental Health. Methods: A total of 120 participants were assessed prior randomization. Chi square or F-tests were used to compare sites across variables. Spearman correlation was used to associate negative consequences of substance use and motivation to change. Results: The majority of participants were men, and the most prevalent substances reported were alcohol, marijuana, and cocaine. Participants were predominantly on the contemplation or action stage of change, and this was correlated with the perception of the negative consequences associated with substance use. Participants reported a high prevalence of substance use related problems. Conclusions: Substance use related problems, clinical features, and addiction severity reported by treatment seekers are important characteristics to take into account when planning treatment as they facilitate tailoring treatment to meet patients’ needs.

Three versions of the Short Alcohol Dependence Data Questionnaire (SADD) in Mexican population: a comparative analysis of psychometric properties and diagnostic accuracy.

Background. The Short Alcohol Dependence Data Questionnaire (SADD) has shown good reliability and validity in previous studies. In Mexico, although it is widely used in addiction treatment centers, little is known about its psychometric properties and diagnostic accuracy. Objective. Hence, this study performed a Confirmatory Factorial Analysis (CFA) on three SADD versions (15, 14 and 12 items) and examined their operating characteristics. Method. The sample included 570 individuals from the 30 Addiction Residential Centers localized in the central zone of Mexico. Results. The three versions showed an internal consistency of >.90, fair goodness-of-fit, and significant correlations with the Mini International Neuropsychiatric Interview (MINI) 5.0 Alcohol dependence (AD) diagnostic criteria. The analysis of the operating characteristics revealed that each version accounted for 84-85% of the area under the curve (AUC). Discussion and conclusion. The three SADD versions possess reliability and validity properties for the assessment of the alcohol dependence syndrome (ADS) and adequate diagnostic accuracy for the improvement of patients with AD in residential settings.

Cuestionario de expectativas de resultado de consumo de alcohol (CERCA): propiedades psicométricas en pacientes en tratamiento residencial para las adicciones en México

Alcohol expectancies are the anticipations that a person makes to the effects that this substance will cause. This construct has proven to be useful in explaining alcohol consumption; however they have been scarcely measured in clinical population. The aim of this study was to develop and evaluate the psychometric properties of a test measuring these expectations in Mexican people with severe alcohol consumption under inpatient treatment. The final version of the test has a high Cronbachs alpha (.857) with three factors with a theoretical foundation explaining 61.5% of the variance: these properties are superior to those shown by other evidence. For future studies is suggested to include a greater number of women in the sample in order to confirm its psychometric properties.Las expectativas de resultado de consumo de alcohol son las anticipaciones que una persona hace ante los efectos que el consumo de esta sustancia le provocara. Son utiles al explicar el consumo de alcohol, sin embargo se han evaluado escasamente en poblacion clinica. El objetivo de este trabajo fue desarrollar y evaluar las propiedades psicometricas de una prueba que midiera estas expectativas en mexicanos consumidores de alcohol bajo tratamiento residencial. La version final de la prueba tiene una alfa de Cronbach alta (0.857) con tres factores con una base teorica que explican un 61.5% de la varianza; estas propiedades son superiores a las mostradas por otras pruebas. Para futuros estudios se sugiere incluir un mayor numero de mujeres en la muestra a fin de confirmar sus caracteristicas psicometricas.

Effects of co-occurring disorders on the perception of family functioning

ABSTRACT Introduction: Comorbidity of other psychiatric disorders is a common issue in individuals with substance use disorder (SUDs); this phenomenon is known as co-occurring disorders (CODs). Previous studies have pointed that CODs are strongly associated with familial difficulties. There are CODs where the association between family function and COD remains unknown. The objective of this study was to analyze the relation between CODs and family functioning in a sample of individuals with SUDs receiving treatment in residential addiction facilities. Method: A total of 490 participants were evaluated with Mini International Neuropsychiatric Interview for psychiatric disorders and Intra-family Relationships Scale (IRS) for family functioning. Two models were analyzed using multiple linear regression, predictors for each model were (1) any disorders and (2) each disorders, in order to evaluate the relation between psychiatric disorders and factors from the IRS. Models were compared through ANOVA. Results: Model 1 (including any disorder as predictor) was significant for every dimension of the family functioning. In Model 2, significant associations between the three IRS factors and antisocial personality disorder, major depressive disorder, and anorexia nervosa were found, being negative in difficulties and positive in cohesion and support and expression. Posttraumatic stress disorder was only significantly associated with cohesion and support. Conclusions: CODs displayed differential relations in the family functioning.

Latent Impulsivity Subtypes in Substance Use Disorders and Interactions with Internalizing and Externalizing Co-Occurring Disorders

This study explored the clinical importance of latent impulsivity subtypes within a sample of individuals with substance use disorders (SUDs) and high rates of co-occurring disorders (CODs) receiving residential treatment, aiming to assess the heterogeneity of the associations between SUDs and CODs across such impulsivity subtypes. The abbreviated Barratt impulsiveness scale was used to assess motor and cognitive (attentional and nonplanning) impulsivity, a structured interview for diagnosis of SUD and CODs, and other clinimetric measures for severity of substance use. Latent class analysis was conducted to extract subgroups of impulsivity subtypes and Poisson regression to analyze effects of interactions of classes by CODs on severity of substance use. 568 participants were evaluated. Results featured a four-class model as the best-fitted solution: overall high impulsivity (OHI); overall low impulsivity; high cognitive-low motor impulsivity; and moderate cognitive-low motor impulsivity (MC-LMI). OHI and MC-LMI concentrated on most of the individuals with CODs, and individuals within OHI and MC-LMI showed more severity of substance use. The expression of this severity relative to the impulsivity subtypes was modified by their interaction with internalizing and externalizing CODs in very heterogeneous ways. Our findings suggest that knowing either the presence of trait-based subtypes or CODs in individuals with SUDs is not enough to characterize clinical outcomes, and that the analysis of interactions between psychiatric categories and behavioral traits is necessary to better understand the expressions of psychiatric disorders.

Neuropsychiatric characterization of individuals with inhalant use disorder and polysubstance use according to latent profiles of executive functioning

BACKGROUND Inhalant use disorder (IUD) is associated with deficits in executive functions (EFs). We described latent profiles of EFs and distribution of neuropsychiatric disorders and patterns of severity of use across these profiles. METHODS Individuals with IUD were recruited at community-based residential facilities for substance use treatment in Mexico City. Latent profile analysis was conducted with the following tasks: self-ordered pointing, Stroop, Iowa gambling, Wisconsin Card Sorting and Tower of Hanoi. RESULTS Three latent profiles were extracted from n = 165: lowest performances of inhibition of response and processing speed; lowest performance of self-monitoring, intermediate performance of inhibition of response and relatively spared processing speed; and intermediate performance of processing speed and self-monitoring, and relatively spared inhibition of response. CONCLUSION Between-group differences were observed mainly for antisocial personality disorder and lifetime suicidal. Findings remark the need for identifying distinct profiles of EFs within these populations to better understand the transdiagnostic heterogeneity of EFs.

Effect of substance use on condom use in the Theory of Planned Behavior: Analysis of differential item functioning

Introduction. Substance use is one of the factors associated with lower condom use in young adults, which increases the likelihood of HIV infection. The Theory of Planned Behavior (TPB) is one of the most useful models for explaining this phenomenon since it considers the aim of engaging in a behavior based on attitudes, subjective norms and self-efficacy. Objective. To develop a questionnaire and to evaluate the Differential Item Functioning (DIF) caused by substance use in TPB indicators, using the Multiple Indicators Multiple Causes Analysis (MIMIC). Method. The study was conducted in two phases with Mexico City college students age 18 to 25. Results. Adequate goodness of fit was obtained in all three models of the TPB: attitudes χ 2 S-B (2) = 3.902, p s = .999; TLI s = .996; RMSEA s = .037, 90% CI ≤ .001-.095; subjective norms χ 2 S-B (7) = 9.103, p s = .999; TLI s = .998; RMSEA s = .022, 90% CI ≤ .001-.056; and self-efficacy χ 2 S-B (25) = 65.115, p s = .982; TLI s = .974; RMSEA s = .050, 90% CI = .036-.066; in one item in attitudes and two items in subjective norms a DIF effect was observed, while no item proved significant regarding self-efficacy. Discussion and conclusion. There is little evidence in the detection of DIF due to substance use in TPB indicators in condom use, and this is the first study to conduct this type of analysis. Items presenting DIF open the door to future research due to the importance of assessing how the indicator behaves with a population displaying a particular trait.

Latent class profile of psychiatric symptoms and treatment utilization in a sample of patients with co-occurring disorders

Objective: To identify symptom-based subgroups within a sample of patients with co-occurring disorders (CODs) and to analyze intersubgroup differences in mental health services utilization. Methods: Two hundred and fifteen patients with COD from an addiction clinic completed the Symptom Checklist 90-Revised. Subgroups were determined using latent class profile analysis. Services utilization data were collected from electronic records during a 3-year span. Results: The five-class model obtained the best fit (Bayesian information criteria [BIC] = 3,546.95; adjusted BIC = 3,363.14; bootstrapped likelihood ratio test p < 0.0001). Differences between classes were quantitative, and groups were labeled according to severity: mild (26%), mild-moderate (28.8%), moderate (18.6%), moderate-severe (17.2%), and severe (9.3%). A significant time by class interaction was obtained (chi-square [χ2 [15]] = 30.05, p = 0.012); mild (χ2 [1] = 243.90, p < 0.05), mild-moderate (χ2 [1] = 198.03, p < 0.05), and moderate (χ2 [1] = 526.77, p < 0.05) classes displayed significantly higher treatment utilization. Conclusion: The classes with more symptom severity (moderate-severe and severe) displayed lower utilization of services across time when compared to participants belonging to less severe groups. However, as pairwise differences in treatment utilization between classes were not significant between every subgroup, future studies should determine whether subgroup membership predicts other treatment outcomes.

Psychiatric symptoms, substance use, and other medical conditions in patients with obesity who seek treatment for weight loss

Introduction . Scaling in obesity classes increases its effect on medical comorbidities and psychiatric symptoms. Anxiety and depression have a significant effect on treatment adherence and weight loss. Objective . This study had three aims: a) to evaluate the prevalence of psychiatric symptoms; b) to evaluate the interactions between obesity classes and demographic variables in relation to psychiatric symptoms; and c) to analyze the interactions between obesity classes, demographic variables, and psychiatric symptoms in association with medical comorbidities in a sample of obese individuals seeking treatment for weight loss. Method . Medical record review of 22 weight loss clinics during January-December 2014. Binomial logistic regression was carried to assess univariate associations, second- and third-order interactions. Results . Total sample was composed of 13,305 patients, mostly women (82.04%), married (53.66%), with elementary education (38.6%), mean body max index was 34.94 (SD = 4.39). The most prevalent psychiatric symptoms were anxiety (45.21%) and depression (16.36%). When analyzing interactions, it was found that men with class II obesity had higher odds for alcohol use (OR 1.56, IC 95% 1.10-2.22), and participants with obesity class III and married had more probability of diabetes II (OR 1.53, IC 95% 1.06-2.19). Discussion and conclusion . Results show the complexity of the relation between demographic variables, psychiatric symptoms, medical comorbidities and obesity, underscoring the need to tailor treatments based in such variables, to promote adherence and weight loss.