Mónica Jiménez

The role of behavioral impulsivity in the development of alcohol dependence: a 4-year follow-up study.

BACKGROUND Although many studies have established a close relation between impulsivity and alcohol use disorders, little is known about the role of behavioral impulsivity in the development of these disorders. OBJECTIVES To determine the role of 2 laboratory paradigms of impulsivity in the development of alcohol use disorders. METHODS Follow-up study carried out with 471 participants diagnosed as heavy drinkers (HD) and followed-up for 4 years. Initially, they were compared with a healthy control group. Assessment of behavioral impulsivity was carried out with the Continuous Performance Test (CPT), and the Stop-Signal Task (SST) assessed behavioral inhibitory control. Differential reinforcement for low-rate responding (DRLR) was used to evaluate the delay reward dimension. The Structured Clinical Interview (SCID-DSM-IV) was used to diagnose alcohol dependence. RESULTS The HD performed worse than the control group in all the behavioral tests of impulsivity. Performance in DRLR was the only behavioral impulsivity test that classified the HD correctly compared to controls. Logistic regression analysis indicated that performance on SST was a significant predictor [odds = 1.52(CI = 1.08-2.31)] of developing alcohol dependence. CONCLUSIONS Our results support the relation between behavioral impulsivity and alcohol use disorders. The paradigm related to delay of reward may be a factor associated with the use of alcohol and the incapacity to control inhibition as dependence develops.

DRD2 TaqIA polymorphism is associated with urinary homovanillic acid levels in a sample of spanish male alcoholic patients

TheTaqIA1 allele of the dopamine receptor gene D2 (DRD2) has been associated with alcoholism, as well as with other addictive behaviours. The exact nature of how the presence of this allele can be a vulnerability factor in the development of alcoholism remains unclear. In this study we found that the presence in theDRD2 genotype of theTaqIA1 allele in Spanish alcoholics is associated with higher levels of urine homovanillic acid (HVA) when compared to patients homozygous for theTaqIA2 allele.A sample of 142 Spanish male alcoholic patients was split into 2 groups on the basis of the presence or absence of the A1 allele in their genotype. The urine sample was analyzed by high performance liquid cromatography (HPLC), and the concentration of homovanillic acid (HVA), 5-hydroxyin-doleacetic acid (5-HIAA) and vanilylmandelic acid (VMA) was determined. We found a statistical difference in the concentration of HVA between the groups, that suggests this polymorphism could be related to the variance of urine HVA levels.

Modelos teóricos de conceptualización del craving

Objetivo El concepto de craving puedeser valorado en diferentes aspectos. Puede definirseen terminos generales como el deseo de losefectos del alcohol previamente experimentados, yes considerado por muchos adictos y clinicos comouna parte importante del proceso adictivo que puedeconducir a una recaida. Material y metodos Para el desarrollo de unadefinicion de craving es necesario revisar los modelosteoricos relevantes desarrollados durante lasultimas dos decadas. Estos incluyen los modelosde condicionamiento clasico y operante, modeloscognitivos del craving, modelos fenomenologicos,la teoria de la sensibilizacion del incentivo, el modelode desregulacion homeostatica, y un modelode regulacion tonico/fasico del sistema dopaminergico. Resultados Esta variedad de modelos pone demanifiesto la potencial importancia de investigaciontransdisciplinaria para delimitar el papel delcraving por drogas en las adicciones. Conclusiones Una sintesis transdisciplinaria podriaguiar el desarrollo de los metodos e instrumentosdiagnosticos y contribuiria a la mejora detratamientos y estrategias de prevencion.

Alcohol Craving Scale Based on Three Factors

Background: Alcohol craving is a central aspect of alcoholism about which various explanatory theories and assessment questionnaires, based on such craving, have been developed. However, there are no instruments for the assessment of craving in line with the integrative hypotheses recently formulated that propose three types of craving: positive reinforcement, negative reinforcement, and loss of control. Objectives: The construction and validation of a craving scale based on three factors. We expect to obtain a correlation between each factor and associated variables from prior studies. We also expect significant differences in craving between alcoholic individuals and controls. Sample: The scale was administered to 209 alcohol-dependent subjects and 137 controls. Instruments: Alcohol Craving Scale Based on Three Factors (ACS-3F); Sensitivity to Punishment and Sensitivity to Reward Questionnaire, Barratt Impulsiveness Scale, Severity of Alcohol Dependence Scale. Results: We confirmed the existence of the three factors initially proposed in the structure of the instrument, with high reliability. The relationship between the scale and the measures employed for its validation was confirmed. Adequate capacity of the scale to discriminate between the sample of alcoholics and the controls was observed. Conclusions: The ACS-3F has adequate psychometric properties and may be useful in future research and in clinical practice.

Variables involved in the cue modulation of the startle reflex in alcohol-dependent patients.

Cue modulation of the startle reflex is a paradigm that has been used to understand the emotional mechanisms involved in alcohol dependence. Attenuation of the startle reflex has been demonstrated when alcohol‐dependent subjects are exposed to alcohol‐related stimuli. However, the role of clinical variables on the magnitude of this response is unknown. The objective of this study was to determine the relationship between a number of clinical variables—severity of alcoholism, family history of alcoholism (FHA+), personality traits related to the sensitivity to reward—and the startle reflex response when subjects with alcohol dependence were viewing alcohol‐related cues. After detoxification, 98 participants completed self‐report instruments and had eye blink electromyograms measured to acoustic startle probes [100‐millisecond burst of white noise at 95 dB(A)] while viewing alcohol‐related pictures, and standardised appetitive, aversive and neutral control scenes. Ninety‐eight healthy controls were also assessed with the same instruments. There were significant differences on alcohol‐startle magnitude between patients and controls. Comparisons by gender showed that women perceived alcohol cues and appetitive cues more appetitive than men. Male and female patients showed more appetitive responses to alcohol cues when compared with their respective controls. Our patients showed an appetitive effect of alcohol cues that was positively related to severity of alcohol dependence, sensitivity to reward and a FHA+. The data confirmed that the pattern of the modulation of the acoustic startle reflex reveals appetitive effects of the alcohol cues and extended it to a variety of clinical variables.

Instrumentos de evaluación en el alcoholismo

Resumen Objetivo El alcoholismo es un fenomeno sumamente complejo en el que influyen diversos factores a lo largo de todo el proceso adictivo, desde su aparicion y mantenimiento hasta las recaidas tras largos periodos de abstinencia. Material y metodos En este articulo realizaremos una revision de los instrumentos de evaluacion mas utilizados. Resultados Entre los factores mas frecuentemente considerados estan las evaluaciones tipologicas, la valoracion de la motivacion, de los aspectos cognitivos y conductuales, del deseo y perdida de control, de la dependencia y la evaluacion de los problemas asociados al consumo. Para ello nos servimos de cuestionarios especificos y que se pueden clasificar en funcion de las variables que evaluan, y de cuestionarios multidimensionales con los que podemos obtener informacion integrada de diversos aspectos mas complejos y globales del paciente. Conclusiones En la clinica es necesario la evaluacion de multiples aspectos individuales con el objetivo de conocer la situacion particular de cada persona, y en consecuencia poder indicar un tratamiento personalizado adecuado que permita prolongar la abstinencia el mayor tiempo posible.

Intervenciones psicosociales en alcoholismo

Resumen Objetivo En el abordaje de los trastornos por uso de alcohol se utilizan diversas psicoterapias como coadyuvantes del tratamiento psicofarmacologico. Material y metodos Se revisan las intervenciones psicosociales utilizadas en el tratamiento del alcoholismo. Resultados A continuacion vamos a exponer las descritas en la literatura, el fundamento teorico, procedimiento y eficacia de cada una de ellas, haciendo mas hincapie en las de mayor utilizacion por los profesionales que manejan el alcoholismo. Conclusiones Se agrupan en terapias cognitivoconductuales (prevencion de recaidas, tecnicas de autocontrol, entrenamiento en habilidades sociales, desensibilizacion sistematica), terapias conductuales (terapia aversiva, contrato de contingencias, exposicion con prevencion de respuesta) y terapias psicodinamicas. Asimismo, se mencionan la intervencion familiar y grupal.