Sergio Fernández-Artamendi

A comparison of treatment outcomes for adolescent community reinforcement approach participants with and without co-occurring problems

This study examined the relationship between Adolescent Community Reinforcement Approach (A-CRA) participation with treatment engagement, retention, and satisfaction, and with substance use and emotional problem outcomes. Participants had substance use disorders (SUD) only or co-occurring substance use and psychiatric problems. Those with co-occurring problems reported more days of substance use and emotional problems at intake to treatment than those with SUD only. All groups received equivalent exposure to A-CRA during treatment implementation. At the 12-month follow-up, adolescents classified as externalizers (n = 468) or those with both externalizing and internalizing problems (n = 674) had significantly greater improvement in their days of abstinence and substance problems relative to adolescents with substance use disorders only (n = 666). Additionally, adolescents reporting symptoms of internalizing (n = 154), externalizing, or both externalizing and internalizing disorders had significantly greater improvements in days of emotional problems relative to adolescents with SUD only.

Spanish adaptation and validation of the Barratt Impulsiveness Scale for early adolescents (BIS-11-A)

Impulsivity has been associated with several psychiatric disorders such as substance abuse. The Barratt Impulsiveness Scale (BIS-11) is one of the most commonly administered self-reports for the assessment of impulsiveness in both research and clinical settings. There is a version for adolescents called BIS-11-A, which has not been yet properly adapted to Spanish population. The goal of this study is to offer an alternative and more adequate Spanish version of the BIS-1-A, as well as to assess its psychometric properties including factor structure, reliability and predictive validity regarding substance use (last month alcohol, tobacco and cannabis use, presence of last month intoxication, binge drinking and problem drinking). The BIS-11-A and items from the European School Survey Project on Alcohol and other Drugs (ESPAD) were applied to1,183 students (aged 12-14) at 16 Spanish secondary schools. The BIS-11-A showed a bidimensional factor structure, high reliability (Cronbachs alpha = .87) and good capacity for identifying substance use, binge drinking and problem drinking (sensitivity = 67.3-75%; specificity = 83.4-85.4%). The BIS-11-A Spanish version is a reliable and valid instrument for be used among early adolescents.

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.

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.

Suicidio, desempleo y recesión económica en España

INTRODUCTION The aim of the present work is to determine the association between unemployment and suicide, and to investigate whether this association is affected by changes in the economic cycle or other variables such as age and sex. METHODS A time-trend analysis was conducted to study changes in the number of suicides between 1999 and 2013 in Spain. Pearsons correlation coefficients and regression models were used to find the association between unemployment and suicide. RESULTS A significant positive association was found between unemployment and suicide in the pre-crisis period in men. In that period (1999-2007), each 1% annual increase in unemployment was associated with a 6.90% increase in the annual variation of suicide in the total population, and with a 9.04% increase in the annual variation of suicide in working age men. CONCLUSIONS The correlation between unemployment and suicide is significant in periods of economic stability, but has weakened during the recent financial crisis. Unemployment and suicide have a complex relationship modulated by age, sex and economic cycle.

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.

Tabaco y rendimiento cognitivo en pacientes con esquizofrenia: diseño del estudio COGNICO

People with schizophrenia constitute a substantial part of the people who still smoke. Regarding cognitive performance, the self-medication hypothesis states that patients smoke to improve their cognitive deficits based on the stimulating effects of nicotine. The aim of this paper is to describe in detail the methodology used in the COGNICO study. A quasi-experimental, observational, prospective, multicenter study with follow-ups over 18 months was conducted in three cities in northern Spain (Oviedo, Ourense and Santiago de Compostela). A total of 81 outpatient smokers with schizophrenia were recruited with a mean age 43.35 years (SD = 8.83), 72.8% of them male. They were assigned to 3 groups: a) control group (smokers); b) patients who quit smoking using nicotine patches; c) patients who quit smoking with Varenicline. The MATRICS neuropsychological battery was applied as a primary measure. In addition, a comprehensive assessment of patients was performed, including the number of cigarettes per day, physical and psychological dependence on nicotine and CO expired. Clinical evaluation (PANSS, HDRS, CGI, C-SSRS), anthropometric measurements and vital signs assessment was also performed. The aim is to identify the relationship between the pattern of tobacco use and cognitive performance by comparing scores on the neuropsychological battery MATRICS during the follow-up periods (3, 6, 12 and 18months). The importance of this study lies in addressing a topical issue often ignored by clinicians: the unacceptably high rates of tobacco use in patients with severe mental disorders.

The association of both self-reported and behavioral impulsivity with the annual prevalence of substance use among early adolescents

BackgroundIn relation to substance use, Spanish adolescents aged 12 to 14 can be largely classified in four groups, from highest to lowest prevalence: a) No substance use, b) Only alcohol use, c) Alcohol and tobacco use, and d) Alcohol, tobacco and cannabis use. The aim of the present study is to analyze the possible relationship between impulsivity and the substance-use group to which the young person belongsMethodsOne thousand three hundred and forty-eight adolescents aged 12 to 14 in northern and eastern Spain reported their drug use, completed impulsivity self-reports (BIS-11-A and ImpSS) and performed behavioral tasks (Stroop Test and Delay Discounting).ResultsResults from both measurement approaches were related to early drug use. An increasing impulsivity trend is found across groups from less to more substance involvement, except in the case of Delay Discounting, which is sensitive only for those with more substance-involved.ConclusionsImpulsivity is a key factor for early drug use, especially as regards more substance-involved. This should be taken into account in designing prevention programs or as a key variable for interventions aimed at delaying the onset of substance use.

Gender Differences in Early Alcohol and Tobacco Use as a Risk Factor in Spanish Adolescents

The sample is made up of 1,190 adolescents (52.8% boys; mean age = 16.81) from 37 random schools in the urban and rural areas of Asturias (northern Spain). The survey was conducted in 2008, assessing the use and patterns of use of alcohol and other drugs, age at onset of use, and psychosocial consequences. Items from the ESPAD and FRIDA questionnaires were employed. Univariate analyses and binary logistic regression analyses were carried out to determine the different predictive value for boys and girls of early-onset alcohol and tobacco use. The studys limitations and implications are noted.