Open Access
Rendimiento neuropsicológico en la adicción a la cocaína: una revisión crítica
(Viguera Editores, 2010) Lorea Conde, Iñaki; Fernández-Montalvo, Javier; Tirapu Ustárroz, Javier; Landa González, Natalia; López-Goñi, José Javier; Psicología y Pedagogía; Psikologia eta Pedagogia
Introducción. El uso crónico de cocaína se ha asociado con un amplio rango de déficits neuropsicológicos que afectan a la atención, la memoria, el aprendizaje o las funciones ejecutivas, aunque no se ha encontrado un perfil único de afectación asociado a la adicción a esta sustancia. Objetivo. Revisar los principales estudios de rendimiento neurocognitivo en adictos a la cocaína, con especial atención al método de investigación empleado. Desarrollo. Existe una gran diversidad metodológica en la investigación del déficit cognitivo asociado a la adicción a la cocaína. Estas diferencias dificultan la comparación de resultados y la obtención de un perfil claro de alteraciones neurocognitivas. Aun así, la mayoría de investigaciones encuentran déficit neuropsicológico, casi siempre de tamaño medio, asociado a la adicción a la cocaína. Este déficit afecta a la atención, memoria verbal y visual, y funciones ejecutivas (memoria de trabajo, flexibilidad mental, fluidez verbal, inhibición y toma de decisiones). Algunos estudios arrojan resultados con un perfil de ejecución cognitiva disociado. Conclusiones. El uso crónico de cocaína se asocia con un peor rendimiento cognitivo. Por lo tanto, la valoración cognitiva de adictos a la cocaína puede mejorar la comprensión de la naturaleza de las dificultades que estos pacientes exhiben en su vida cotidiana y, además, puede servir de referencia para orientar su tratamiento. Es posible que sutiles alteraciones cognitivas conlleven importantes consecuencias en la conducta de estos pacientes. Sin embargo, la evaluación neuropsicológica no forma parte aún de los protocolos habituales de evaluación de este trastorno. Por lo tanto, se propone incluir una evaluación neuropsicológica en los protocolos de evaluación inicial de estos pacientes y adaptar el tratamiento al déficit encontrado.
Open Access
Employment integration after therapeutic community treatment: a case study from Spain
(Wiley, 2011) López-Goñi, José Javier; Fernández-Montalvo, Javier; Menéndez, Juan Carlos; Yudego, Fausto; Rico García, Ángel; Esarte Eseverri, Sonia; Psicología y Pedagogía; Psikologia eta Pedagogia
This article describes the employment evolution from pre- to post-treatment of 112 patients in two therapeutic communities of Proyecto Hombre (Spain). Moreover, an analysis was made using the composite scores of the EuropASI in order to evaluate the secondary outcomes in work status, beyond drug consumption. The results show that nearly half of the patients (46% of the sample) changed their employment status after treatment. Specifically, 78.6 per cent of the men (N=77) and 64.3 per cent of the women (N=9) were working after treatment; there were no statistically significant differences between them. Although the unemployment figures after treatment remained high, the residents were satisfied with their work integration. No statistically significant differences were observed between those who completed the treatment and those who did not. Implications of these results for further research and clinical practice are discussed.
Open Access
Frustration tolerance and personality traits in patients with substance use disorders
(Frontiers Media, 2019) Ramírez-Castillo, David; García-Roda, Carlos; Guell, Francisco; Fernández-Montalvo, Javier; Bernacer, Javier; Morón, Ignacio; Ciencias de la Salud; Osasun Zientziak
Previous research has suggested the prevalence of certain personality traits, some of which are related to a disorganized attachment, in substance abuse disorders. Further, frustration tolerance (FT) has been proposed as an important factor in addiction, both at the inception—following the “self-medication” hypothesis—and regarding treatment compliance. In turn, an inadequate response to frustrating events has been also associated with a disrupted attachment. Our goal is to explore the mediational role of FT in the relationship between personality traits and two different treatments for substance addiction: therapeutic community (TC) and ambulatory treatment (AT). Eighty-four subjects with substance abuse disorder were recruited in total (22 female), including 46 volunteers (13 female) in TC and 38 (9 female) in AT. They were assessed with Rosenzweig’s test for FT and the Millon Clinical Multiaxial Inventory-III (MCMI-III) test to evaluate personality factors. By comparing with a control sample (335 volunteers, 268 female), we found that FT was lower in patients. Between therapeutic groups, FT was significantly lower in TC. Depressive, antisocial, sadistic, negativistic, schizotypal, borderline, paranoid, anxiety, dysthymia, alcohol use, drug use, posttraumatic stress disorder (PTSD), thought disorder, and delusional disorder traits were suggestive of pathology in the clinical samples and were significantly different between control, AT, and TC groups. Further, anxiety and PTSD traits were higher in TC than in AT. A mediational analysis revealed that the effect of anxiety and PTSD scales on therapeutic group was partially mediated by FT. In conclusion, FT and its interplay with personality traits commonly related to disorganized attachment (anxiety and PTSD) might be important factors to consider within therapeutic programs for persons with substance addiction.
Open Access
Suicidal ideation and attempts among patients with lifetime physical and/or sexual abuse in treatment for substance use disorders
(Taylor & Francis, 2019) Fernández-Montalvo, Javier; López-Goñi, José Javier; Arteaga Olleta, Alfonso; Haro Escribano, Begoña; Ciencias de la Salud; Osasun Zientziak
Background: Several studies indicate that lifetime abuse is a relevant risk factor for suicidal ideation and/or attempts. However, little is known about this phenomenon in patients seeking treatment for substance use disorder. The prevalence rate of suicidal ideation and/or suicide attempts was explored among lifetime physically and/or sexually abused patients receiving treatment for drug addiction. The differential characteristics between these patients and those without suicidal behaviours were studied. Method: Three hundred and seventy-five patients were assessed. Socio-demographic characteristics, addiction severity, lifetime abuse, suicidal ideation and attempts, and psychopathological symptoms were explored. Results: Eighty-two patients (21.9%) presented with a history of lifetime abuse and were included in the study (37 men and 45 women). Sixty-two per cent of them presented with lifetime suicidal ideation (12.2% in the last month), and 30.5% with suicide attempts (1.2% in the last month). Patients with suicidal ideation or attempts showed a more severe addiction profile (assessed by the EuropASI) and more psychopathological symptoms (assessed by the SCL-90-R). Conclusion: This study highlights the relationship between previous traumatic experiences and suicidal behaviours. According to these results, systematic screening of suicidal risk in patients seeking treatment in addiction centres with histories of abuse is recommended.
Open Access
Efectividad del tratamiento de la violencia contra la pareja en pacientes drogodependientes
(Colegio Profesional de Psicólogos de Costa Rica, 2014) Fernández-Montalvo, Javier; Arteaga Olleta, Alfonso; López-Goñi, José Javier; Psicología y Pedagogía; Psikologia eta Pedagogia
En este artículo se analiza la efectividad de los programas de tratamiento psicológico para drogodependientes, que presentan conductas violentas contra la pareja. Para ello, se revisan, en primer lugar, los estudios que valoran la influencia del tratamiento habitual sobre las adicciones y la reducción de las conductas violentas contra la pareja. En segundo lugar, se analizan los resultados de los programas de intervención conjunta que se han desarrollado hasta la fecha, en el ámbito internacional, en los centros de tratamiento para la adicción con drogodependientes que ejercen, además, violencia contra la pareja. Los resultados muestran, por una parte, que la intervención con pacientes adictos produce una disminución importante en la tasa de violencia contra la pareja asociada a la adicción. Por otra parte, los programas de intervención con adicciones constituyen un marco de gran utilidad para aplicar, de forma conjunta, tratamientos específicos para aquellos adictos con un problema asociado de violencia contra la pareja. Los resultados de estos programas de intervención muestran los mejores datos en la reducción de la tasa de violencia contra la pareja de los pacientes adictos. Se comentan las implicaciones de todo ello para la práctica clínica y para las investigaciones futuras.
Open Access
Are there gender‐based effects for an educational program for parents of adolescents with risk behaviors?
(Wiley, 2019) Fernández-Montalvo, Javier; Arteaga Olleta, Alfonso; López-Goñi, José Javier; Ituráin Jiménez de Bentrosa, Sonia; Ciencias de la Salud; Osasun Zientziak
The goals of this study were to evaluate the gender-based effectiveness of the parental intervention of the Suspertu (“recovery” in English) prevention program for adolescents with risk behaviors in Spain. The sample included 229 parents (105 fathers and 124 mothers). One open-label trial with repeated measures was used. Parents received a family therapy and a group education. The intervention improved parents’ authoritative parenting style, decreasing the degree of parental stress and reducing parent’s psychopathological symptoms and maladjustment. Improvement in both groups (fathers and mothers) was mainly observed from pre- to post-intervention assessment. According to the results, prevention programs for adolescents with risk behaviors may be a suitable context both to teach parents to deal appropriately with their children’s risk behaviors, and to improve parent’s psychological state.
Open Access
Suicidal attempts among patients with substance use disorders who present with suicidal ideation
(Elsevier, 2019) López-Goñi, José Javier; Fernández-Montalvo, Javier; Arteaga Olleta, Alfonso; Haro Escribano, Begoña; Ciencias de la Salud; Osasun Zientziak
Background and aims: Patients with addictions have a great risk of suicidal ideation and attempts. Suicidal behaviour is a continuum that begins with ideation and may continue with planning, attempts and suicide completion. Investigating the speciﬁc risk characteristics for suicidal attempts in patients with addiction pro- blems who present with suicidal ideation is crucial for developing prevention strategies. The main aims of this study were to determine the prevalence rate of suicide attempts among patients with lifetime suicidal ideation receiving treatment for addiction, and o explore the diﬀerential characteristics for suicide ideators with and without suicide attempts. Methods: A sample of 149 patients with suicidal ideation (110 male and 39 female) who sought treatment for addiction in a Spanish clinical centre was assessed. Measurements: Information concerning socio-demographic characteristics, addiction severity, and psycho- pathological symptoms was obtained. Results: In total, 39.6% of the patients had attempted suicide (95% Conﬁdence Interval: 32.1%–47.6%). Although all patients with suicidal behaviours presented a high severity in their addiction, patients with both suicidal ideation and suicide attempts showed a more severe addiction proﬁle and more maladjustment to ev- eryday life than patients with only suicidal ideation. Speciﬁcally, three psychopathological variables were re- lated to suicide attempts: worse psychiatric state, previous hospitalization for psychological problems, and history of delirium. Conclusions: According to the results, a systematic screening of suicidal risk in patients seeking treatment for addiction problems is recommended. Addiction treatment centres should develop treatment strategies to prevent suicidal ideators from attempting suicide, mainly in those cases with a worse lifetime psychiatric condition.
Open Access
Trastornos de personalidad en hombres maltratadores a la pareja: perfil diferencial entre agresores en prisión y agresores con suspensión de condena
(Colegio Oficial de Psicólogos de Madrid, 2011) Echauri, José Antonio; Fernández-Montalvo, Javier; Martínez, María; Azcárate, Juana M.; Psicología y Pedagogía; Psikologia eta Pedagogia
En este artículo se lleva a cabo una descripción de los trastornos de personalidad que aparecen con mayor frecuencia en una muestra de 217 hombres maltratadores. Todos ellos forman parte de un programa de tratamiento especializado que es desarrollado por PSIMAE Instituto de Psicología Jurídica y Forense, y dirigido por el Servicio Social de Justicia del Gobierno de Navarra. Todos los participantes completaron el MCMI-II en el transcurso de la evaluación pretratamiento. Asimismo, se llevo a cabo una comparación en las variables de personalidad estudiadas entre los agresores con suspensión de condena (N=137) y aquellos que cumplían sentencia en prisión (N=80). Los resultados mostraron que el 79,3% de la muestra de agresores presentaba al menos un trastorno de personalidad. El trastorno de mayor prevalencia era el trastorno obsesivo-compulsivo de la personalidad (61,3% de los casos), seguido del trastorno paranoide (30%). Además, los resultados mostraron la existencia de numerosas diferencias significativas entre los dos grupos estudiados. En general, los maltratadores en prisión mostraban un perfil de personalidad más grave y con más trastornos que los maltratadores que acudían a tratamiento por suspensión de condena. Se comentan las implicaciones de este estudio para la práctica clínica y para las investigaciones futuras.
Open Access
Group and individual change in the treatment of drug addictions: a follow-up study in therapeutic communities
(Cambridge University Press, 2010) López-Goñi, José Javier; Fernández-Montalvo, Javier; Menéndez, Juan Carlos; Yudego, Fausto; Rico García, Ángel; Esarte Eseverri, Sonia; Psicología y Pedagogía; Psikologia eta Pedagogia
The pre-post treatment change of 112 patients in two therapeutics Spanish communities is described. The Addiction Severity Index (ASI) was used at intake and at the end of the treatment program. Results of the treatment program were evaluated by applying composite scores (CS) of the ASI, and the evolution of each patient was evaluated using the Reliable Change Index (RCI). 69.7% of the sample completed treatment, and 30.3% dropped out prematurely. At intake, the percentage of people who could improve in the different areas of the ASI ranged between 35.1% for alcohol consumption and 95.3% for family relationships. At the follow-up, the percentage of subjects who showed significant statistical improvements in the different areas varied between 7.9% in family relations and 66.7% in alcohol consumption. The percentage of patients who deteriorated was less than 10% for all variables. Implications for further research and clinical practice are commented upon.
Open Access
Treatment effectiveness of intimate partner violence perpetration among patients in a drug-addiction programme
(American Psychological Association, 2019) Fernández-Montalvo, Javier; Arteaga Olleta, Alfonso; López-Goñi, José Javier; Ciencias de la Salud; Osasun Zientziak
Objective: This article evaluates the treatment effectiveness of an integrated intervention compared to addiction treatment as usual (TAU) in reducing intimate partner violence perpetration (IPV-P) among patients in a drug-addiction intervention programme. Method: A parallel, randomized, controlled trial was carried out with repeated measures of assessment (pre-treatment, post-treatment and 6-month follow-up). A sample of 227 consecutive patients was assessed, and 70 patients with IPV-P were selected to participate in the study and then divided into two groups: treatment (n = 34) and control (n = 36). The treatment group participated in an integrated intervention programme for addiction and IPV-P, and the control group received the TAU without intervention for IPV-P. Treatment success was defined as the complete absence of IPV-P episodes, both physical and psychological. Results: At the follow-up, the patients in the treatment group showed an IPV-P success rate (60.7%) that was significantly higher (X2 = 3.85; p < .05) than that of the patients in the control group (31.6%). Moreover, both groups achieved statistically significant improvements in associated variables. Conclusions: The presence of IPV-P should be assessed in drug addiction treatment programmes. The combined treatment for addiction and IPV-P seems to be effective.