IMPULSIVITY PROCESSES UNDERLYING DRUG CHOICE AND RISKY SEXUAL BEHAVIOR

The current study included a sample of 86 inner-city treatment seeking drug users, comparing risky sexual behavior (RSB) across primary users of a) heroin and not crack/cocaine, b) crack/cocaine and not heroin, and c) both heroin and crack/cocaine. To explore potential mechanisms, additional analyses also examined impulsivity across several domains as mediators of RSB and drug choice. RSB was higher in primary crack/cocaine users than in primary heroin users, with those using both drugs evidencing equal or lesser levels of RSB than crack/cocaine users. A similar pattern was found for impulsivity for several measures. Little support for any dimension of impulsivity as a mediator in the relationship between drug group and RSB was found. The current results allow insight into contextual elements that contribute to RSB across drug groups, allowing one to determine if elevated impulsivity in crack/cocaine users is due to pharmacological effects of crack/cocaine

DISTRESS TOLERANCE TREATMENT FOR INNER-CITY DRUG USERS: A PRELIMINARY TRIAL

Despite advances in preventing treatment failure, a large percentage of substance-using individuals drop out of treatment. Current work indicates that one's threshold for tolerating psychological distress (i.e., distress tolerance) is a key factor in treatment dropout. Following from this work, we developed a treatment for prevention of treatment drop-out in a residential treatment setting. Specifically 66 individuals who were a) receiving residential substance use treatment and b) evidenced deficits in distress tolerance at a baseline assessment were assigned to receive either the novel treatment (Skills for Improving Distress Intolerance, SIDI), supportive counseling (SC) treatment, or no-treatment control (NTC). We hypothesized that compared to individuals in the SC and NTC, individuals in the SIDI would show greater improvements in levels of distress tolerance, greater improvement on measures theoretically related to distress tolerance (i.e., levels of negative affect, disengagement coping, emotion regulation, self-efficacy in high-risk situations, and self-efficacy of mood regulation), and higher rates of treatment completion. Results indicated that those in SIDI evidenced greater improvement in distress tolerance, compared to SC and NTC. However, there were no significant differences in improvement in the secondary measures, except for affect regulation self-efficacy (approaching significance). It should be noted, however, that the percentage of individuals reaching clinically significant improvement showed that more individuals in SIDI, compared to SC and NTC, reached such improvement. Comparison of 30-day treatment completion showed that there were no dropouts in either SIDI or SC; all dropouts occurred in NTC. When considering dropout throughout the entire residential treatment contract (ranging from 30 to 180 days), the least dropouts occurred in SIDI, followed by SC and NTC (in this order); however, this difference was not significant. The current results suggest that SIDI is effective in increasing distress tolerance in inner-city drug users. Additionally, the variable rates of dropout that were, nevertheless, nonsiginficant suggest a need for larger-scale studies to test the effect of SIDI on dropout

Les progrès dans la réalisation de la classification quantitative de la psychopathologie

Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad "spectrum level'' dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the "problem of comorbidity'' by explicitly modeling patterns of co-occurrence among signs and symptoms within a detailed and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach. (C) 2020 Published by Elsevier Masson SAS