Guided Self-Change Treatment for alcohol abuse in Spain: a single-case study

Aunque existe evidencia de la efectividad de intervenciones breves para disminuir el consumo problemático de alcohol, son escasos los datos en población española. El objetivo de este estudio es analizar, por primera vez en España, la efectividad del Programa de Auto-Cambio Dirigido (Guided Self-Change Treatment; GSCT). Método: Se aplicaron 4 sesiones individuales con frecuencia semanal del programa a una consumidora de alto riesgo de alcohol. Resultados: Los resultados indican una disminución del consumo de alcohol de 42 a 0 unidades de bebida estándar por semana y un aumento de la autoeficacia percibida, manteniéndose en el seguimiento a 6 meses. Conclusiones: Como ya señalaron estudios anteriores en población latinoamericana, el GSCT parece ser efectivo en la reducción del consumo de alcohol y las consecuencias negativas asociadas al mismoAlthough there is evidence of the effectiveness of brief interventions at reducing problem drinking, there is a lack of studies in Spanish population. This study aims to analyze, for the first time in Spain, the effectiveness of the Guided Self-Change Treatment (GSCT).Methods: One-day a week, the 4-sesion program was individually applied to a woman with a pattern of high-risk alcohol consumption. Results: After treatment, thefrequency of drinking decreased from 42 to 0 standard drinks per week and self-efficacywas clinically significantimproved. Changes were maintained at 6-months follow up. Conclusions: To conclude, the GSCT seems to be effective at reducing problem drinking and the negative consequences associated with it, which is consistent with the results of previous studies in Latin American population

Evaluación del uso problemático de fármacos opioides y sus factores de riesgo en pacientes con dolor crónico

El dolor crónico es un problema de salud que se estima afecta al 20% de la población adulta española. Pese a las reservas sobre su efectividad y seguridad a largo, los fármacos opioides se han convertido en el tratamiento de elección en pacientes con dolor crónico de intensidad media-alta. El crecimiento de su prescripción a nivel mundial ha sido exponencial y, aunque en España no existen datos actualizados, se estima que el empleo de opioides se ha multiplicado por 14 en las últimas dos décadas. El crecimiento del uso de este tipo de fármacos, los cuales poseen un alto poder adictivo, se ha visto asociado a un aumento de las tasas de uso problemático de estos fármacos. Sin embargo, los datos de prevalencia del uso problemático de analgésicos opioides son escasos y poco concluyentes, debido, en cierta medida, a la heterogeneidad de los criterios y métodos utilizados en los estudios para la evaluación de la misma. En España, además, este tema sigue siendo un ámbito poco estudiado de la investigación. Hasta el punto de que, a día de hoy, no existen instrumentos específicos para la evaluación del uso problemático de estos fármacos en población española y menos aún en poblaciones específicas, como pacientes con dolor crónico. Esta falta de instrumentos de evaluación también ha derivado en una escasez de estudios que analicen cuáles son los principales factores de riesgo asociados al uso problemático de fármacos opioides. Por último, ante los recientes y controvertidos cambios en los criterios diagnósticos de la nueva edición del DSM-5, faltan estudios que evalúen la idoneidad de la eliminación de criterios como el síndrome de abstinencia, para el diagnóstico del trastorno por consumo de opioides en pacientes que consumen estos fármacos bajo supervisión médica apropiada. Por todo ello, los objetivos de la presente Tesis Doctoral son los siguientes: (a) analizar la prevalencia de consumo y uso problemático de fármacos opioides, así como la gravedad del mismo, durante el tratamiento del dolor crónico no oncológico en población española usuaria de Unidades de Tratamiento de Dolor; (b) analizar los factores de riesgo psicológicos, médicos y sociales asociados al uso problemático de estos fármacos, en pacientes de dichas Unidades; (c) adaptar, traducir y analizar las propiedades psicométricas de un instrumento para la evaluación del síndrome de abstinencia durante el tratamiento con opioides a largo plazo, dada la importancia que este tiene en la aparición del uso problemático; y (d) evaluar la utilidad clínica de dicho instrumento para la predicción de la gravedad del trastorno por consumo de opioides (TCO) durante el tratamiento con opioides a largo plazo. Los resultados de esta Tesis Doctoral señalan que las tasas de prevalencia de TCO en población española con dolor crónico que consume fármacos opioides a largo plazo son elevadas. En cuanto a los factores de riesgo, el uso de una mayor cantidad de medicamentos y de opioides, tener una menor edad y la presencia de mayores niveles de dolor parecen estar relacionados con el desarrollo de un TCO en tratamientos prolongados (más de 90 días). Asimismo, los hallazgos señalan al estado de ánimo negativo como el factor de riesgo más importante en el desarrollo de un TCO durante el tratamiento a largo plazo con opioides, motivo por el cual la incorporación de la evaluación y la intervención psicológica durante el tratamiento con opioides parece ser fundamental para la prevención del desarrollo de un TCO. Por otro lado, aunque el síndrome de abstinencia aparece en la mayoría de pacientes cuando se saltan u olvidan la toma de una dosis del fármaco opioide, la intensidad de estos síntomas es mucho mayor en los pacientes que cumplen criterios de un TCO. De igual forma, los hallazgos de esta Tesis Doctoral cuestionan la idoneidad de la eliminación del criterio de síndrome de abstinencia en la nueva clasificación diagnóstica del TCO en el DSM-5, puesto que la escalada en la intensidad de los síntomas de abstinencia se ha mostrado como un importante predictor del TCO, incluso cuando el fármaco se consume bajo supervisión médica apropiada. Finalmente, la versión adaptada al español del ARSW y validada en población con dolor crónico resulta ser un instrumento válido y fiable para la evaluación del síndrome de abstinencia durante el tratamiento con opioides. Además, los resultados señalan que el ARSW puede ser también una herramienta de gran utilidad para la detección de un posible TCO en pacientes bajo tratamiento con opioides a largo plazo, evaluando con la misma precisión tanto a hombres como mujeres.Chronic pain is a significant health problem, with an estimated prevalence of 20% in the Spanish adult population. Despite reservations concerning their long-term safety and efficacy, opioid drugs have become the treatment of choice for patients with chronic pain of medium-high intensity and the number of prescriptions written for opioids has exponentially increased. Although there are no updated data for Spain, it is estimated that the use of opioids has multiplied by 14 in the last two decades. This increase has been also related to an increase in the rates of misuse on these drugs. However, prevalence data on the problematic use of opioid analgesics are scarce and inconclusive, due, to some extent, to the heterogeneity of the criteria and methods used in the studies for its assessment. Moreover, prescription opioid misuse in chronic pain population remains a little studied area of research in Spain. To date, there are no specific tools for the assessment of opioid misuse in the Spanish population and even less in specific populations, such as chronic pain patients. This lack of assessments instruments has also led to a lack of studies that analyze the main risk factors associated with the misuse of prescription opioids. In addition, the recent changes included in the DSM-5 to the diagnostic criteria for prescription opioid-use disorder (POUD)has been without controversy and there is a lack of studies that assess the suitability of the removal of criteria, such as withdrawal symptoms, for those taking opioids under appropriate medical supervision. For all these reasons, the goals of this Doctoral Thesis were as follows: (a) to analyze the prevalence of prescription opioids use and misuse, as well as its severity, during the treatment of chronic non-cancer pain in the Spanish population attending a Pain Management Unit; (b) to analyze the psychological, medical and social risk factors associated with a prescription opioid use disorder (POUD); (c) to adapt, translate and analyze the psychometric properties of an instrument for the assessment of withdrawal symptoms during long-term opioid treatment (more than 90 days), given the importance that this variable has in the development of POUD; and (d) to assess the ability of this tool to assess severity of POUD during long-term opioid treatment. The findings of this Doctoral Thesis point to a high prevalence rates of POUD in Spanish population with chronic pain under long-term treatment with these analgesics. Regarding the risk factors, a greater number of medications and opioids consumed, a lower mean age and the presence of higher levels of pain intensity seem to be associated with the development of POUD in long-term treatments. Likewise, the findings point to negative mood as the most important risk factor and reveal the need of including along with the pharmacological treatment, psychological assessment and intervention in order to minimize the risk of developing POUD. On the other hand, although the withdrawal syndrome appears in most patients when they skip or forget to take a dose of the prescription opioid, the severity of these symptoms is much greater in patients who meet POUD criteria. Likewise, the findings of this Doctoral Thesis question the suitability of the removal of the withdrawal symptoms criterion in the new DSM-5 diagnostic classification of POUD, since the escalation of withdrawal intensity has been shown as an important predictor of POUD, even when the medication is consumed under appropriate medical supervision. Finally, the Spanish version of the ARSW has also shown to be a valid andreliable instrument for the assessment of the withdrawal symptoms in chronic pain population under opioid treatment. In addition, the results indicate that the ARSW can also be a very useful and clinically feasible tool for identifying POUD in patients under long-term treatment with opioids, achieving the same accuracy level for assessing both men and women

Factores asociados a la dependencia de fármacos opioides en pacientes con dolor crónico

El aumento del uso inadecuado de fármacos opioides se considera un problema de salud pública, por lo que es necesario estudiar los factores asociados al desarrollo de la dependencia de estos fármacos. Objetivos: Analizar los factores asociados a la dependencia de fármacos opioides en pacientes con dolor crónico, así como elaborar un modelo matemático para la predicción de la misma. Método: Participaron 178 consumidores de fármacos opioides, de los cuales el 48,3% (n=83) cumplían 3 o más criterios de los trastornos por dependencia a sustancias psicoactivas del DSM-IV-TR. Se evaluaron variables sociodemográficas, variables médicas (pauta de consumo de psicofármacos, consumo de otros fármacos y número de especialistas visitados habitualmente) y variables psicológicas (gravedad de la dependencia, sintomatología ansioso-depresiva y dolor percibido). Se llevaron a cabo análisis descriptivos, bivariados y de regresión logística binaria. Resultados: El número total de años en tratamiento, de fármacos prescritos y de especialistas visitados habitualmente es significativamente mayor en los pacientes dependientes (p<,01), los cuales consumen más antidepresivos y ansiolíticos (p<,05) y presentan más (p<,01) percepción de intensidad e interferencia del dolor. El modelo creado con las variables número de fármacos consumidos, presencia de depresión, consumo de ansiolíticos e intensidad percibida del dolor, clasifica correctamente al 73,3% de los pacientes dependientes. Conclusiones: En el desarrollo de la dependencia parecen influir variables médicas y psicológicas que deben tenerse en cuenta en la planificación del tratamiento. Son necesarios estudios con muestras más amplias para analizar aplicabilidad del modelo en la identificación de pacientes dependientes.Introduction: The increasing misuse of prescription opioids is a public health problem, so it is necessary to study the factors associated with the development of dependence on these drugs. Objectives: To analyze the factors associated with dependence on prescription opioids in patients with chronic pain and to develop a mathematical model for predicting it. Method: A total of 178 consumers of prescription opioids, of which 48.3% (n = 83) met three or more DSM-IV-TR criteria for psychoactive substance dependence. Sociodemographic, medical variables (consumption pattern of prescription opioids, use of other drugs and number of specialists visited regularly) and psychological variables (severity of dependence, anxiety-depressive symptoms and perceived pain) were assessed. Descriptive, bivariate and binary logistic regression analyses were carried out. Results: The total number of years in treatment, the number of prescribed drugs and the number of specialists visited is significantly bigger in opioid-dependent patients (p <.01), which consume more antidepressants and anxiolytics (p <.05) and perceived a greater pain intensity and interference (p <.01). The predictive model created with the variables number of prescribed drugs consumed, presence of depression, use of anxiolytics and perceived pain intensity, correctly classifies 73.3% of opioid-dependent patients. Conclusions: Medical as well as psychological variables seem to be involved in the development of prescription opioids dependence, so they should be considered in the treatment planning. Further studies with a bigger sample size are needed to analyze the applicability of the model to identify prescription opioids-dependent patients

Barriers for identification and treatment of problem drinkers in primary care

Objective: Due to the lack of studies in the Spanish population, this study aims to analyze the barriers perceived by health professionals from different Spanish health centers when attempting to identify and treat problem drinkers and the importance given to this aspect, as well as analyzing the possible differences as a function of the professionals’ health teams. We also analyze the psychometric properties of the questionnaire used to assess these barriers. Method: The participants included 107 health professionals: 62.7% belonged to the medical team and 32.4% to the nursing team. After we had reviewed previous studies, collecting the main barriers referred to in them, participants completed an ad hoc questionnaire. Results: The main barriers found were the belief that patients will lie about their actual consumption and will not identify its negative consequences, and the belief that they will reject participating in an intervention for their alcohol consumption. No significant differences between doctors and nurses were found in any of the barriers assessed. The results provide empirical evidence of the reliability of the test for the assessment by both teams of professionals. Conclusions: Studies are needed to examine in greater depth these conclusions, extending the number of variables studied to determine a more complete profile of the health professionals who are reluctant to incorporate the assessment and treatment of problem drinkers in their consultation. This could help to improve the design of programs to facilitate and encourage its implementation in primary care

Validation of the Glover–Nilsson Smoking Behavioral Questionnaire (GN-SBQ) to Evaluate Nicotine Dependence in Spanish Clinical Settings

An assessment of the different aspects of tobacco addiction is central to adapting interventions to the profiles and needs of smokers. The Glover–Nilsson Smoking Behavioral Questionnaire (GN-SBQ) is one of the few and most used scales to evaluate the behavioral aspects of tobacco addiction. However, few studies involve the validation of the GN-SBQ in clinical settings. Thus, this study aimed to analyze the psychometric properties of the GN-SBQ in a sample of Spanish smokers. A total of 341 smokers attending clinical services in Spain participated in this cross-sectional study. Measures included the psychological factors related to tobacco addiction, assessed with the GN-SBQ, the physical factors of nicotine addiction, withdrawal symptoms, smoking-related variables, and alcohol use. Data analysis included descriptive statistics, internal consistency coefficients, confirmatory factor analyses, Spearman correlations, and the Kruskal–Wallis test. The GN-SBQ showed adequate reliability (α = 0.76 and ω = 0.76) and a unidimensional structure. GN-SBQ scores also provided evidence of convergent and concurrent validity. GN-SBQ scores significantly correlated with the physical symptoms of addiction, age, number of cigarettes, and withdrawal symptoms. The results of discriminant validity were also adequate, as no correlation was observed between GN-SBQ scores and CO levels or alcohol use. Significant differences were found between all levels of psychological addiction based on the GN-SBQ scores regarding physical nicotine addiction, withdrawal symptoms, and age. Thus, this questionnaire is a reliable and valid instrument to assess the psychological aspects of tobacco addiction in smokers in clinical settings. The short length of the GN-SBQ proves advantageous for its use in time-limited assessments, which are common in public health services

Programa de Auto-cambio Dirigido en abuso de alcohol en población española: un estudio de caso [Guided Self-Change Treatment for alcohol abuse in Spain: a single-case study]

Introducción: Aunque existe evidencia de la efectividad de intervenciones breves para disminuir el consumo problemático de alcohol, son escasos los datos en población española. El objetivo de este estudio es analizar, por primera vez en España, la efectividad del Programa de Auto-Cambio Dirigido (Guided Self-Change Treatment; GSCT). Método: Se aplicaron 4 sesiones individuales con frecuencia semanal del programa a una consumidora de alto riesgo de alcohol. Resultados: Los resultados indican una disminución del consumo de alcohol de 42 a 0 unidades de bebida estándar por semana y un aumento de la autoeficacia percibida, manteniéndose en el seguimiento a 6 meses. Conclusiones: Como ya señalaron estudios anteriores en población latinoamericana, el GSCT parece ser efectivo en la reducción del consumo de alcohol y las consecuencias negativas asociadas al mismo. Introduction: Although there is evidence of the effectiveness of brief interventions at reducing problem drinking, there is a lack of studies in Spanish population. This study aims to analyze, for the first time in Spain, the effectiveness of the Guided Self-Change Treatment (GSCT). Methods: One-day a week, the 4-sesion program was individually applied to a woman with a pattern of high-risk alcohol consumption. Results: After treatment, the frequency of drinking decreased from 42 to 0 standard drinks per week and selfefficacy was clinically significant improved. Changes were maintained at 6- months follow up. Conclusions: To conclude, the GSCT seems to be effective at reducing problem drinking and the negative consequences associated with it, which is consistent with the results of previous studies in Latin American population

The Moderating Role of Caregiving on Fear of COVID-19 and Post-Traumatic Stress Symptoms

Caregiving has been associated with increased levels of fear and post-traumatic stress symptoms (PTSS) during COVID-19 pandemic. However, there is a lack of studies that analyze when the relationship between fear and PTSS occur, using informal caregiving as a moderator variable. To explore this moderating role, we conducted a cross-sectional online study between November 2020 and January 2021. A total of 503 men and women from the Spanish general population completed the survey. Sociodemographic and Covid-19-related data, fear of COVID-19, PTSS symptoms, and current psychological history were assessed. Prevalence of informal caregiving in the sample was 16.5%. Increased levels of fear and PTSS were found in caregivers compared to non-caregivers. Female gender and high number of COVID-19 related risk factors was also associated with fear and PTSS severity. The moderation analyses showed an interaction effect between caregiving and fear of COVID-19 when predicting PTSS symptoms. Particularly, results showed that informal caregivers reported greater PTSS symptoms, when compared to non-caregivers with same levels of fear of COVID-19. This evidence suggests that being a caregiver could increase the fear’s impact on PTSS severity in the context of pandemics. Further studies with larger samples are needed to confirm these findings

EVALUACIÓN PSICOLÓGICA DEL ABUSO DE FÁRMACOS OPIOIDES

El incremento de la preinscripción de fármacos analgésicos opioides se ha asociado a un aumento de las tasas de abuso y las consecuencias negativas asociadas a su uso inadecuado. Diversos organismos sanitarios internacionales recomiendan la realización de una evaluación global y multidisciplinar del paciente durante todo el proceso terapéutico con opiáceos, con el fin de identificar un posible abuso. Ante la ausencia de quías específicas en el ámbito sanitario español, el objetivo de este artículo ha sido presentar una propuesta de evaluación psicológica, en base a los principales instrumentos de evaluación, disponibles actualmente para evaluar el abuso de opioides. Se establecen pautas para el proceso de evaluación en función de las variables psicológicas que puedan predecir y mantener dicho abuso, clasificando todo ello en función del momento del proceso terapéutico en el que los pacientes se encuentren, Aunque existen instrumentos con buenas propiedades psicométricas, son necesarias futuras investigaciones para la adaptación, traducción y validación de éstos a población española. Al mismo tiempo son necesarios futuros estudios que profundicen en estrategias de prevención e intervención para reducir la probabilidad de abuso en pacientes tratados con fármacos opioides

PSYCHOLOGICAL ASSESSMENT OF OPIOID DRUG ABUSE

The increase in the prescription of opioid analgesics is related to increased rates of opioid abuse and the negative consequences of medication misuse. Several international health organisations recommend comprehensive and multidisciplinary patient assessment for the duration of the opioid treatment in order to identify and prevent medication abuse. Due to the lack of specific clinical guidelines in the Spanish National Health System, the aim of this paper is to present a proposal for psychological assessment based on the main psychological tools currently available for assessing opioid abuse. The assessment guidelines have been established based on the psychological variables that can predict and prolong the abuse, classifying all of the variables depending on the current stage of the therapeutic process for each patient. Although there are instruments with good psychometric properties, further research is necessary to adapt, translate and validate these instruments for use in the Spanish population. Future studies are also needed to investigate intervention and prevention strategies in depth in order to reduce the likelihood of abuse in patients treated with opioids