Psychoeducation as a strategy to improve family support perceived from patient with alcohol dependence and personality disorder

The aim of this study was to prospectively analyze the impact of psychoeducation with relatives of addicted patients with personality disorders. We measured the impact of the psychoeducational intervention using a self-report questionnaire designed to assess perceived familiar support. The sample was composed by 37 patients with alcohol dependence following outpatient treatment. They underwent a cognitive-behavioral therapy relapse prevention program especially tailored for addicted individuals with comorbid personality disorders. 56.8% of patients followed individual therapy, and 43.2% followed group therapy. The relatives of the subgroup patients following group therapy simultaneously received the psychoeducational intervention. The analyses of the familiar support questionnaire across treatment showed a significant difference between groups as a function of treatment modality. Patients whose relatives followed the psychoeducational intervention had greater perception of familiar support throughout the treatment process

Prefrontal gray matter and motivation for treatment in cocaine dependent individuals with and without personality disorders

Addiction treatment is a long-term goal and therefore prefrontal–striatal regions regulating goal-directed behavior are to be associated with individual differences on treatment motivation. We aimed at examining the association between gray matter volumes in prefrontal cortices and striatum and readiness to change at treatment onset in cocaine users with and without personality disorders. Participants included 17 cocaine users without psychiatric comorbidities, 17 cocaine users with Cluster B disorders, and 12 cocaine users with Cluster C disorders. They completed the University of Rhode Island Change Assessment Scale, which measures four stages of treatment change (precontemplation, contemplation, action, and maintenance) and overall readiness to change, and were scanned in a 3 T MRI scanner. We defined three regions of interest (ROIs): the ventromedial prefrontal cortex (including medial orbitofrontal cortex and subgenual and rostral anterior cingulate cortex), the dorsomedial prefrontal cortex (i.e., superior medial frontal cortex), and the neostriatum (caudate and putamen). We found that readiness to change correlated with different aspects of ventromedial prefrontal gray matter as a function of diagnosis. In cocaine users with Cluster C comorbidities, readiness to change positively correlated with gyrus rectus gray matter, whereas in cocaine users without comorbidities it negatively correlated with rostral anterior cingulate cortex gray matter. Moreover, maintenance scores positively correlated with dorsomedial prefrontal gray matter in cocaine users with Cluster C comorbidities, but negatively correlated with this region in cocaine users with Cluster B and cocaine users without comorbidities. Maintenance scores also negatively correlated with dorsal striatum gray matter in cocaine users with Cluster C comorbidities. We conclude that the link between prefrontal–striatal gray matter and treatment motivation is modulated by co-existence of personality disorders

Prefrontal gray matter and motivation for treatment in cocaine-dependent individuals with and without personality disorders

Addiction treatment is a long-term goal and therefore prefrontal–striatal regions regulating goal-directed behavior are to be associated with individual differences on treatment motivation. We aimed at examining the association between gray matter volumes in prefrontal cortices and striatum and readiness to change at treatment onset in cocaine users with and without personality disorders. Participants included 17 cocaine users without psychiatric comorbidities, 17 cocaine users with Cluster B disorders, and 12 cocaine users with Cluster C disorders. They completed the University of Rhode Island Change Assessment Scale, which measures four stages of treatment change (precontemplation, contemplation, action, and maintenance) and overall readiness to change, and were scanned in a 3T MRI scanner. We defined three regions of interest (ROIs): the ventromedial prefrontal cortex (including medial orbitofrontal cortex and subgenual and rostral anterior cingulate cortex), the dorsomedial prefrontal cortex (i.e., superior medial frontal cortex), and the neostriatum (caudate and putamen). We found that readiness to change correlated with different aspects of ventromedial prefrontal gray matter as a function of diagnosis. In cocaine users with Cluster C comorbidities, readiness to change positively correlated with gyrus rectus gray matter, whereas in cocaine users without comorbidities it negatively correlated with rostral anterior cingulate cortex gray matter. Moreover, maintenance scores positively correlated with dorsomedial prefrontal gray matter in cocaine users with Cluster C comorbidities, but negatively correlated with this region in cocaine users with Cluster B and cocaine users without comorbidities. Maintenance scores also negatively correlated with dorsal striatum gray matter in cocaine users with Cluster C comorbidities. We conclude that the link between prefrontal–striatal gray matter and treatment motivation is modulated by co-existence of personality disorders

Variables de interés clínico en el tratamiento cognitivo-conductual de la adicción a la cocaína: Especificidad de los trastornos de la personalidad

The aim of this study was to examine the association between social interaction variables and premature cessation of treatment, psychological adjustment and quality of life, as a function of co-existing diagnoses of personality disorders. The sample was composed of 95 individuals who commenced treatment for cocaine addiction. Of the sample, 53.7% had personality disorders diagnoses. The results highlight the relevance of addressing dysfunctional coping styles during early stages of treatment, especially coping styles linked to emotion processing as they associate with lower levels of self-efficacy, lower perceived quality of life, poorer psychosocial adjustment and higher risk of treatment dropout. These deficits are significantly more prominent in individuals with personality disorders, who present lower levels of self-efficacy, self-esteem, optimism, self-control and social skills.El objetivo de este estudio fue conocer la relevancia y relación de variables de interacción social con el riesgo de abandono prematuro del tratamiento, el nivel de ajuste psicológico y la calidad de vida, analizando las diferencias que puedan deberse a la presencia de trastornos de la personalidad. La muestra estuvo compuesta por 95 personas que iniciaron el tratamiento por su adicción a la cocaína. El 53.7 % de los pacientes presentaban trastornos de la personalidad. Los resultados evidencian la importancia de prestar suficiente atención en fases iniciales del tratamiento al estilo de afrontamiento de los problemas, particularmente al centrado en la emoción porque se relaciona con menores niveles de autoeficacia, calidad de vida autopercibida, menor nivel de ajuste psicológico y mayor riesgo de abandono del tratamiento. Estas deficiencias se observan significativamente más en pacientes con trastornos de la personalidad, entre los que se aprecian además menores niveles de autoeficacia, autoestima, optimismo, autocontrol y habilidades sociales

Decisional balance and processes of change in community-recruited with moderate-high versus mild severity of cannabis dependence

Decisional Balance and Processes of Change are generally addressed in motivational interventions for the treatment of cannabis use disorders. However, specific aspects of these multifaceted constructs, with greater relevance for severe cannabis users, need to be ascertained to enable better interventions. This study aimed to compare the different facets of decisional balance and processes of change between mild and severe cannabis users in a community-based sample of young undergraduates. Thirty-one severe cannabis users and 31 mild cannabis users, indicated with the Severity of Dependence Scale, were assessed using the Decisional Balance Questionnaire (DBQ) and the Processes of Change Questionnaire (PCQ). We found that severe cannabis users had higher scores in the DBQ dimensions of Utilitarian Gains for the Self, Utilitarian Gains for Significant Others, and Self-approval, as well as in the total subscale of Gains but not Losses. The group of severe cannabis users also had higher scores in the PCQ dimensions of Self-revaluations and Counter-conditioning. Our results pinpoint specific dimensions of Decisional Balance and Processes of Change that are endorsed by severe cannabis users. This knowledge could be applied to inform motivational interventions targeting severe cannabis users

Brain networks alterations in cocaine use and gambling disorders during emotion regulation

Cocaine use disorder (CUD) and gambling disorder (GD) share clinical features and neural alterations, including emotion regulation deficits and dysfunctional activation in related networks. However, they also exhibit differential aspects, such as the neuroadaptive effects of long-term drug consumption in CUD as compared to GD. Neuroimaging research aimed at disentangling their shared and specific alterations can contribute to improve understanding of both disorders. We compared CUD (N = 15), GD (N = 16) and healthy comparison (HC; N = 17) groups using a network-based approach for studying temporally coherent functional networks during functional magnetic resonance imaging (fMRI) of an emotion regulation task. We focused our analysis in limbic, ventral frontostriatal, dorsal attentional (DAN) and executive networks (FPN), given their involvement in emotion regulation and their alteration in CUD and GD. Correlations with measures of emotional experience and impulsivity (UPPS-P) were also performed. The limbic network was significantly decreased during emotional processing both for CUD and GD individuals compared to the HC group. Furthermore, GD participants compared to HC showed an increased activation in the ventral frontostriatal network during emotion regulation. Finally, networks' activation patterns were modulated by impulsivity traits. Functional network analyses revealed both overlapping and unique effects of stimulant and gambling addictions on neural networks underpinning emotion regulation

Computational modelling of reinforcement learning and functional neuroimaging of probabilistic reversal for dissociating compulsive behaviours in gambling and cocaine use disorders.

Background: Individuals with cocaine use disorder or gambling disorder demonstrate impairments in cognitive flexibility: the ability to adapt to changes in the environment. Flexibility is commonly assessed in a laboratory setting using probabilistic reversal learning, which involves reinforcement learning, the process by which feedback from the environment is used to adjust behavior. Aims: It is poorly understood whether impairments in flexibility differ between individuals with cocaine use and gambling disorders, and how this is instantiated by the brain. We applied computational modelling methods to gain a deeper mechanistic explanation of the latent processes underlying cognitive flexibility across two disorders of compulsivity. Method: We present a re-analysis of probabilistic reversal data from individuals with either gambling disorder (n = 18) or cocaine use disorder (n = 20) and control participants (n = 18), using a hierarchical Bayesian approach. Furthermore, we relate behavioural findings to their underlying neural substrates through an analysis of task-based functional magnetic resonanceimaging (fMRI) data. Results: We observed lower 'stimulus stickiness' in gambling disorder, and report differences in tracking expected values in individuals with gambling disorder compared to controls, with greater activity during reward expected value tracking in the cingulate gyrus and amygdala. In cocaine use disorder, we observed lower responses to positive punishment prediction errors and greater activity following negative punishment prediction errors in the superior frontal gyrus compared to controls. Conclusions: Using a computational approach, we show that individuals with gambling disorder and cocaine use disorder differed in their perseverative tendencies and in how they tracked value neurally, which has implications for psychiatric classification

Complicaciones neuropsicológicas asociadas a la comorbilidad entre trastornos de personalidad y consumo de cocaína

Tesis Univ. Granada. Departamento de Personalidad, Evaluación y Tratamiento Psicológic