Exploring Attentional Bias toward Alcohol Content: Insights from Eye-Movement Activity.

INTRODUCTION: Attentional bias (AB) is an implicit selective attention toward processing disorder-significant information while neglecting other environmental cues. Considerable empirical evidence highlights the clinical implication of AB in the onset and maintenance of substance use disorder. An innovative method to explore direct measures of AB relies on the eye-movement activity using technologies like eye-tracking (ET). Despite the growing interest regarding the clinical relevance of AB in the spectrum of alcohol consumption, more research is needed to fully determine the AB patterns and its transfer from experimental to clinical applications. The current study consisted of three consecutive experiments. The first experiment aimed to design an ad-hoc visual attention task (VAT) consisting of alcohol-related and neutral images using a nonclinical sample (n = 15). The objective of the second and third experiments was to analyze whether the effect of type of image (alcohol-related vs. neutral images) on AB toward alcohol content using the VAT developed in the first experiment was different for type of drinker (light vs. heavy drinker in the second experiment [n = 30], and occasional social drinkers versus alcohol use disorder (AUD) patients in the third experiment [n = 48]). METHODS: Areas of interest (AOIs) within each type of image (neutral and alcohol-related) were designed and raw ET-based data were subsequently extracted through specific software analyses. For experiment 1, attention maps were created and processed for each image. For experiments 2 and 3, data on ET variables were gathered and subsequently analyzed through a two-way ANOVA with the aim of examining the effects of the type of image and drinker on eye-movement activity. RESULTS: There was a statistically significant interaction effect between type of image and type of drinker (light vs. heavy drinker in experiment 2, F(1, 56) = 13.578, p < 0.001, partial η2 = 0.195, and occasional social drinker versus AUD patients in the experiment 3, F(1, 92) = 35.806, p < 0.001, partial η2 = 0.280) for "first fixation" with large effect sizes, but not for "number of fixations" and "dwell time." The simple main effect of type of image on mean "first fixation" score for AUD patients was not statistically significant. CONCLUSION: The data derived from the experiments indicated the importance of AB in sub-clinical populations: heavy drinkers displayed an implicit preference for alcohol-related images compared to light drinkers. Nevertheless, AB fluctuations in patients with AUD compared to the control group were found. AUD patients displayed an early interest in alcohol images, followed by an avoidance attentional processing of alcohol-related images. The results are discussed in light of recent literature in the field.

Advantages of telephone assistance on adherence to treatment in patients with alcohol and other addictions during the Covid19 pandemic. / Beneficios de la atención telefónica durante la pandemia covid19 en la adherencia terapéutica en pacientes con alcoholismo y otras adicciones.

The Covid19 pandemic has led to many publications about its influence on the treatment and evolution of individuals with a substance use disorder, leading to contradictory results. In this study, the adherence and abstinence rates of patients who started treatment in an Addictive Behavior Unit during the pandemic are analyzed, compared with others who attended the previous year and comparing those who were attended in person or by phone. The results indicate that during the Covid19 period, patients had greater adherence to treatment after one month of follow up and when attended to by phone. At 3 and 12 months, greater adherence was maintained, although it was not statistically significant. Regarding abstinence, the small sample size made it difficult to obtain significant differences. The conclusion is that, despite a quantitative decrease in the number of patients beginning drug treatment, in qualitative terms the pandemic led to greater adherence in the short and medium term. Telephone attention can play an important and positive role at this point, complementary to other resources and interventions.

La pandemia por covid19 ha generado muchas publicaciones acerca de su influencia en el tratamiento y evolución de personas con un trastorno por uso de sustancias, con resultados contradictorios, a veces basadas en datos y otras en inferencias indirectas de otros datos. En este trabajo se estudia la adherencia y tasas de abstinencia de pacientes que inician tratamiento en una Unidad de Conductas Adictivas durante la pandemia, respecto a otros que acudieron el año previo y comparando los que hicieron visita presencial o telefónica. Los resultados indicaron mejor adherencia al mes de seguimiento en los pacientes del periodo covid19 y en los que fueron atendidos telefónicamente. A los 3 y 12 meses se mantuvo una mejor adherencia, aunque no significativa estadísticamente. Respecto a la abstinencia, el pequeño tamaño de la muestra dificultó obtener diferencias significativas. Se concluye que la pandemia, aunque ha significado una disminución del número de inicios de tratamientos por consumo de sustancias, también ha repercutido en una mayor adherencia a corto y medio plazo. La atención telefónica puede jugar un papel importante y positivo en este aspecto, complementario a otros recursos e intervenciones.

[Methamphetamine use in chemsex and its consequences on mental health: a descriptive study.] / Uso de metanfetamina en el contexto chemsex y sus consecuencias en la salud mental: un estudio descriptivo.

OBJECTIVE: Chemsex is a term applicable to the use of drugs related to sex among men who have sex with men (MSM). Because it is a recent trend, there is little information about its management and consequences. The aim of the study was to describe the clinical profile of a sample of chemsex users who consulted for treatment. METHODS: This is a longitudinal and retrospective study of 53 patients who consulted for chemsex in an addiction unit of a general hospital in Barcelona, from January 2017 to June 2019. Data was collected from electronic medical records and a descriptive analysis was performed by calculating proportions and means. RESULTS: The most common drug used in chemsex was methamphetamine (81.1%; n=43) and 67.4% (n=29) of these used at least other two drugs. The prevalence of HIV infection was high (71.2%; n=37) and 72.1% (n=41) had psychiatric comorbidity, being the most common psychosis (37.2%; n=16). CONCLUSIONS: Methamphetamine was the most common drug chemsex user's seeked for treatment. Furthermore, there is a high prevalence of HIV diagnosis in this population. Both conditions can enhance the risk of suffering from psychosis and may explain why psychiatric comorbidity is so high in the sample.

OBJETIVO: El fenómeno chemsex es una práctica de consumo de sustancias asociada a las relaciones sexuales en hombres que tienen sexo con hombres. Debido a la novedad que supone, disponemos de poca información en cuanto a su abordaje y pronóstico desde el punto de vista de la salud mental. El objetivo de este estudio fue describir el perfil de una muestra de usuarios de chemsex que solicitaron tratamiento para abandonar el consumo. METODOS: Se realizó un estudio longitudinal retrospectivo de una muestra de 53 sujetos que consultaron en la unidad de adicciones de un hospital de Barcelona en el período entre enero de 2017 y junio de 2019 por consumo de drogas en contexto de chemsex. Los datos se recogieron a través de una revisión de historias clínicas y se realizó un análisis estadístico de tipo descriptivo mediante el cálculo de proporciones y medias. RESULTADOS: La metanfetamina fue la droga principal por la que más frecuentemente se solicitaba tratamiento (81,1%; n=43). De éstos, el 67,4% (n=29) consumía además, como mínimo, otras dos sustancias. El 71,2% (n=37) presentaba infección por VIH. El 72,1% (n=41) de los sujetos presentó comorbilidad psiquiátrica, siendo lo más frecuente la sintomatología psicótica (37,2%; n=16). CONCLUSIONES: Un porcentaje elevado de usuarios de chemsex presentan diagnóstico de VIH y la droga principal más utilizada y por la que más consultaron fue la metanfetamina. Ambas condiciones podrían estar relacionadas con la elevada prevalencia de sintomatología psicótica.

Determinants of Cue-Elicited Alcohol Craving and Perceived Realism in Virtual Reality Environments among Patients with Alcohol Use Disorder.

The identification of variables that can modulate the efficacy of cue exposure using virtual reality (VR) is crucial. This study aimed to explore determinant variables of cue-elicited alcohol craving and perceived realism (PR) of environments and alcoholic beverages during a VR cue-exposure session among alcohol use disorder (AUD) outpatients. A prospective cohort study was conducted amongst 72 outpatients with AUD from a clinical setting. Alcohol craving experienced during VR exposure and PR of virtual environments and alcoholic drinks were evaluated after a VR session of exposure to alcohol-related contexts and cues. Sociodemographic, psychological and consumption characteristics were examined as possible predicting variables. Multiple linear regression analyses showed that the AUD severity and PR of beverages were predictors of cue-elicited alcohol craving. Educational level, PR of beverages and age were predictors of the PR of VR environments. In relation to the PR of VR beverages, cue-elicited alcohol craving and the PR of environments were predictors. A simple mediational model was also performed to analyze the influence of the PR of beverages on the relationship between the AUD severity and alcohol craving experienced during VR exposure: an indirect or mediational effect was found. PR of alcoholic beverages was (1) a key predictor of the PR of VR environments (and vice versa) and the alcohol craving (and vice versa) experienced during VR cue-exposure sessions using ALCO-VR software among AUD patients and (2) a mediator between AUD severity and cue-elicited alcohol craving.

Attentional Bias, Alcohol Craving, and Anxiety Implications of the Virtual Reality Cue-Exposure Therapy in Severe Alcohol Use Disorder: A Case Report.

Aims: Attentional bias (AB), alcohol craving, and anxiety have important implications in the development and maintenance of alcohol use disorder (AUD). The current study aims to test the effectiveness of a Virtual Reality Cue-Exposure Therapy (VR-CET) to reduce levels of alcohol craving and anxiety and prompt changes in AB toward alcohol content. Method: A 49-year-old male participated in this study, diagnosed with severe AUD, who also used tobacco and illicit substances on an occasional basis and who made several failed attempts to cease substance misuse. The protocol consisted of six VR-CET booster sessions and two assessment sessions (pre- and post-VR-CET) over the course of 5 weeks. The VR-CET program consisted of booster therapy sessions based on virtual reality (VR) exposure to preferred alcohol-related cues and contexts. The initial and final assessment sessions were focused on exploring AB, alcohol craving, and anxiety using paper-and-pencil instruments and the eye-tracking (ET) and VR technologies at different time points. Results: Pre and post assessment sessions indicated falls on the scores of all instruments assessing alcohol craving, anxiety, and AB. Conclusions: This case report, part of a larger project, demonstrates the effectiveness of the VR-CET booster sessions in AUD. In the post-treatment measurements, a variety of instruments showed a change in the AB pattern and an improvement in craving and anxiety responses. As a result of the systematic desensitization, virtual exposure gradually reduced the responses to significant alcohol-related cues and contexts. The implications for AB, anxiety and craving are discussed.

Predictors of Changes in Alcohol Craving Levels during a Virtual Reality Cue Exposure Treatment among Patients with Alcohol Use Disorder.

BACKGROUND/OBJECTIVE: Determining the predictive variables associated with levels of alcohol craving can ease the identification of patients who can benefit from treatments. This study aimed to describe changes (improvement or no change/deterioration) in alcohol craving levels and explore the predictors of these changes from admission to discharge in outpatients with alcohol use disorder (AUD) undergoing treatment-as-usual (TAU), or treatment-as-usual supplemented with virtual reality cue-exposure therapy (TAU + VR-CET). METHOD: A prospective cohort study was conducted amongst 42 outpatients with AUD (n = 15 TAU + VR-CET and n = 27 TAU) from a clinical setting. Changes in the levels of alcohol craving between admission and discharge were assessed with the Multidimensional Alcohol Craving Scale. Sociodemographic characteristics (age, gender, education, and socioeconomic and civil status), cognitive-affective behavioral patterns (AUD severity, abstinence duration, psychiatric comorbidity, state anxiety, attentional bias, and substance use), and type of treatment (TAU + VR-CET and only TAU) were also evaluated. RESULTS: The TAU + VR-CET group showed greater changes of improvement in the levels of alcohol craving than the TAU group (χ2 = 10.996; p = 0.001). Intragroup changes in alcohol craving from pre to post-treatment were significant in the TAU + VR-CET group (χ2 = 13.818; p = 0.003) but not within the TAU group (χ2 = 2.349; p = 0.503). The odds of an improvement in any of the craving levels between pre- and post-test was 18.18 (1/0.055) times higher in the TAU + VR-CET group with respect to the TAU group. The use of illicit drugs in the month prior to the test increased the odds of having a positive change by 18.18 (1/0.055) with respect to not having consumed. CONCLUSIONS: Including VR-CET in TAU programs may provide benefits in the treatment of AUDs mainly among patients with intense alcohol craving and individuals having used illicit substances prior to treatment.

Cue-Elicited Anxiety and Alcohol Craving as Indicators of the Validity of ALCO-VR Software: A Virtual Reality Study.

BACKGROUND: This study is part of a larger project aiming to develop a virtual reality (VR) software to be implemented as a clinical tool for patients diagnosed with alcohol use disorder (AUD). The study is based on previous research in which we identified factors that elicit craving for alcohol in a sample of AUD patients, and which led to the development of a virtual reality software to be used in cue exposure treatments of alcohol use disorder (ALCO-VR). The main objective of this study was to test the effectiveness of ALCO-VR to elicit cue-induced craving and anxiety responses among social drinkers (SD) and AUD patients. Our secondary objective was to explore which responses (cue-induced craving or anxiety) can best differentiate between AUD patients and the SD group. METHOD: Twenty-seven individuals (13 AUD patients and 14 SD) participated in this study after giving written informed consent. Their anxiety and alcohol craving levels were measured by different instruments at different stages of the procedure. The VR equipment consisted of Oculus Rift technology, and the software consisted of the ALCO-VR platform. RESULTS: Our data indicate that the ALCO-VR software can elicit responses of anxiety and alcohol craving, especially in the group of AUD patients. The cue-induced anxiety response differentiated AUD patients and the SD group better than the cue-induced craving response. CONCLUSIONS: The general interest in applying new technologies to the assessment and treatment of mental health disorders has led to the development of immersive real-life simulations based on the advantages of VR technology. Our study concluded that the ALCO-VR software can elicit anxiety and craving responses and that cue-induced anxiety responses can distinguish between AUD and SD groups better than cue-induced craving. The data on craving and anxiety were assessed consistently by different instruments. In addition, we consider that ALCO-VR is able to ecologically assess cue-induced anxiety and alcohol craving levels during exposure to VR alcohol-related environments.

Identifying Triggers of Alcohol Craving to Develop Effective Virtual Environments for Cue Exposure Therapy.

Background: Many studies have indicated that alcohol craving is a core mechanism in the acquisition, maintenance, and precipitation of relapse in alcohol use disorder (AUD). A common treatment approach in AUD is cue exposure therapy (CET). New technologies like virtual reality (VR) have the potential to enhance the effectiveness of CET by creating realistic scenarios in naturalistic environments. In this study, we aimed to determine relevant triggers of alcohol craving in patients with AUD. Methods: We enrolled 75 outpatients diagnosed with AUD according to the DSM-5 criteria Participants completed the Alcohol Use Disorder Identification Test and a self-administered questionnaire to assess alcohol craving. The variables included in the craving questionnaire were as follows: presence of others, situations, time of the day, day of the week, mood, and type of alcoholic beverage. Results: Greater levels of alcohol craving were seen in many situations, including being at a party, in a restaurant, in a bar or pub, and at home. Drinking alone and drinking with two or more friends were equally associated with higher levels of craving. Drinking at night and drinking at weekends also emerged as triggers for alcohol craving. Emotional states like anxiety or tension, sadness, stress, frustration, or irritability were highly associated with urges to drink alcohol. The alcoholic drinks most highly associated with increased levels of craving were beer, wine, and whisky. Gender and age implications were discussed. Conclusion: This study is part of a larger project aiming to develop and validate CET based on VR technology for patients with AUD who are resistant to classical treatment. The identified triggers have been used to develop relevant VR environments for CET, and further research is ongoing to implement our findings.

Temperament and character in transsexuals.

The aim of this study was to evaluate personality in transsexuals. The Temperament and Character Inventory (TCI) profiles of 166 male-to-female (MF) and 88 female-to-male (FM) transsexuals were compared with those of a control group of males and females. MF and FM transsexuals scored significantly lower than males and females in RD4 (more independent) and C3 (more self-centeredness). MF transsexuals scored higher than males and females in HA4 (more fatigable), ST and ST3 (more spiritual acceptance), and lower in C5 (more opportunistic); moreover, they showed higher scores than males in RD1 (more sentimental) and lower than females in C (less cooperativeness). FM transsexuals scored lower than females in HA2 (more daring and confident), RD (less sentimental), and C5 (more opportunistic). Compared with FM, MF transsexuals scored higher on HA2 (more fearful), RD, RD1 (more sentimental), ST, ST2 and ST3 (more spiritual). All these differences were less than half a standard deviation except for C3. Data show that transsexuals and controls display a similar personality profile, even though there are some differential personality traits. Moreover, the personality profile of transsexuals was closer to the profile of subjects who shared their gender identity than those who shared their anatomical sex.

Predictive factors of abstinence in patients undergoing liver transplantation for alcoholic liver disease.

INTRODUCTION: Alcoholic cirrhosis is one of the most common indications for liver transplantation (LT) in western countries. A major concern about transplant patients due to alcoholic liver disease (ALD) is alcoholic recidivism. Data concerning psycho-social characteristics of patients with 6 months of abstinence at initial evaluation for LT is scarce. Objectives. The aims of this study were 1) To evaluate the psycho-social profile of a cohort of patients with alcoholic cirrhosis being evaluated for LT. 2) Determine factors associated with abstinence from alcohol at initial psycho-social evaluation for LT and 3) To evaluate the potential impact of alcohol-free beer consumption on 6-month abstinence. MATERIAL AND METHODS: Ninety patients referred to the Alcohol Unit of the Hospital Clínic of Barcelona (January 1995-December 1996) were included. Univariate and multivariate logistic regression analyses were used to identify the factors associated with cessation in alcohol consumption and with 6-month abstinence. RESULTS: Factors associated with cessation in alcohol consumption were awareness of alcohol toxicity (OR = 5.84, CI 1.31-26.11, p = 0.02) and family recognition (OR = 3.81, CI 1.27-11.41, p = 0.01). Cessation of alcohol consumption at knowledge of ALD (OR = 5.50, CI 1.52-19.81, p = 0.009), awareness of alcohol toxicity (OR = 2.99, CI 1.02-9.22, p = 0.05) and family recognition (OR = 5.21, CI 1.12-24.15, p = 0.03) were the independent factors associated with 6-month abstinence previous to psycho-social evaluation for LT. CONCLUSION: In conclusion awareness of alcohol toxicity and family recognition are the independent factors that influence cessation in alcohol consumption and 6-month abstinence in patients evaluated for LT. The use of alcohol-free beer was associated with a higher rate of abstinence in patients without alcohol cessation.

Prevalence of alcohol consumption related disorders in a prison population convicted of crimes against road safety.

INTRODUCTION: Alcohol consumption is a major cause of traffic accidents, so that stricter laws have been enacted to avoid it. Despite this, there are still persons who break the law and go to prison because of driving under the effects of alcohol. We have investigated if these persons are occasionally alcohol drinkers or if they are alcoholics with difficult to modify alcohol patterns. MATERIAL AND METHODS: A cross-sectional study including 50 inmates from two prisons who had committed traffic crimes were interviewed about their alcohol consumption habits and their criminal and psychopathological backgrounds. RESULTS: 88% had indicators of alcoholism and most consumed other drugs. Previous psychopathology signs were only detected in 10% of the sample. A total of 72% had previous criminal records, half because of violent offences. They were socially adapted, with mean age 39 years, Spanish (86%), had a stable job and family (76%). CONCLUSIONS: Most of the inmates due to traffic crimes are alcoholic, but very few are detected. Their alcohol consumption generates other criminal conduct, treatment being necessary in order to avoid relapse and social exclusion.

[Alcoholic patients hospitalized in a psychiatry unit: mortality at 14 years]. / Alcohólicos ingresados en una sala de psiquiatría: mortalidad a los 14 años.

INTRODUCTION: Alcoholic patients show a high mortality rate. We know about the increased mortality of outpatients following specialized treatment for alcohol abuse and inpatients with organic diseases related to alcohol, but it is not clear whether alcoholics with a comorbid psychiatric profile also die prematurely. OBJECTIVE: To investigate clinical characteristics, therapeutic evolution, survival, and factors that can better predict mortality. MATERIALS: 14-year longitudinal monitoring of 91 patients hospitalized in 1993 for detoxification in a psychiatric unit and who subsequently received outpatient treatment. RESULTS: Patients show a high prevalence of psychiatric disorders (40.6%) and multiple periods of previous treatment (78%). After 14 years the mortality rate was 34.1%. Deceased patients more often presented cognitive decline and were more often on pensions. They were also taking more antidepressants, had less family support and were more likely to have relapsed into alcohol use. DISCUSSION: Many of the factors that predict higher mortality are age-related. In younger patients, the presence of neuropsychological deterioration symptoms may indicate a premature organic disorder and probably greater risk of treatment failure, poor physical care and traumatic physical and mental situations, all of which would also increase the likelihood of premature mortality.

[Assessing coping strategies in alcoholics: Comparison while controlling for personality disorders, cognitive impairment and benzodiazepine misuse]. / Estrategias de afrontamiento en enfermos alcohólicos. Diferencias según el consumo de benzodiacepinas, los trastornos de la personalidad y el deterioro cognitivo.

INTRODUCTION: Better coping skills are related to greater capacity for dealing with stressful situations. This relationship could be relevant for the prevention of alcohol-misuse relapse. Relapse rate is higher among severe alcoholics. The current study examines whether this may be due to a lack of coping skills in those cases. The COPE (Coping Orientations to Problems Experienced) is a questionnaire used for assessing coping strategies. METHOD: COPE scores of 216 alcohol inpatients are compared while controlling for personality disorders (PDs), cognitive impairment (CI) and benzodiazepine misuse (BM). RESULTS: Patients with PDs score higher on the scales of Humor, Venting emotions, Substance use and Use of instrumental support. However, there are no differences in COPE scores attributable to CI or BM. CONCLUSIONS: Alcoholics with Personality disorders use maladaptive coping strategies. Patients presenting CI or BM have low capacity for introspection and are unable to properly evaluate their own abilities, so that they tend to give a socially favorable but unrealistic image of themselves. Longitudinal studies are needed to evaluate the predictive validity of the coping skills before training alcoholics, who are especially difficult to assess due to their lower capacity for objective self-observation.

[Clinical guideline for the evaluation of liver transplant candidates with addictions]. / Guía clínica de evaluación de pacientes con conductas adictivas para trasplante hepático.

Liver transplantation is the only effective treatment for advanced cirrhosis. Nevertheless, the number of potential recipients far exceeds that of available donors. Therefore, liver transplant candidates must be carefully selected to optimize donor utilization. Candidate selection is complex in patients with addictive and/or psychopathological disorders. Alcohol consumption causes one-third of advanced liver disease in our environment and comorbid consumption of other addictive substances is frequent in these patients. The use or abuse of these substances in transplant recipients can be associated with graft loss. Despite the importance of this subject, there is no well established protocol in our environment for the evaluation and selection of candidates with addictive and/or psychopathological disorders. Therefore, a specific diagnostic and therapeutic strategy must be established for these patients. Hospital Clínic in Barcelona has an active liver transplantation program (90 transplantations in 2007). Since the start of this program in 1988, candidates with addictive and/or psychopathological disorders have been evaluated jointly by the Hepatology Service and Alcohol Unit, including psychiatrists, psychologists and social workers. We present the protocol approved by the Committee for Liver Transplantation and the Ethics Committee of Hospital Clínic in 2007 for the evaluation, selection and follow-up of transplant candidates with addictive and/or psychopathological disorders. This protocol includes a description of the evaluation process and defines the inclusion and exclusion criteria with respect to consumption of toxic substances, the social and family situation and psychiatric disorders. In addition, recommendations for the follow-up of these patients are provided.

[Personality profile in alcoholic inpatients by TCI questionnaire. Differences between abusers and non abusers of benzodiazepines and between patients with personality disorders and patients without]. / Caracteristicas de personalidad en pacientes alcoholicos mediante el cuestionario Temperament and Character Inventory (TCI). Diferencias segun la existencia de abuso de benzodiacepinas (BZD) y trastornos de la personalidad.

OBJECTIVE: To find differential personality traits, through the TCI questionnaire, between alcoholic patients who abuse benzodiazepines (BZD) and those who do not, and between patients affected by personality disorders (PD) and those not affected. These traits can then be used as criteria of good prognosis and as psychotherapeutic targets. METHODS: Cross-sectional study of 218 alcoholic inpatients, comparing TCI scores between BZD abusers and non-abusers, and between PD-affected patients and non-PD-affected patients. RESULTS: BZD-abusing patients score higher in Harm Avoidance and lower in Self-Directedness than non-abusers. Patients with PD score higher in Novelty-Seeking and lower in Cooperativeness than patients without PD. CONCLUSIONS: BZD-abusing patients are less mature and self-sufficient, more impressionable, insecure, and have a high tendency to avoid risk. Patients with PD are more impulsive and less cooperative. The characteristics found with TCI are coherent with the difficulties of these patients during treatment and with clinical impressions. These problematic areas should become therapeutic targets to be modified through treatment. For all of these reasons the TCI emerges as a useful instrument for understanding, assessing and identifying alcoholic patients and their treatment needs.

[Alcohol-dependent patients with benzodiazepine abuse: its relation to personality disorders and neuropsychological impairment]. / Consumo de tranquilizantes en pacientes alcohólicos y su relación con los trastornos de personalidad y el deterioro neuropsicológico.

BACKGROUND AND OBJECTIVE: Alcohol and drug dependent patients present a higher psychiatric comorbidity, which increases according to the number of drugs. Moreover, there are complications from the treatment and the prognosis is aggravated. We aimed to observe the differences regarding personality disorders (PD) and cognitive deterioration between alcohol dependent patients and patients who were benzodiazepine dependent as well. PATIENTS AND METHOD: Transversal study. Comparison between benzodiazepine-abusers (BZD+) and non-abusers (BZD-) from a cohort of 401 alcoholic inpatients under detoxification treatment. RESULTS: 28.1% of patients had benzodiazepine abuse or dependence (n=113). There was a higher proportion of women and PD within the BZD+ group (50.4% and 25.7%) than in the BZD- group (20.1% and 15.6%). They were of similar age -mean (standard deviation): 48,2 (10) versus 47,4 (10) years- and presented a smaller frequency, although not significant, of neuropsychological deterioration (19% versus 26%). This difference was stronger in women (8.8% versus 36.2%) than in men (30.4% versus 23%). CONCLUSIONS: Benzodiazepine consumption predominates in women and in patients with PD. In women it tends to occur before alcohol addiction and is related to a PD, decreasing alcohol consumption and the frequency of cognitive deterioration. This deterioration is more frequent in men because of higher alcohol consumption, since benzodiazepines are taken later when deterioration has already started, to diminish withdrawal symptoms.

[Alcoholism and immigration. Adherence of immigrant patients to group therapy]. / Alcoholismo e inmigración. Adherencia de los pacientes inmigrantes a la terapia grupal.

BACKGROUND AND OBJECTIVE: Group therapy (GT) is considered a cornerstone in the treatment of alcohol dependence. Increasing numbers of foreigners are accessing alcohol treatment facilities, but efficacy of TG in those patients has not been studied. This work focuses on the influence of ethnicity and language in the compliance of GT. PATIENTS AND METHOD: 1856 consecutive patients who were referred to GT for alcohol dependence were followed until discharge or dropout. Time on treatment and final endpoint were compared according to place of birth. RESULTS: 31% of patients born in Barcelona, 39% born in Catalonia, 27% from the rest of Spain and 14.5% of foreigners (20% from Europe, 4% from America and none born in Africa (p = 0.02) completed successfully GT. The probability to stay in GT was 351, 412, 320 and 212 days (p = 0.000), respectively. DISCUSSION: Patients born abroad have lower chances to complete GT successfully, presenting with higher dropout rates and shorter treatments. The low compliance found in South American patients (who share a common language) and the better compliance found in Europeans (who are also a bit older) suggest that dropout is probably more related to social integration than to language problems.

[Alcoholism in the general hospital: 4 years mortality and hospitalization]. / Alcoholismo en el hospital general: mortalidad y hospitalizaciones a los 4 años de su detección.

BACKGROUND AND OBJECTIVE: We aimed to analyze the mortality, and emergency room and hospital admissions in a sample of alcohol dependent patients during the four years following their identification in a general hospital. PATIENTS AND METHOD: 198 inpatients from a general hospital who where identified as alcohol dependent and referred during 1998 to the liaison-psychiatry service. RESULTS: 30.8% had died, at a mean age of 57.5 (11.3). Deaths had a direct relationship to the illness responsible for the initial admission to hospital. 42.6% of patients had previous admissions, and 74% had been previously attended at emergency room departments. During the 4 years of follow up, there were new hospital admissions (54.6%), emergency room visits (72.7%) and repeated liaison-psychiatry consultations (20%). Previous admissions to hospital predicted future admissions. Acceptance of alcohol treatment did not reduce the mortality rates. Mortality correlated with age, it was increased in patients with cognitive deficits and was reduced in those with psychiatric co-morbidity. CONCLUSIONS: Late detection of alcohol dependence leads to pour outcomes both in the treatment of alcohol dependence and the concomitant somatic diseases. Early detection strategies of hazardous and harmful alcohol consumption should be implemented in hospital settings.