Association between e-cigarette and conventional cigarette use among Spanish adolescents. / Asociación entre el uso de cigarrillos electrónicos y cigarrillos convencionales en adolescentes españoles.

In recent years, studies have highlighted the upward trend in electronic cigarette use among adolescents, as well as the potential of e-cigarette use to lead to subsequent conventional cigarette use. The study's aims were two-fold: 1) to examine the progression from e-cigarette use to conventional cigarette use; and 2) to analyze the differences in the severity of smoking pattern among dual users (i.e., e-cigarette and conventional cigarette use), cigarette-only smokers, and e-cigarette-only users in a Spanish adolescent population. Data were obtained from the ESTUDES, a representative survey of addictive behaviors of Spanish adolescents aged 14-18, which was comprised of 38,010 adolescents (Mage = 15.69; SD = 1.19; 51.35% females). Results indicate that lifetime e-cigarette use increased the prevalence of subsequent conventional cigarette use by 1.86 times (95% CI 1.74, 1.99), and the prevalence of conventional cigarette use in the last month by 2.38 times (95% CI 2.19, 2.58), independently of whether the e-cigarette contains nicotine or not. Dual users showed a higher percentage of daily smokers, and a greater number of cigarettes per day, a higher use of e-cigarettes with nicotine, and an earlier age of smoking onset. Regarding risk perception, e-cigarette-only users perceived both conventional tobacco and e-cigarettes as less harmful (all p-values < .001). These findings document the strength of association between e-cigarette and conventional cigarettes, and underscore the importance of developing legal restrictions and prevention strategies aimed at reducing e-cigarette use, which in turn would reduce tobacco use.

En los últimos años, algunos estudios han destacado la tendencia ascendente en el uso del cigarrillo electrónico entre adolescentes, así como el potencial para el posterior consumo de cigarrillos convencionales. Este estudio tuvo dos objetivos: 1) examinar la progresión del cigarrillo electrónico al cigarrillo convencional; y 2) analizar las diferencias en el patrón de gravedad del tabaquismo entre consumidores duales (i.e., cigarrillos electrónicos y convencionales), fumadores de cigarrillos y consumidores de cigarrillos electrónicos. Los datos se obtuvieron de la encuesta ESTUDES, una encuesta nacional que recoge información de conductas adictivas en adolescentes entre 14 y 18 años, la cual consta de 38 010 personas (Medad = 15,69; DT = 1,19; 51,35% mujeres). Los resultados indicaron que haber usado alguna vez un cigarrillo electrónico incrementó la probabilidad de un consumo posterior de cigarrillos 1,86 veces (IC 95% 1,74-1,99), y la probabilidad de consumir tabaco en el último mes 2,38 veces (IC 95% 2,19-2,58), independientemente de si los cigarrillos electrónicos contienen o no nicotina. Los consumidores duales mostraron un mayor porcentaje de fumadores diarios, un mayor número de cigarrillos al día, un mayor uso de cigarrillos electrónicos con nicotina y una edad de inicio más temprana. Con respecto a la percepción de riesgo, los adolescentes que han usado solo cigarrillos electrónicos percibían tanto el tabaco como los cigarrillos electrónicos como menos dañinos (todos los valores p < ,001). Estos hallazgos indican la fuerte asociación entre los cigarrillos electrónicos y los convencionales, y subrayan la importancia de desarrollar restricciones legales y estrategias preventivas dirigidas al cigarrillo electrónico, lo que reduciría a su vez el consumo de tabaco.

Systematic Review of Preventive Programs for Reducing Problem Gambling Behaviors Among Young Adults.

Young adulthood is a developmental period from late adolescence to one's late twenties or early thirties. Prevalence studies internationally have reported that individuals in this age group tend to have the highest rates of problem gambling. However, much of the prevention work designed to minimize the risk of problem and disordered gambling has been primarily focused on school settings and aimed at high school students. The objective of this study was to summarize the existing literature on the effectiveness of prevention programs aimed at reducing the prevalence of gambling problems in young adults. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six electronic academic databases were consulted in order to examine the studies conducted during the last 20 years. After removing duplicates and adhering to the inclusion and exclusion criteria, nine studies were included in this review. All studies targeted college or university students and followed a selective or indicated prevention strategy. A Personalized Normative Feedback approach was incorporated in most of the studies, which had generally good results in reducing and/or minimizing at-risk or problem gambling. The limited number of studies included in this review highlights the need to address scientific quality standards before proceeding with the design, implementation and widespread dissemination of these preventive programs as well as the need to ensure the program's efficacy prior to implementation.

Substance Use and Gambling Patterns Among Adolescents: Differences According to Gender and Impulsivity.

Although alcohol, tobacco and cannabis are the most prevalent drugs used by adolescents, gambling is a growing concern due to its increasing popularity. To date there have been few studies exploring the existing patterns of concurrent use of drugs and gambling in adolescents. This study aims to identify subpopulations of adolescents using different substances and gambling activities, to explore gender differences and to examine impulsivity as a predictor of class membership. A cross-sectional survey was carried out in 22 high-schools, and 1644 adolescents were assessed (54.1% males; mean age = 15.21 years, SD = .75). Participants reported their last-year frequency of using alcohol, tobacco and cannabis, as well as bingo, poker, other casino games, sports betting, lottery, scratch tickets and electronic gaming machines. Problem drinking was evaluated with the Rutgers Alcohol Problems Index, and gambling severity with the South Oaks Gambling Scale for Adolescents. Impulsivity was assessed using a Delay Discounting task, the Barratt Impulsiveness Scale and the Impulsive Sensation-Seeking Scale. Based on a latent class model of drugs and gambling activities, four subpopulations of males and five of females were found. General impulsivity and sensation seeking were the most consistent predictors of class membership. These novel findings support the need to consider specific groups of adolescents engaging in different patterns of addictive behaviors when implementing selective prevention strategies.

Gambling Motives Questionnaire validation in adolescents: Differences based on gambling severity and activities. / Validación del Cuestionario de Motivos de Juego en adolescentes: Diferencias según la gravedad y las actividades de juego.

Self-reported reasons for gambling have been highlighted as crucial to understanding why adults develop problems with gambling. However, research on motives among adolescents remains scarce. The aim of this study is to explore the factorial structure of the Gambling Motives Questionnaire (GMQ) and to analyze differences in motives among adolescents, depending on the gambling activity and level of gambling severity. A total of 698 adolescent gamblers (M = 15.24, SD = .76) were assessed. As well as the GMQ, the South Oaks Gambling Screen (SOGS-RA) questionnaire was used. Gamblers were classified into three categories (strategic, non-strategic, and mixed) according to the activities engaged in during the last year. An Exploratory Factor Analysis was conducted followed by a Confirmatory Factor Analysis in order to explore the internal structure of the GMQ. Three two-way between-groups Analyses of Variance (ANOVA) were conducted to explore differences in motives according to the type of activity and the gambling severity levels. According to the factorial structure of the GMQ, three main groups of motivations were found: enhancement, coping and social. Compared to non-problem gamblers, problem gamblers scored higher on all motives. Moreover, gamblers seeking enhancement prefer strategic games, those gambling to cope with stress use non-strategic games more frequently, while social gamblers do not show a preference for either strategic or non-strategic games. In conclusion, gambling motives are related to gambling severity and structural characteristics of gambling. These findings may be useful from a prevention standpoint.

Los motivos de juego han sido considerados como variables clave para comprender el desarrollo de problemas asociados al mismo en adultos. Sin embargo, la literatura sobre las motivaciones de los adolescentes para jugar es escasa. El presente estudio tiene como objetivo explorar la estructura factorial del Cuestionario de Motivos de Juego (GMQ) y analizar las diferencias de los motivos de los adolescentes según la actividad de juego y la gravedad de los problemas asociados. Se evaluó una muestra de 698 jugadores adolescentes (M = 15,24, DT = ,76) a los que se les aplicó, además del GMQ, el cuestionario South Oaks Gambling Screen (SOGS-RA). Los jugadores fueron clasificados en tres categorías (estratégicos, no estratégicos, mixtos) según el tipo de juegos utilizados durante el último año. Para el estudio de la estructura interna del GMQ se realizó un primer Análisis Factorial Exploratorio y un segundo Análisis Factorial Confirmatorio. Se emplearon tres Análisis de Varianza (ANOVA) de dos vías para evaluar las diferencias en motivos entre los niveles de gravedad y tipo de actividad. De acuerdo con la estructura factorial del GMQ, existen tres principales grupos de motivaciones para jugar: búsqueda de emociones positivas, afrontamiento del estrés y causas sociales. En comparación con los jugadores sin problema, los jugadores problemáticos puntuaron más alto en todos los motivos. Además, los jugadores que buscan emociones positivas se decantan más por los juegos estratégicos, los que utilizan el juego para afrontar el estrés utilizan más los no estratégicos, mientras que los jugadores sociales no presentan preferencia por ninguno de los dos. En conclusión, la motivación para jugar se encuentra en relación con la gravedad y las características del juego. Estos resultados son de utilidad desde el punto de vista de la prevención.

What Predicts What? Self-Reported and Behavioral Impulsivity and High-Risk Patterns of Alcohol Use in Spanish Early Adolescents: A 2-Year Longitudinal Study.

BACKGROUND: The directionality of the relationship between impulsivity and heavy drinking patterns remains unclear. Recent research suggests it could be reciprocal and depends on different facets of impulsivity and different patterns of drinking. The aim of this study was to analyze this potential reciprocal relationship between self-reported and behavioral measures of impulsivity and sensation seeking with specific patterns of heavy drinking in a sample of Spanish adolescents across 2 years. METHODS: The study has a cross-lagged prospective design in which participants were evaluated 3 times over 2 years (once a year). Participants were 1,430 adolescents (53.9% male; mean age at study commencement = 13.02, SD = 0.51) from 22 secondary schools in Spain. Computerized versions of the following instruments were used: 2 subscales of Impulsive Sensation Seeking, 2 behavioral measures (Stroop Test and Delay Discounting [DD] task), frequency of intoxication episodes (IE), and the Rutgers Alcohol Problem Index to evaluate alcohol-related problems (ARP). Random intercepts cross-lagged panel models of reciprocal relationships between impulsivity measures and alcohol use outcomes were used. RESULTS: Individual levels of self-reported impulsivity and sensation seeking significantly predicted prospective involvement in IE and ARP. Performance in behavioral measures (Stroop Test and DD) did not predict subsequent heavy drinking or alcohol problems. No measure of drinking was found to be a significant predictor of prospective changes in impulsivity. CONCLUSIONS: Within-person levels of self-reported impulsivity and sensation seeking significantly predicted further heavy drinking from as early as 13 years old, whereas behavioral measures were not predictive. In our study, neither IE nor ARP predicted prospective changes in impulsivity. Further studies should address additional specific relationships between facets of impulsivity and specific outcomes of heavy drinking.

Long-term reliability and stability of behavioral measures among adolescents: The Delay Discounting and Stroop tasks.

Delay Discounting (DD) and the Stroop test are two fundamental tasks for the assessment of impulsivity and inhibitory control, core features of several behavioral disorders. Although the study of reliability and temporal stability is important, only studies with adults and small samples have been carried out. The aim of this study is to assess the one-year reliability and temporal stability of both tasks among adolescents. A total of 1375 adolescents (M = 13.08 years old, SD = 0.51) made up the final sample (53.5% males). The results showed moderate stability and good reliability for both DD (α = 0.90) and Stroop (α = 0.85). Indices based on the reaction times and not the number of errors are recommended when using the Stroop test. These results support the use of both behavioral tasks in longitudinal research among adolescents.

Attachment and substance use in adolescence: a review of conceptual and methodological aspects.

Attachment is currently considered one of the major risk and/or protective factors for substance use in adolescence. This paper reviews the most important studies published in the last 30 years in this field, focusing on the conceptual and methodological issues that may be making it more difficult to draw conclusions about the impact of attachment – especially attachment to parents – on substance use among youths. In general, the results indicate that secure attachment or stronger attachment between parents and children acts as a protective factor against drug use, even though there is a great variability in relation to the concept of addiction and its assessment. Secondly, most of the research reviewed also covers other factors that may be conditioning the influence of attachment to parents on children'’s drug use and which would explain, at least in part, the disparity of the results from different studies. Notable among such factors would be individual characteristics (such as sex, age or self-esteem) and the influence of other sources of attachment, including peers and their circumstances (such as their drug use). Finally, we discuss the importance of taking into account the mentioned conceptual and methodological considerations aspects in research on attachment as a risk and/or protective factor for drug use in adolescence.

Duration of Internet use and adverse psychosocial effects among European adolescents.

Despite the significant contributions from previous studies about the prevalence of problematic Internet use (PIU) among adolescents in Europe, important questions remain regarding adverse consequences of PIU. This study aims to assess the relation between duration of Internet use and adverse psychosocial effects among adolescents from six European countries. The final sample included 7,351 adolescents (50.8% male and 49.2% female; mean age: 14.6±1.90) recruited from randomly selected schools within the six study sites. Results showed that 12.9% of adolescents used Internet more than 20 hours per week. There was a significant relationship between duration of Internet use and frequency of alcohol, tobacco, cannabis and other illegal drug use. Duration of Internet use is also significantly associated with school problems, with use of slot machines and with other psychosocial problems. These findings highlight the need to strengthen preventive efforts for reducing PIU and related consequences among adolescents. Key Words: Internet, adolescents, psychosocial problems.

Gender differences in early alcohol and tobacco use as a risk factor in Spanish adolescents.

The sample is made up of 1,190 adolescents (52.8% boys; mean age = 16.81) from 37 random schools in the urban and rural areas of Asturias (northern Spain). The survey was conducted in 2008, assessing the use and patterns of use of alcohol and other drugs, age at onset of use, and psychosocial consequences. Items from the ESPAD and FRIDA questionnaires were employed. Univariate analyses and binary logistic regression analyses were carried out to determine the different predictive value for boys and girls of early-onset alcohol and tobacco use. The study's limitations and implications are noted.

Gender differences in the prevalence of DSM-IV alcohol use disorders in adolescents.

Despite the availability of data about drinking frequency and patterns, the surveys on alcohol use among adolescents carried out in Europe tend not to provide information about diagnostic criteria for alcohol use disorders (AUD) or estimation of their prevalence. This study assesses the prevalence of AUD among a sample of Spanish adolescents, to identify the most prevalent symptoms, and explore gender differences in AUD in this population. The final sample consisted of 504 participants aged 15 to 18, obtained by means of random sampling from all the schools in the region of Asturias (Spain). The presence of alcohol abuse (AA) and alcohol dependence (AD) disorders was evaluated according to DSM-IV-TR criteria. The results showed that 12.5% of the sample met the criteria for the diagnosis of AUD (6.7% for alcohol abuse, AA, and 5.8% for alcohol dependence, AD). The most prevalent symptoms were having social problems for AA diagnosis (9% of students who reported alcohol use in the past year) and tolerance for AD diagnosis (45.8% of students who reported alcohol use in the past year). Males showed a significantly higher score than females in AUD, AA and two AA diagnosis criteria (hazardous use and legal problems). The prevalence of AUD among Spanish adolescents is very high, males being more likely than females to endorse criteria for AUD and AA, though not for AD. These findings reveal a serious health issue and highlight the need to develop preventive efforts and provide coordinated alcohol-abuse interventions.

What predicts retention on an in-prison drug treatment program?

UNLABELLED: The effectiveness of treatments for substance use disorders is strongly related to retention, since early dropout from treatment is associated with greater likelihood of relapse. The purpose of this prospective, ex post facto study is to analyze the effect of individual variables on retention in a treatment program carried out in a prison drug-free unit. The Addiction Severity Index, motivation and personality profile of fifty inmates were assessed on entry to the prison. Inmates were monitored for a year to identify length of stay. RESULTS: Motivation variables at intake play a vital role in the prediction of retention in a prison drug-free unit; scores on the Aggressive-Sadistic and Narcissistic scales are also strong predictors of treatment retention.

[How does family disorganization influence children's drug use? A review]. / ¿Cómo influye la desorganización familiar en el consumo de drogas de los hijos? Una revisión.

It is well known that various aspects of family functioning can influence children's drug use, both by promoting resilience and by increasing the risk of use. This review examines studies published in the last 30 years about the influence of family disorganization on children's drug use. Based on the results, we consider that disorganised families (charactirezed by parents' mental illness, parents' substance use and/or non-intact families) are more likely to have children who are drug users, both legal and illegal. Finally, we stress the need to improve the conceptualization of family disorganization and its assessment, and point out other methodological limitations found in the empirical studies reviewed.

[Spanish adaptation and validation of The Adolescent-Cannabis Problems Questionnaire (CPQ-A)]. / Adaptación y validación española del Adolescent-Cannabis Problems Questionnaire (CPQ-A).

Cannabis is a widely used substance among adolescents and young adults, but demand for help and treatment from this age group continues to be low. It is therefore essential to develop instruments especially designed for the early detection of problems associated with cannabis use in this population. The purpose of this work is to adapt and validate the CPQ-A (Adolescent Cannabis Problems Questionnaire) for its use as a screening instrument in Spanish population. The sample was made up of 144 young people (71.5% male) aged 16 to 20 (M = 17.12; SD = 1.17) who had used cannabis in the last month and were on some kind of study or training course at various educational institutions in Asturias (a region in northern Spain). Factor analysis of the CPQ-A in this sample provides evidence of a unidimensional structure, with a Cronbach's Alpha of 0.86 for the questionnaire. The evidence also shows that the instrument's convergent validity is good. The CPQ-A score permits discrimination between moderate and excessive cannabis users over the last month, is positively related to score on the CAST (Cannabis Abuse Screening Test), and presents adequate sensitivity and specificity for identifying cases of cannabis abuse and dependence according to the DSM IV-TR criteria. It is also sensitive to young people's degree of concern about cannabis use and the psychopathological effects associated with it. In accordance with the results obtained, the CPQ-A can be considered a useful screening tool for young cannabis users with problems.

[Psychometric performance of the 6th version of the Addiction Severity Index in Spanish (ASI-6)]. / Rendimiento psicométrico de la sexta versión del Addiction Severity Index en español (ASI-6).

This work analysed the psychometric properties of the 6th version of the Addiction Severity Index (ASI-6) translated and adapted to the Spanish language. A multicentre, observational and prospective design was used. A total of 258 participants were included, 217 were patients (35 stable patients and 182 unstable patients), and 41 were controls. The results show satisfactory psychometric performance of the ASI-6. The degree of the internal consistency of the standardized objective scores ranged between .47 and .95. As for test-retest reliability, the values were acceptable, varying from .36 to 1. The study of the internal structure revealed a good fit to a unidimensional solution for all scales taken independently. Regarding convergent-discriminant validity, the correlations between the primary and secondary scales of the ASI-6 and the Clinic Global Impression score were low, with values from .01 to .26. Likewise, 8 of the 15 scales differentiated between controls and unstable patients. The psychometric properties of the ASI-6 Spanish version seem to be acceptable, though it is necessary to carry out new studies to test metric quality with independent samples of patients.

[The COVID-19 psychological helpline of the Spanish Ministry of Health and Spanish Psychological Association: characteristics and demand.] / El teléfono de asistencia psicológica por la COVID-19 del Ministerio de Sanidad y del Consejo General de la Psicología de España: Características y demanda.

Between March and May 2020, the Spanish Ministry of Health and the Spanish Psychological Association created the Psychological First Care Service (Servicio de Primera Ayuda Psicológica-SPAP), a national helpline designed to provide early psychological intervention to those people affected by COVID-19. This service attended more than 15,000 calls and carried out more than 11,000 interventions and 9,500 follow-ups with the general population, healthcare and other essential professionals and the patients and relatives of the sick or deceased. Results show that the majority of calls (45.7%) came from the Autonomous Community of Madrid, that women significantly used this service in a higher proportion than men (73.5%) and that the commonest age range among users was 40-59. 75.9% of consultations were related to psychological problems linked to anxiety and depressive symptoms. However, grief symptoms also stood out among the patients or relatives of the sick and deceased and, to a lesser extent, stress symptoms were prevalent in the group of professionals. These data show the usefulness of this early psychological care service and the need for similar resources to be implemented in coordination with or within the National Health System.

Entre marzo y mayo de 2020, el Ministerio de Sanidad y el Consejo General de la Psicología de España, pusieron en marcha el Servicio de Primera Ayuda Psicológica (SPAP), un servicio telefónico para toda España, diseñado para proveer atención psicológica temprana a las personas afectadas por la COVID-19. En el tiempo en que el servicio estuvo disponible, se gestionaron 15.170 llamadas, que condujeron a realizar 11.417 intervenciones psicológicas con personal sanitario y otros intervinientes, con enfermos y familiares de enfermos o fallecidos, y población general. Los resultados muestran que la mayoría de llamadas (45,7%) provenían de la Comunidad Autónoma de Madrid, que hubo significativamente más mujeres que utilizaron el servicio (73,5%) y que el rango de edad más común entre los usuarios era el de 40-59 años. El 75,9% de las consultas tuvo que ver con problemas psicológicos relacionados con sintomatología ansiosa y depresiva, aunque también destacaba la sintomatología de duelo entre los enfermos o familiares de enfermos y fallecidos y, en menor medida, la sintomatología de estrés en el grupo de intervinientes. Estos datos muestran la necesidad de este servicio de atención psicológica temprana y sugieren que recursos como este deberían implementarse de manera integrada en el Sistema Nacional de Salud.

Effectiveness of three intensities of smoking cessation treatment in primary care.

The purpose of this study was to compare the effectiveness of three smoking cessation programs of varying intensity applied in a primary care setting. Participants were 89 individuals randomly assigned to one of three treatment groups: brief counseling plus information pamphlet, self-help program with telephone follow-up, and intensive behavioral treatment. At the 12-mo. follow-up, intensive behavioral treatment (42.8% abstinence) was more effective than the self-help program (27.5%), which was in turn more effective than counseling (12.9%). Continued abstinence was also higher in the intensive treatment group (37.9%) than in the self-help (17.2%) and the counseling groups (9.7%), although these differences only reached statistical significance in the first and third of these groups. Treatment adherence was higher in the intensive behavioral group (82.8% of participants attended all the sessions) than in the self-help group (61.8% completed the program). The results appear to confirm a dose-response effect in the treatment of smokers and indicate satisfactory acceptability of intensive behavioral programs applied in primary care.

Self-change strategies in smokers and former smokers: Spanish adaptation of the SCS-CS and SCS-FS.

The purpose of this study was to validate and adapt the Self-Change Strategies in Current Smokers (SCS-CS) and the Self-Change Strategies in Former Smokers (SCS-FS) (Christie & Etter, 2005) to the Spanish population. We also wished to analyze the differences in the self-change strategies used as a function of gender. Participants were 370 subjects (190 smokers and 180 former smokers) who were recruited by means of the "snowball" method. The alpha coefficients for the SCS-CS and the SCS-FS were .86 and .87, respectively. Both scales present satisfactory psychometric properties, so they are shown to be useful instruments to use in the Spanish population. The SCS-CS score showed that male smokers used more self-change strategies than females (46.6 vs. 11.9, p < .01), specifically, more cognitive strategies. In the SCS-CS, men scored higher than women (49 vs. 12.08, p < .01), in both the group of cognitive and behavioral strategies. The psychological mechanisms used to control the smoking habit are the same in men as in women, but the men tend to use a larger number of strategies. Treatments to quit smoking do not need to be substantially different, but they should be more intensive in the case of women smokers.

[The school and family risk factors in attendance at family-based programmes for the prevention of drug use]. / El colegio y los factores de riesgo familiar en la asistencia a programas de prevención familiar del consumo de drogas.

UNLABELLED: Several studies have indicated that certain aspects of schools may influence parents decision to participate in preventive interventions related to the health of their children. OBJECTIVES: 1) To study the relationship between parental rating of calls for participation sent from the school and family risk factors. 2) To study differences in parents attendance and drop-out for a family-based drug-use prevention programme according to their rating of the calls for participation sent out by the school. SAMPLE: 339 families of children aged 12-14 from 3 state (public) secondary schools in the region of Asturias (Spain). RESULTS AND CONCLUSIONS: It is noteworthy that parents with higher educational level present better parenting practices, and therefore, fewer risk factors in relation to drug use in their children. Furthermore, the presence of fewer risk factors correlated with the items related to attendance and calls for participation and the interest shown in such calls, indicating that the children least likely to use drugs are those whose parents are most actively involved in their education. As regards the effect of the calls for participation on programme attendance and drop-out, we found that parents who attended several sessions have had previous and satisfactory experience of some kind of preventive intervention, and receive with great interest the calls for participation from the school.

Differences among substance abusers in Spain who recovered with treatment or on their own.

This exploratory study compared the differences among substance abusers in Spain who recovered with treatment or on their own. Advertisements were used to recruit 58 individuals (29 self-changers and 29 treatment-changers) who had had problems with alcohol or drugs, and who had been recovered for at least one year. The groups differed significantly in severity of dependence, psychiatric treatment prior to recovery, and coping strategies to maintain recovery. Consistent with previous studies, those who had recovered through treatment had a more serious substance use history than those who changed on their own. In addition, social support was associated with maintenance of change for both groups. These findings parallel those for English-speaking populations.