Is there such a thing as gambling dual disorder? Preliminary evidence and clinical profiles.

Patients with gambling disorder (GD) frequently present other mental disorders, such as substance use disorder (SUDs), attention deficit/hyperactivity disorder (ADHD), mood disorders, and impulse-control disorders. We propose that GD should not be conceptualized as a single nosological entity, but rather as a gambling dual disorder (GDD). This study aims to provide further evidence of the co-occurrence of GD and other mental disorders in routine clinical practice and to identify different clinical profiles of severity. This descriptive, cross-sectional, and observational study included 116 patients with GD who were undergoing treatment in a specialized center. The MULTICAGE-CAD 4 and South Oaks gambling screen questionnaires confirmed the presence of GD in 97.4% and 100% of the patients, respectively. Other addictive behaviors such as compulsive spending, Internet, video games, or SUD (59.5%, 27.6%, 11.2%, and 13.8%, respectively) were also identified. The most used substances were tobacco (42.2%) and alcohol (5.2%). Half of the patients suffered from ADHD, 30.2% showed moderate or severe depression, and 17.2% suffered from a social anxiety problem. The majority (76.7%) also presented a phenotype with high impulsiveness. The cluster analysis identified two different clinical profiles of severity in patients with GDD. One profile showed higher severity of other mental disorders (ADHD, depression, anxiety, SUD, or insomnia), impulsivity, general psychopathological burden, and disability. In conclusion, our study provides further evidence on the co-occurrence of GD and other mental disorders supporting the GDD existence, shows impulsiveness as a vulnerability factor for GD, and identifies two clinical severity profiles.

Study to determine relevant health outcome measures in opioid use disorder: Multicriteria decision analysis. / Estudio para la determinación de medidas de resultados en salud relevantes en el trastorno por consumo de opiáceos. Análisis de decisión multicriterio.

The aim of the current study was to establish the most relevant health outcomes to assess opioid substitution treatment programmes (OSP) in patients with opioid use disorder (OUD) in Spain. A multicriteria decision analysis was applied in 3 phases: 1) concepts and criteria definitions; 2) criteria screening and weighting by means of a discrete choice experiment; 3) deliberative process. Criteria established in phase 1 were: substance use (opioids, alcohol, tobacco, stimulants and cannabis), other mental disorders (affective/anxiety disorder, psychosis, attention deficit hyperactivity disorder, borderline personality disorder, antisocial personality disorder, gambling disorder and other impulse control disorders), level of disability, adherence, medical illnesses (medical comorbidities, risk behaviours, infectious and sexually transmitted diseases), psychosocial aspects (hostile and/or violent behaviour and work problems), functional disability (quality of life, treatment and service satisfaction, social functionality). In phase 2, the most relevant factors in OSP were determined, and subsequently assessed in the deliberative process: remission of substance use (opioids, alcohol and stimulants), improvement of other mental disorders (psychosis and borderline personality disorder), improvement in comorbidity management, and improvement in social functionality, with a weighting of 56.5%, 21.9%, 11.0%, and 10.7%, respectively. The current analysis defines the main health outcomes in OSP in patients with OUD in Spain, supporting decision making and socio-health management of existing resources.

El objetivo fue establecer los resultados en salud con mayor relevancia en la evaluación de programas de tratamiento de sustitución de opiáceos (PTSO) en pacientes con trastorno por consumo de opiáceos (TCO) en España. Se realizó un análisis de decisión multicriterio con 3 fases: 1) definición de conceptos y criterios a evaluar; 2) cribado y ponderación de criterios mediante un experimento de elecciones discretas; 3) proceso deliberativo. Los criterios de la fase 1 fueron: consumo de sustancias (opiáceos, alcohol, tabaco, estimulantes y cannabis), trastornos mentales (trastorno afectivo ansioso, psicosis, trastorno por déficit de atención e hiperactividad, trastorno límite de personalidad, trastornos de personalidad antisocial, trastorno por juego y otras alteraciones del control de los impulsos), nivel de discapacidad, adherencia, enfermedades médicas (comorbilidades, conductas de riesgo, enfermedades infecciosas y de transmisión sexual), aspectos psicosociales (conducta hostil y/o violenta, presencia de problemas laborales), discapacidad funcional (calidad de vida, satisfacción con el tratamiento y servicio, funcionamiento social). En la fase 2 se determinaron los factores fundamentales en la elección de un PTSO, revisados en el proceso deliberativo: remisión del consumo de sustancias (opiáceos, alcohol y estimulantes), mejoría en el manejo de otros trastornos mentales (psicosis y trastorno límite de la personalidad), mejoría en manejo de comorbilidades médicas y mejoría en el funcionamiento social, con un peso del 56,5%, 21,9%, 11,0% 10,7% respectivamente. Este análisis define los resultados sanitarios más relevantes en PTSO en pacientes con TCO en España, favoreciendo la toma de decisiones y la gestión socio-sanitaria de los recursos existentes.

Ibero-American initiative for dual disorders to improve public treatment programs / Iniciativa iberoamericana en patología dual para el mejoramiento de los programas públicos de tratamiento

Abstract Introduction: Dual disorders (DD) are defined as the co-occurrence of substance use disorders with other psychiatric disorders across the lifespan. DD represent a diagnostic dimension with clinical peculiarities and specific healthcare needs, which raises the need to implement integrative treatment algorithms. However, worldwide, most programs address this condition through serial or parallel approaches. In Latin America, as in the rest of the world, there is no health care network that adequately addresses this problem. Objective: To describe the development of the initiative for the integral treatment of DD in Latin America. Method: The Organización Panamericana de la Salud (Pan American Health Organization), together with other collaborating organizations, implemented a three-stage plan for developing a regional initiative: 1. meeting of DD experts, 2. review of the literature on DD, and 3. identification of services for DD care in Latin America. Results: The creation of the Iniciativa Iberoamericana para la Patología Dual (Ibero-American Initiative for Dual Disorders) seeks to implement four lines of action to improve of public services: a) build a theoretical-conceptual consensus on DD, b) propose a treatment model, c) develop skills-based training, and d) create collaborative networks for research on DD. Discussion and conclusion: The following actions include the formation of working groups to create a regional collaborative network, discuss the role of participating organizations and establish guidelines for the implementation of the initiative.

Resumen Introducción: La patología dual (PD) se define como la coocurrencia de trastornos por uso de sustancias con otros trastornos psiquiátricos a lo largo del ciclo vital. La PD representa una dimensión diagnóstica con peculiaridades clínicas y necesidades asistenciales específicas, lo que implica la necesidad de implementar algoritmos de tratamiento integrativos. Sin embargo, la mayoría de los programas en el mundo ofrecen sólo modelos que atienden de forma serial o paralela esta condición. En Latinoamérica, como en el resto del mundo, no se cuenta con una red de atención sanitaria que aborde correctamente esta problemática. Objetivo: Presentar el desarrollo de la iniciativa para el abordaje integral de la PD en Latinoamérica. Método: La Organización Panamericana de la Salud, junto con otras organizaciones colaboradoras, implementó un plan de trabajo de tres etapas para generar una iniciativa regional: 1. reunión de expertos en PD, 2. revisión de la literatura sobre PD, y 3. identificar los servicios para atender la PD en Latinoamérica. Resultados: Se generó una Iniciativa Iberoamericana para la Patología Dual. Ésta pretende implementar cuatro líneas de acción para mejorar los servicios públicos: a) generar un consenso teórico-conceptual sobre PD, b) proponer un modelo de tratamiento, c) desarrollar un entrenamiento basado en competencias, y d) crear redes de colaboración para la investigación en PD. Discusión y conclusión: Las siguientes acciones incluyen la conformación de grupos de trabajo para crear una red colaborativa regional, discutir el rol de las organizaciones participantes y establecer lineamientos para la implementación de la iniciativa.

Dual disorders in individuals under treatment for both alcohol and cocaine: Madrid study on the prevalence of dual disorders / Patología dual en individuos en tratamiento por uso de cocaína y alcohol: estudio Madrid sobre prevalencia de patología dual

Abstract: Introduction: Descriptive data about co-occurrence of alcohol and cocaine consumption is scarce, despite its important prevalence. Dual disordes shows high prevalence in clinical samples, and patients report worse evolution and need more health services. Objective: To compare psychopathology in patients in treatment with lifetime alcohol and cocaine (Alc + Coc) substance use disorder (SUD) with subjects with alcohol but not cocaine (Alc) lifetime SUD and cocaine but not alcohol (Coc) SUD. Method: The sample consisted of 837 outpatients from Madrid, Spain, under treatment in substance misuse or mental health units. Two analyses were made: we compared subjects in the Alc + Coc (n = 366) to the Alc group (n = 162), and then to the Coc group (n = 122). Socio-demographic variables were addressed by interview. The Mini International Neuropsychiatric Interview (MINI) was used to evaluate Axis I disorders and the Personality Disorder Questionnaire (PDQ) to evaluate Personality Disorders (PD). Results: Compared to Alc group, patients in the Alc + Coc group were younger, had different socio-demographic characteristics, had more proportion of cannabis and opioid SUD, had less proportion of major depressive disorder, obsessive and depressive PD, more proportion of antisocial PD and lower suicide risk. Compared to the Coc group, they had more cannabis SUD and lower opioid SUD, showed higher prevalence of bipolar disorder, general anxiety disorder, paranoid, histrionic and dependent PD. Discussion and conclusion: We present a cross-sectional study describing comorbidity of dual disordes on treatment-seeking concurrent alcohol and cocaine problematic users. This concurrence showed different dual disordes prevalence profile than single users in some specific mental disorders.

Resumen: Introducción: La patología dual presenta una alta prevalencia en muestras clínicas. Estos pacientes sufren mayor comorbilidad y requieren más servicios. Existen escasos datos de comorbilidad por alcohol y cocaína. Objetivo: Valorar datos sociodemográficos, prevalencias de trastorno por uso de sustancias (TUS), trastorno mental y trastornos de personalidad en pacientes con trastorno por uso de alcohol y cocaína frente a pacientes con uno de los dos TUS. Método: La muestra incluyó 837 pacientes procedentes de Centros de Salud Mental y Centros de Atención a Drogodependientes. Se realizaron dos análisis: se comparó el grupo de alcohol y cocaína (Alc + Coc, n = 366) con el grupo de alcohol (Alc, n = 162), y posteriormente con el grupo de cocaína (Coc, n = 122). Se recogieron variables sociodemográficas y sobre TUS mediante entrevista, diagnósticos de trastorno mental del eje I mediante la entrevista estructurada Mini International Neuropsychiatric Inerview (MINI) y los trastornos de personalidad mediante el Personality Disorder Questionnaire (PDQ). Resultados: Los pacientes del grupo Alc + Coc frente al grupo Alc presentaban diferencias sociodemográficas significativas, mayor prevalencia de TUS asociados, riesgo más alto de suicidio y mayor proporción de trastorno antisocial de personalidad. Además, tenían menor prevalencia de trastornos depresivos. Frente al grupo Coc presentaron mayor prevalencia de trastorno por consumo de cannabis, pero menor de opioides y mayor prevalencia de trastorno bipolar, trastorno de ansiedad generalizada y trastornos de personalidad. Discusión y conclusión: Los pacientes comórbidos para alcohol y cocaína presentaron un distinto perfil de prevalencia de algunos trastornos mentales específicos.

Abuse or dependence on cannabis and other psychiatric disorders. Madrid study on dual pathology prevalence.

OBJECTIVES: Cannabis use has been associated to a wide variety of mental disorders, the possible causal role of this use in the etiology of severe mental disorders as schizophrenia or bipolar disorder standing out. Moreover, the cannabinoid system is involved in emotional regulation, so cannabis use could disturb this process and provoke anxiety and mood disorders. The main objective of this study was to analyze the cannabis addict subgroup from Madrid study of prevalence of dual disorders in community mental health and substance misuse services. MATERIAL AND METHODS: The sample consisted of 837 outpatients under treatment in the mental health network or drug network of the Community of Madrid (Spain). Of these, 353 subjects had a lifetime diagnosis of cannabis abuse or dependence and 357 subjects did not have cannabis substance use disorder. We used the Mini International Neuropsychiatric Interview (MINI) to evaluate axis I mental disorders, and Personality Disorder Questionnaire to evaluate personality disorders. RESULTS: It was considered that 76.5% of the cannabis addicts had a current dual disorder. The most prevalent ones were mood and anxiety disorders. Of those addicted to cannabis, 51% had a personality disorder. Most of them had several substance use disorders. Cannabis abuse or dependence subjects had an earlier onset in consumption of other drugs such as alcohol, cocaine, and tobacco than addicts without cannabis abuse or dependence. The cannabis addicts also differed from the other addicts because of an association to antisocial personality disorder, bipolar disorder, psychosis and agoraphobia. The presence of these mental disorders was significantly associated to a lower age at initiation of cannabis use. CONCLUSIONS: Dual pathology is very high in cannabis addicts under treatment. Said consumption of cannabis, probably within a polysubstance use pattern, is associated to severe mental disorders as psychosis and bipolar disorder. An earlier age of onset in cannabis use is associated to a greater risk of said mental disorders.