Predictors of cocaine use disorder treatment outcomes: a systematic review.

BACKGROUND: Psychosocial approaches are the first-line treatments for cocaine dependence, although they still present high dropout and relapse rates. Thus, there is a pressing need to understand which variables influence treatment outcomes to improve current treatments and prevent dropout and relapse rates. The aim of this study is to explore predictors of treatment retention and abstinence in CUD. METHODS: This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched three databases-PubMed, PsychINFO and Web of Science-for randomized clinical trials (RCTs) published in English and Spanish from database inception through April 1, 2023. We selected all studies that met the inclusion criteria (adults aged ≥ 18, outpatient treatment, CUD as main addiction, and no severe mental illness) to obtain data for the narrative synthesis addressing cocaine abstinence and treatment retention as main outcome variables. After data extraction was completed, risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB-2). RESULTS: A total of 566 studies were screened, and, of those, 32 RCTs were included in the synthesis. Younger age, more years of cocaine use, and craving levels were significant predictors of relapse and treatment dropout. Fewer withdrawal symptoms, greater baseline abstinence, greater treatment engagement, and more self-efficacy were all predictors of longer duration of abstinence. The role of impulsivity as a predictor of CUD is unclear due to conflicting data, although the evidence generally suggests that higher impulsivity scores can predict more severe addiction and withdrawal symptoms, and earlier discontinuation of treatment. CONCLUSION: Current evidence indicates which variables have a direct influence on treatment outcomes, including well-studied cocaine use-related variables. However, additional variables, such as genetic markers, appear to have a high impact on treatment outcomes and need further study. SYSTEMATIC REVIEW REGISTRATION: This systematic review is registered at PROSPERO (ID: CRD42021271847). This study was funded by the Spanish Ministry of Science, Innovation and Universities, Instituto Carlos III (ISCIII) (FIS PI20/00929) and FEDER funds and Fundació Privada Hospital de la Santa Creu i Sant Pau (Pla d'acció social 2020).

Dysfunctional personality, Dark Triad and moral disengagement in incarcerated offenders: implications for recidivism and violence.

It is particularly important to study the underlying processes of the dysfunctional personality patterns and of antisocial behaviour in the prison population, to identify them and to analyse the functioning of the psychological mechanisms involved in these constructs. The main goal of this study was to analyse dysfunctional personality patterns, Dark Triad, moral disengagement mechanisms and their relationship with violence and recidivism. Participants were 63 incarcerated offenders in two prisons. The study found a higher degree of moral disengagement in the participants convicted for crimes involving the use of violence. The results indicated that antisocial and aggressive-sadistic tendencies were the dysfunctional personality traits most strongly associated with moral disengagement. The binary logistic regression analysis showed that the variables, which influenced recidivism in criminal behaviour, were the use of violence in the crime committed, antisocial personality traits, and advantageous comparison and dehumanisation as mechanisms of moral disengagement.

Posttraumatic symptomatology, meaning in life, and perceived family functioning in nonclinical trauma-exposed university students.

OBJECTIVE: This study aims to explore and analyze the associations among posttraumatic symptoms, meaning in life dimensions, and perceived family functioning in trauma-exposed university students. METHOD: Participants (N = 158) answered a sociodemographic questionnaire, the Posttraumatic Stress Global Assessment (Crespo et al., 2017), the Purpose in Life Test (Crumbaugh & Maholick, 1969), and the Family APGAR (Smilkstein, 1978). RESULTS: Outcomes indicated several negative associations between posttraumatic symptoms and both meaning in life and family functioning areas. CONCLUSIONS: These findings suggest family functioning and meaning-in-life clinical practical relevance concerning the assessment, prevention, and intervention in persons affected by trauma. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Traumatic experiences and resilience: Associations with mental health, death attitudes, and religion in university students.

Resilience may be related to mental health and profound beliefs and attitudes. Utilizing a survey design, we examined relationships among resilience, clinical syndromes, death attitudes, and religion. Mexican university students (N = 161) answered a sociodemographic questionnaire, the Global Post-Traumatic Stress Scale, the Millon Multiaxial Inventory, the Connor-Davidson Resilience Scale, and the Death Attitudes Profile. Pearson correlation analyses showed that resilience correlated inversely with clinical syndromes and fear of death and positively with approach acceptance. Religion entailed higher death attitudes and resilience. Regression analysis revealed that lower anxiety, alcohol use, persistent depression, and higher delusion and death approach acceptance explained resilience.

Pretending emotions in the early years: The role of language and symbolic play.

Although 3-year-old children sometimes simulate emotions to adapt to social norms, we do not know if even younger children can pretend emotions in playful contexts. The present study investigated (1) what emotions infants of 1-2 years old are capable of pretending and (2) the possible role of language and symbolic play in the ability to pretend emotions. The sample included 69 infants aged 18 to 31 months and their parents. Infants were administrated the Test of Pretend Play, and their parents responded to the MacArthur-Bates CDI-II inventory, part of the MacArthur-Bates CDI-I, and a questionnaire about the expression of pretend emotions. Results suggest that very young children simulate emotions. Furthermore, children's simulation of emotions was related to both symbolic play and language. Specifically, the ability to label emotions was linked to the ability to simulate them. The role of language and symbolic play in the development of the capacity to express and understand pretend emotions is discussed.

Identifying Emotional Expressions: Children's Reasoning About Pretend Emotions of Sadness and Anger.

This study aims to further understand children's capacity to identify and reason about pretend emotions by analyzing which sources of information they take into account when interpreting emotions simulated in pretend play contexts. A total of 79 children aged 3 to 8 participated in the final sample of the study. They were divided into the young group (ages 3 to 5) and the older group (6 to 8). The children were administered a facial emotion recognition task, a pretend emotions task, and a non-verbal cognitive ability test. In the pretend emotions task, the children were asked whether the protagonist of silent videos, who was displaying pretend emotions (pretend anger and pretend sadness), was displaying a real or a pretend emotion, and to justify their answer. The results show significant differences in the children's capacity to identify and justify pretend emotions according to age and type of emotion. The data suggest that young children recognize pretend sadness, but have more difficulty detecting pretend anger. In addition, children seem to find facial information more useful for the detection of pretend sadness than pretend anger, and they more often interpret the emotional expression of the characters in terms of pretend play. The present research presents new data about the recognition of negative emotional expressions of sadness and anger and the type of information children take into account to justify their interpretation of pretend emotions, which consists not only in emotional expression but also contextual information.

Understanding the Relationship Between Complicated Grief Symptoms and Patterns of Personality Disorders in a Substance Users' Sample: A Network Analysis Approach.

BACKGROUND: The presence of personality disorders is greatly prevalent among substance users. Personality disorders could increase vulnerability to complicated grief symptoms. Bereavement is commonly overlooked among substance users. We used network analysis to estimate the structure of relations between patterns of personality disorders and complicated grief symptoms among a bereaved substance-using population. METHODS: Complicated grief and personality disorders were assessed in a sample of 196 bereaved substance users. We use the graphical least absolute shrinkage selection operator (LASSO) to compute a regularized partial correlation network revealing associations among different patterns of personality disorders and complicated grief symptoms. RESULTS: In a network involving nodes for personality disorders and symptomatology of complicated grief, patterns of depressive and paranoid personality disorder showed small relationships to complicated grief symptoms. All other personality disorders showed negligible to no relationship to complicated grief symptoms. Further, in the overall network, complicated grief showed the lowest level of centrality, suggesting that it is independent of personality disorders, whereas depressive and paranoid personality disorder symptoms showed the highest centrality. CONCLUSION: Network analysis can be used to understand the relationships among higher-level constructs such as disorders. We found that complicated grief is largely independent of patterns of personality disorders with the exception of depressive and paranoid. Findings have implications for assessment and appropriate treatment of complicated grief symptoms and substance use disorder.

Coping Strategies and Complicated Grief in a Substance Use Disorder Sample.

Background: Previous research has identified a link between the loss of a significant person, grief complications, and substance abuse. People with substance use disorder (SUD) are more vulnerable to complicated grieving symptoms following loss. From sociocognitive theories, the model of coping with stress assumes that substance use is one of the responses used to cope with traumatic life events. The main objective of this study is to identify the coping strategies of people with SUD and to analyze their relationship to complicated grief (CG). Methods: A sample of 196 bereaved drug-dependent patients was assessed, after providing written consent, in sociodemographic variables, drug and bereavement related characteristics, CG symptomatology (Inventory of Complicated Grief) and coping strategies (Coping Strategies Inventory). Results: There are differences in relation to the coping strategies used among patients with CG, using more those focused on emotional expression, social withdrawal, wishful thinking, and self-criticism. Conclusion: We can conclude that, in general, CG in patients with SUD is more associated with the use of less adaptive coping strategies. This data can contribute to a better understanding of the different variables involved in the grieving process among people with SUD. It is important to point out the clinical implications of addressing what the coping strategies associated with improved grief outcomes among people with addiction problems are.

Which Psychopathological Syndromes Could Be Associated with the Risk of Suicide among Substance Users?

Background: Research has shown that suicide is a highly present phenomenon among the drug dependent population. Moreover, individuals with substance use disorder (SUD) present high psychopathological comorbidity. This study aimed to describe which clinical syndromes are linked to the presence of risk of suicide. Methods: The study was based on a consecutive non-probabilistic convenience sample of 196 patients who attended the Public Addiction Center in Girona (Spain). Sociodemographic data, as well as suicide risk and drug related characteristics, were recorded. The risk of suicide was assessed with the Spanish version of "risk of suicide". Complicated grief was assessed with the Spanish version of the Inventory of Complicated Grief. Clinical syndromes were measured with the Spanish version of MCMI-III. Results: The syndromes most frequently associated with the presence of risk of suicide were complicated grief, major depression and thought disorder. Conclusions: Different psychopathological syndromes were identified in relation to risk of suicide among patients with SUD. The present results highlight the importance of accurately diagnosing those individuals.

Risk of Suicide and Dysfunctional Patterns of Personality among Bereaved Substance Users.

Background: Research has shown that suicide is a phenomenon highly present among the drug dependent population. Different studies have demonstrated an upraised level of comorbidity between personality disorders (PD) and substance use disorders (SUD). This study aimed to describe which PDs are more frequent among those patients with a risk of suicide. Methods: The study was based on a consecutive non-probabilistic convenience sample of 196 bereaved patients attended to in a Public Addiction Center in Girona (Spain). Sociodemographic data, as well as suicide and drug related characteristics were recorded. The risk of suicide was assessed with the Spanish version of "Risk of suicide". Personality disorders were measured with the Spanish version of Millon Multiaxial Clinical Inventory. Results: The PDs more associated with the presence of risk of suicide were depressive, avoidant, schizotypal and borderline disorders. However, the histrionic, narcissistic and compulsive PDs are inversely associated with risk of suicide even though the narcissistic scale had no statistical correlation. Conclusions: The risk of suicide is a significant factor to take into account related to patients with SUD and especially with the presence of specific PDs. These findings underline the importance of diagnosing and treating rigorously patients with SUD.

Millon clinical multiaxial inventory III (MCMI-III) and communication styles in a sample of university students.

Despite the controversy generated by the conceptualization of personality disorders, it is well established that the inflexibility of coping styles and dysfunctional behaviors associated with them can lead to a considerable impairment in interpersonal relationships. Although communication is one of the most important processes in relating to others, few empirical studies have been undertaken on the influence of dysfunctional personality patterns on communication styles, which is the main objective of the present cross-sectional study. A total of 529 Spanish university students were assessed using the Millon Clinical Multiaxial Inventory III (MCMI-III), Millon, Davis, and Millon, 1997, and the Communicator Style Measure (Norton, 1978). Results show statistically significant relationships between different personality patterns and styles of communication and suggest that narcissistic, histrionic and compulsive patterns are related to positive communication styles in a non-clinical sample. The implications of this study are discussed.

Feelings of hopelessness in a Spanish university population - descriptive analysis and its relationship to adapting to university, depressive symptomatology and suicidal ideation.

BACKGROUND: The feeling of hopelessness is one of the main risk factors in suicidal behaviour, a clinical symptom of depression and a factor of great etiological relevance in hopelessness depression. With the aim of contributing data relative to the levels of hopelessness in the general population, this study has been made with three objectives in mind: to determine the levels of hopelessness in a university population, to analyse the relationship of hopelessness with the process of adapting to university and, finally, to analyse the relationships between hopelessness, depression, psychopathology and suicidal ideation. METHOD: A total of 1277 first- and second-year students, from different faculties and degree courses, participated voluntarily in this investigation. RESULTS: The results obtained indicate that 13.9% of the students present moderate or severe levels of hopelessness. The students with greater levels of hopelessness are dissatisfied with different aspects of university life, spend less time on extracurricular educational activities and are less likely to go to examinations. Also, the relationship between hopelessness, depression and suicidal ideation is once again clearly seen. CONCLUSION: The results suggest the need to develop some type of programme or service for the university community which could influence the mood of students and modify their expectations with the aim of preventing suicidal behaviour and improving their adaptation to university life and, consequently, their academic performance.