Features and prevalence of patients with probable adult attention deficit hyperactivity disorder who request treatment for cocaine use disorders.

To characterize those patients with probable adult attention deficit hyperactivity disorder (ADHD) who ask for treatment of cocaine use disorders; to estimate the prevalence of probable adult ADHD among these patients. This is a cross-sectional and multi-center study performed at outpatient resources of 12 addiction treatment centers in Spain. Participants were treatment-seeking primary cocaine abusers recruited consecutively at one center and through convenience sampling at the other centers. Assessments included semi-structured clinical interview focused on Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) ADHD criteria adapted to adulthood, and the Wender-Utah Rating Scale (WURS) for screening childhood history of ADHD according to patients. Probable adult ADHD was diagnosed when patients met DSM-IV criteria of ADHD in adulthood and scored WURS>32. All participants were diagnosed with current cocaine dependence (n=190) or abuse (n=15). Patients with probable adult ADHD, compared with patients having no lifetime ADHD, were more frequently male, reported higher impulsivity, and began to use nicotine, alcohol, cannabis, or cocaine earlier. Before starting the current treatment, patients with probable adult ADHD also showed higher cocaine craving for the previous day, less frequent cocaine abstinence throughout the previous week, and higher use of cocaine and tobacco during the previous month. Impulsivity and male gender were the only independent risk factors of probable adult ADHD in a logistic regression analysis. The prevalence of probable adult ADHD was 20.5% in the sub-sample of patients consecutively recruited (n=78). A diagnosis of probable adult ADHD strongly distinguishes among treatment-seeking cocaine primary abusers regarding past and current key aspects of their addictive disorder; one-fifth of these patients present with probable adult ADHD.

Psychometric properties of the Spanish version of the Cannabis Use Problems Identification Test among Chilean university students: A validation study.

BACKGROUND: In Chile, concerns mount about escalating cannabis use. Thus, it is important to have tools for early identification of at-risk users. The Cannabis Use Problems Identification Test (CUPIT) is a useful screening tool, and the aim of this study was to examine the psychometric properties of its Spanish version among Chilean university students. METHODS: The CUPIT was translated into Spanish, pre-tested in a focus group (n=8), and then tested through an online survey (n=3798, 28% response rate). Of the 1061 respondents, 578 reported 12-month cannabis use. Internal reliability, internal structure, and concurrent validity (using the Cannabis Abuse Screening Test [CAST]) were obtained. Test-retest reliability was calculated (n=150) at 3-4 weeks (30% of attrition rate). Discriminative validity was evaluated comparing CUPIT subscales and four DSM-IV diagnostic groups. Receiving operator characteristic (ROC) curve analysis assessed sensitivity and specificity. RESULTS: Test-retest Pearson correlation between total CUPIT scores of 0.90 (p<0.001), and highly significant Kendall Tau-b coefficients for individual items (p<0.001) indicated excellent reliability. Concordance between the CUPIT and CAST (Pearson correlation 0.73, p<0.001) indicated good concurrent validity. ANOVA revealed significant differences in CUPIT scores between the four DSM-IV diagnostic groups (p<0.001), indicative of good discriminative validity. ROC analysis (gold standard: DSM-IV abuse/dependence) yielded an AUC value of 0.72, indicating acceptable discriminative capability. CONCLUSIONS: The Spanish CUPIT is reliable, valid, and accepted by the university population studied, and, thus, a potentially useful tool for identifying both problematic and at-risk users.

Mapping heroin careers: utilising a standardised history-taking method to assess the speed of escalation of heroin using careers in a treatment-seeking cohort.

INTRODUCTION AND AIMS: Although there has been increasing research attention to the concept of addiction careers and treatment careers, there are few standardised measures for assessing illicit drug using careers. A new instrument for mapping lifetime drug use history (LDUH) was used to assess transitions in the initial stages of heroin use careers among illicit drug users. DESIGN AND METHODS: 58 lifetime heroin users completed a one-off researcher-administered interview in treatment settings in two English cities, London and Birmingham, about their histories of drug use, drug treatment and other key life events. RESULTS: The sample reported initiating heroin use at a mean age of 21 years and escalated to daily use by 23 years. On average, there was a gap of nearly 8 years before seeking treatment and at the time of interview the cohort averaged one-third of their heroin careers in treatment. However, there was marked variability across the group, with three discernible groups identified based on use patterns. While one group (n = 21) showed consistent escalation in total quantity of heroin used across the first year, the second group had an intermittent pattern of use and the third group reported an unchanging monthly heroin use pattern. These groups differed in the time taken to initiate treatment and in the proportion of their heroin careers in active use. DISCUSSION AND CONCLUSIONS: The instrument was acceptable to research participants and identified important variability in onset and escalation factors in heroin careers. The implications for therapeutic interventions and for clinical use of the instrument are discussed.

Measuring the use and career histories of drug users in treatment: reliability of the Lifetime Drug Use History (LDUH) and its data yield relative to clinical case notes.

INTRODUCTION AND AIMS: There is no generally accepted clinical or research instrument available for recording the longitudinal course of a drug-using 'career'. This paper reports on an initial examination of the properties of the Lifetime Drug Use History Questionnaire (LDUH), built around monthly mapping of drug use patterns in relation to other life events. DESIGN AND METHODS: Forty heroin and cocaine users completed structured interviews at two treatment sites. Twenty subjects were interviewed on two occasions separated by a 3-day interval, using either the same interviewer (n = 10) or two different interviewers (n = 10) as assessments of inter-rater and test - retest reliability. RESULTS: Very good inter-rater agreements were observed, demonstrated by Cronbach's alpha and intraclass correlation coefficients generally higher than 0.8 and 0.7, respectively. Additionally, concordance with clinical notes was assessed for four drug use history variables, resulting in poorer rates of agreement. An exact matching with clinical records was obtained for the variable 'age of first use of heroin' in 47.2% (n = 17) of the heroin users, while a good agreement (only 1 or 2 years' difference) was found in 36.1% of cases (n = 5). DISCUSSION AND CONCLUSIONS: The LDUH method resulted in high reliability for heroin and cocaine and suggests an effective, clinically applicable method for history-taking. The paucity and inconsistency of similar information in the clinical notes would further justify the use of a standardised method for recording drug histories.

Aspectos psicoterapéuticos en pacientes con enfermedad bipolar / Psychotherapeutic aspects in patients with bipolar disorder

En la actualidad se ha observado que la enfermedad bipolar tiene un pronóstico no tan favorable como se pensaba: influyen en estos aspectos psicodinámicos y psicosociales. Los psicofármacos son capaces, en gran medida, de prevenir las recurrencias y predominan en el manejo terapeútico, sin embargo las alteraciones que las enfermedades provoca en distintas áreas psicosociales y en la vida del paciente empeoran el pronóstico, haciendo necesarias las intervenciones psicoterapéuticas. Este artículo revisa someramente aspectos psicodinámicos de esta enfermedad, además de describir dos principales tipo de abordajes psicoterapéuticos (Psicoterapia familiar y Psicoterapia interpersonal)