The Course of Cognitive Performance during Inpatient Treatment in Patients with Alcohol Use Disorder with No, Mild or Major Neurocognitive Disorders.

AIMS: In patients with a history of chronic alcohol abuse, neurocognitive disorders (NCD) are not uncommon. The current study aimed to explore the course of cognitive performance, as measured by the Montreal Cognitive Assessment (MoCA), and everyday cognitive functioning, as measured by the Patient Competency Rating Scale (PCRS), in a large group of patients with alcohol use disorder (AUD) admitted to the Center of Excellence for Korsakov and Alcohol-related Cognitive Impairments. METHODS: A multiple time-series design was used, in which the MoCA was administered at three time points of assessment, and the PCRS was completed by both the patient and a clinician at two time points, all during clinical treatment. RESULTS: A total of 524 patients were included, 71 of whom were diagnosed with AUD only, 284 with AUD and mild NCD (ARCI) and 169 with AUD, major NCD and fulfilling criteria for Korsakoff's syndrome (KS). CONCLUSIONS: Cognitive performance improved for all three groups during treatment, sustained abstinence and recovery from AUD. A low memory performance on the MoCA without improvement over time was predictive for KS, while improvement on this domain did not differentiate between AUD and ARCI. Changes in overall cognitive performance and orientation in patients with KS were positively related to changes in everyday cognitive functioning.

Chronic Neurologic Effects of Alcohol.

Chronic alcohol use induces silent changes in the structure and function of the central and peripheral nervous systems that eventually result in irreversible, debilitating repercussions. Once identified, nutritional supplementation and cessation measures are critical in preventing further neurologic damage. The proposed mechanisms of neuronal injury in chronic alcohol abuse include direct toxic effects of alcohol and indirect effects, including those resulting from hepatic dysfunction, nutritional deficiencies, and neuroinflammation. Clinical manifestations include cerebellar ataxia, peripheral neuropathy and Wernicke-Korsakoff encephalopathy. Continued exploration of the pathophysiologic mechanisms may lead to the discovery of early interventions that can prevent permanent neurologic injury.

Características de los Instrumentos de Tamizaje del Trastorno por Uso de Alcohol en Jóvenes Universitarios de Argentina / Characteristics of alcohol use disorder screening tests in young university students in Argentina

Los trastornos por uso de alcohol son preocupantemente altos en la población universitaria. Contar con instrumentos de tamizaje es fundamental para la medición epidemiológica y la práctica clínica. El objetivo de este trabajo es comparar el desempeño de los instrumentos de tamizaje más usados a nivel internacional (AUDIT, AUDIT-C, TWEAK, RAPS-QF y CAGE) en estudiantes universitarios de Argentina. Los instrumentos de tamizaje, junto a la Entrevista Diagnóstica Compuesta Internacional, que permite obtener diagnósticos compatibles con el DSM 5, fueron administrados a una muestra probabilística (N = 2,430) de estudiantes de una universidad pública nacional. Entre otros, se evaluaron los puntos de corte óptimos, la sensibilidad, la especificidad, la consistencia interna y la estabilidad temporal, así como la presencia y la capacidad de discriminación de los ítems. La apreciación global de los resultados sugiere que tanto el AUDIT como el RAPS-QF serían los instrumentos preferibles para detectar la presencia de trastorno por uso de alcohol en esta población

The prevalence of alcohol use disorders in university students is alarmingly high. Screening instruments are fundamental for both, epidemiological research and clinical practice. The aim of this article is to compare the performance of the most widely used screening instruments (AUDIT, AUDIT-C, TWEAK, RAPS-QF, and CAGE) in Argentinean university students. Screening tests, along with the Alcohol Section of the Composite International Diagnostic Interview that yields DSM 5 compatible diagnoses were administered to a probabilistic sample (N = 2,430) of university students from a national public university. The following characteristics were evaluated among others: optimal cut-off points, sensitivity, specificity, internal consistency, temporal stability, and item presence and discrimination capacity. The global appraisal of results suggests that the AUDIT and RAPS-QF would be preferable for evaluating AUD in this population

Supersensitive Kappa Opioid Receptors Promotes Ethanol Withdrawal-Related Behaviors and Reduce Dopamine Signaling in the Nucleus Accumbens.

BACKGROUND: Chronic ethanol exposure reduces dopamine transmission in the nucleus accumbens, which may contribute to the negative affective symptoms associated with ethanol withdrawal. Kappa opioid receptors have been implicated in withdrawal-induced excessive drinking and anxiety-like behaviors and are known to inhibit dopamine release in the nucleus accumbens. The effects of chronic ethanol exposure on kappa opioid receptor-mediated changes in dopamine transmission at the level of the dopamine terminal and withdrawal-related behaviors were examined. METHODS: Five weeks of chronic intermittent ethanol exposure in male C57BL/6 mice were used to examine the role of kappa opioid receptors in chronic ethanol-induced increases in ethanol intake and marble burying, a measure of anxiety/compulsive-like behavior. Drinking and marble burying were evaluated before and after chronic intermittent ethanol exposure, with and without kappa opioid receptor blockade by nor-binaltorphimine (10mg/kg i.p.). Functional alterations in kappa opioid receptors were assessed using fast scan cyclic voltammetry in brain slices containing the nucleus accumbens. RESULTS: Chronic intermittent ethanol-exposed mice showed increased ethanol drinking and marble burying compared with controls, which was attenuated with kappa opioid receptor blockade. Chronic intermittent ethanol-induced increases in behavior were replicated with kappa opioid receptor activation in naïve mice. Fast scan cyclic voltammetry revealed that chronic intermittent ethanol reduced accumbal dopamine release and increased uptake rates, promoting a hypodopaminergic state of this region. Kappa opioid receptor activation with U50,488H concentration-dependently decreased dopamine release in both groups; however, this effect was greater in chronic intermittent ethanol-treated mice, indicating kappa opioid receptor supersensitivity in this group. CONCLUSIONS: These data suggest that the chronic intermittent ethanol-induced increase in ethanol intake and anxiety/compulsive-like behaviors may be driven by greater kappa opioid receptor sensitivity and a hypodopaminergic state of the nucleus accumbens.

Moderating effect of working memory capacity on acute alcohol effects on BOLD response during inhibition and error monitoring in male heavy drinkers.

RATIONALE: While alcohol intoxication is known to increase disinhibited behavior, the degree to which disinhibition occurs appears to depend on a number of factors including executive functioning ability. However, the neural mechanisms by which individual differences in executive functioning lead to variable degrees of disinhibition remain unclear. OBJECTIVES: The aim of the current study was to examine the neural mechanisms by which individual differences in working memory (WM) capacity moderate alcohol-induced disinhibition. METHODS: Seventeen heavy-drinking males participated in a within-subjects design in which two sessions were completed: an alcohol session (.82 g/kg) and a control session. Participants completed a go/no-go task while undergoing functional magnetic resonance imaging (fMRI) after ingestion of the control or alcohol beverage. WM capacity was measured using an operation span task. RESULTS: Significant interactions of session and WM capacity emerged in contrasts examining successful response inhibition within superior temporal gyrus and unsuccessful inhibition in regions within the default mode network. In all cases, individuals with low WM capacity demonstrated a relative decrease in blood oxygen level-dependent (BOLD) response during the alcohol compared to control session, whereas the high-WM-capacity group demonstrated relative increases in BOLD response in the alcohol compared to control session. CONCLUSIONS: Low WM capacity appears to be associated with decreased neural response to signals indicating a need for behavioral control, an effect that may lead to increased difficulty with inhibiting responses and increased negative consequences from alcohol intoxication.

Diagnostic challenges in alcohol use disorder and alcoholic liver disease.

Alcohol use disorders represent a heterogeneous spectrum of clinical manifestations that have been defined by the Diagnostic and Statistical Manual of Mental Disorders-5. Excessive alcohol intake can lead to damage of various organs, including the liver. Alcoholic liver disease includes different injuries ranging from steatosis to cirrhosis and implicates a diagnostic assessment of the liver disease and of its possible complications. There is growing interest in the possible different tools for assessing previous alcohol consumption and for establishing the severity of liver injury, especially by non-invasive methods.

Multivariate analysis of Burnout syndrome in Latin-America priests / Análisis multivariante del síndrome de burnout en sacerdotes latinoamericanos

BACKGROUND: Burnout syndrome is a highly prevalent disorder in a wide range of professional groups, and is associated with substantial psychophysiological alterations. Nevertheless, this syndrome has not been analyzed in depth among the clergy, a group which fulfills a fundamental social function and has to deal with numerous stressors that increase the risk of burnout onset. METHOD: In the present study, the authors assessed 881 Catholic priests from Latin America. The Maslach Burnout Inventory-22, the General Health Questionnaire-28 and the CAGE were applied; we also recorded the priests' rates of cigarette-smoking. Specific cut-off points were set for burnout syndrome in priests. RESULTS: The original factor structures of the questionnaires are confirmed in the clerical sample, and the reliability is adequate. As regards the dimensions of the syndrome as a function of the countries studied, no statistically significant differences were found, except for the exhaustion dimension. CONCLUSIONS: The authors established the typology that defines the relevance and effect of each dimension, as well as its prevalence in this group, with a figure of 25.39%. Furthermore, burnout shows a clear relationship with general health and may be associated with addiction to substances such as alcohol or tobacco

ANTECEDENTES: el síndrome de burnout es un trastorno con una prevalencia notable en diferentes colectivos profesionales, relacionándose, además, con importantes alteraciones psicofisiológicas. Sin embargo, este no ha sido analizado en profundidad en el colectivo religioso, el cual cumple una función social fundamental, soportando numerosos estresores que incrementan el riesgo de padecer este síndrome. MÉTODO: en el presente estudio se evaluó a 881 sacerdotes católicos latinoamericanos. Se aplicaron los cuestionarios Maslach Burnout Inventory-22, General Health Questionnaire-28 y CAGE y se registró la cantidad de tabaco consumido. Asimismo, se establecieron puntos de corte específicos para el síndrome de burnout en sacerdotes. RESULTADOS: las estructuras factoriales originales de los cuestionarios se confirman en la muestra eclesiástica, los cuales muestran una fiabilidad adecuada. En cuanto a las dimensiones del síndrome en función de los países estudiados, se comprobó la inexistencia de diferencias estadísticamente significativas, exceptuando la dimensión agotamiento. CONCLUSIONES: se ha establecido la tipología que define la relevancia y efecto de cada dimensión, así como su prevalencia en este colectivo, cifrada en un 25,39%. Por otro lado, el burnout muestra una clara relación con la salud general, pudiendo degenerar, incluso, en conductas adictivas a sustancias como el alcohol o el tabaco

Psychological changes and cognitive impairments in adolescent heavy drinkers.

AIMS: Adolescence is a developmental period characterized by increased risk-taking behavior, including the initiation of alcohol and other substance use. In this brief review paper we describe psychological and cognitive constructs that are associated with heavy drinking during adolescence. These associations raise the question of causality: is alcohol somehow neurotoxic, or can we identify specific psychological and cognitive variables that serve as risk factors for the escalation of heavy drinking? METHODS: This narrative review summarizes results of recent prospective studies that focus on causal relationships between adolescents' alcohol use, and psychological changes and cognitive impairments. RESULTS: Psychological constructs such as elevated impulsivity and poor executive function are risk factors for alcohol involvement in youth. Furthermore heavy drinking during adolescence, particularly in a binge pattern, may exert neurotoxic effects and produce corresponding changes in executive function, perhaps setting the stage for the development of alcohol use disorders later on in life. CONCLUSION: Although the findings of the discussed studies shed light on the nature of the relationships between alcohol involvement and cognitive deficits, the question of cause and effect remains unanswered. The limitations of existing research and the need for well-powered prospective studies are highlighted.

Impact of alcohol use on inhibitory control (and vice versa) during adolescence and young adulthood: a review.

AIMS: Adolescence is usually the time when individuals first drink alcohol and this has been associated with relatively weak or immature inhibitory control. This review examines the changes on brain development and inhibitory function that take place during adolescence and youth as well as the relationship between inhibitory control and alcohol use at this early age. METHODS: Narrative review of the chief studies related to (a) the development of inhibitory control during adolescence, (b) the deficits in the inhibitory ability in alcohol use disorders and (c) the effects of acute alcohol intake and binge drinking on inhibitory control in adolescents and young adults. RESULTS: Inhibitory control processes are developing during adolescence and youth. Poor inhibitory functions may predispose the individual to alcohol misuse. Likewise, acute and binge alcohol drinking may impair the inhibitory control and compromise the ability to prevent or stop behaviour related to alcohol use. CONCLUSION: Poor inhibitory control can be both the cause and the consequence of excessive alcohol use. Adolescence and young adulthood may be a particularly vulnerable period due to (a) the weak or immature inhibitory functioning typical of this stage may contribute to the inability of the individual to control alcohol use and (b) alcohol consumption per se may alter or interrupt the proper development of inhibitory control leading to a reduced ability to regulate alcohol intake. Further longitudinal research is needed to evaluate the interaction between inhibitory control dysfunction and alcohol use in both situations.

Adolescence and Alcohol: a review of the literature.

Up to two thirds of adolescents consume alcohol and about a quarter engage in abusive behavior at some point. Many users begin alcohol use at young ages, and binge drinking is a dominant pattern for a proportion of youth. Because neurogenesis is inhibited by ethanol, consequences of adolescent alcohol abuse include changes in brain development and impairment of neurocognitive performance. A variety of mental and psychosocial problems are also often witnessed in alcohol abusing youth. Apart from the influence exerted by genetic and psychosocial factors, the chance of developing problematic alcohol consumption is increased by consumption in a binge drinking manner and by first contact with alcohol at a young age. Discrimination of alcohol consumption within the frames of normal adolescent behavior from problematic use is still a challenging issue. Different prevention programs provide treatment either directly to the adolescent, in the context of the school, or within the frame of the adolescent's family. Although some of these efforts have been shown to be effective in reducing alcohol misuse in youth, hardly any intervention reveals satisfactory outcomes in a long-term prospect. Successful prevention strategies would need to comprise treatment of current neuropsychological impairment as well as of comorbid mental health problems and concurrent other substance misuse.

Region-specific depression of striatal activity in Wistar rat by modest ethanol consumption over a ten-month period.

The nucleus accumbens (nAc) is the primary target for the mesolimbic dopamine system and a key brain region for the reinforcing effects displayed by drugs of abuse, including ethanol. During the transition from recreational to compulsive consumption of reinforcing drugs, however, the dorsal striatum seems to be recruited. Understanding how synaptic activity is altered in a sub-region specific manner in the striatum during the course of long-term drug consumption thus could be essential for understanding the long-lasting changes produced by addictive substances, including ethanol. Here we evaluated synaptic activity in the dorsolateral striatum (DLS) and ventral striatum (nucleus accumbens, nAc) of single-housed Wistar rats consuming water, or water and ethanol, for up to 10 months. Even though ethanol intake was moderate, it was sufficient to decrease input/output function in response to stimulation intensity in the DLS, while recorded population spike (PS) amplitudes in the nAc were unaffected. Striatal disinhibition induced by the GABAA receptor antagonist bicuculline had a slower onset in rats that had consumed ethanol for 2 months, and was significantly depressed in slices from rats that had consumed ethanol for 4 months. Bicuculline-induced disinhibition in the nAc, on the other hand, was not significantly altered by long-term ethanol intake. Changes in PS amplitude induced by taurine or the glycine receptor antagonist strychnine were not significantly altered by ethanol in any brain region. Even though input/output function was not significantly affected by age, there was a significant decline in antagonist-induced disinhibition in brain slices from aged rats. The data presented here suggest that even modest consumption of ethanol is sufficient to alter neurotransmission in the striatum, while synaptic activity appears to be relatively well-preserved in the nAc during the course of long-term ethanol consumption.

Assessment of alcohol withdrawal in Native American patients utilizing the Clinical Institute Withdrawal Assessment of Alcohol Revised Scale.

BACKGROUND: The Clinical Institute Withdrawal Assessment of Alcohol Revised (CIWA-Ar) is a commonly used scale for assessing the severity of alcohol withdrawal syndrome in the acute setting. Despite validation of this scale in the general population, the effect of ethnicity on CIWA-Ar scoring does not appear in the literature. The purpose of our study was to investigate the validity of the CIWA-Ar scale among Native American patients evaluated for acute alcohol detoxification. METHODS: A case series of all patients seen for alcohol withdrawal at an Acute Drug and Alcohol Detoxification facility was conducted from June 1, 2011, until April 1, 2012. The CIWA-Ar scores were recorded by trained nursing staff on presentation to Triage Department and every 2 hours thereafter. At our institution, a score of 10 or greater indicates the need for inpatient hospital admission and treatment. Ethnicity was self-reported. Age, sex, blood alcohol concentration, blood pressure, and pulse were recorded on presentation and vital signs repeated every 2 hours. Patients were excluded from the study if other drug use was noted by history or initial urine drug screen. A multivariate logistic regression model was utilized to identify statistically significant variables associated with admission to the inpatient unit and treatment. The relationship of CIWA-Ar scores and ethnicity was compared using analysis of variance. RESULTS: A total of 115 whites, 45 Hispanics, and 47 Native Americans were included in the analysis. Native Americans had consistently lower CIWA-Ar scores at 0, 2, 4, and 6 hours than the other 2 ethnic groups (P = 0.002). In addition, Native Americans were admitted to the hospital less often than the other 2 groups for withdrawal (P < 0.001). CONCLUSIONS: The CIWA-Ar scale may underestimate the severity of alcohol withdrawal syndrome in certain ethnic group such as Native Americans. Further prospective studies should be undertaken to determine the validity of the CIWA-Ar scale in assessing alcohol withdrawal across different ethnic populations.

Do sober eyewitnesses outperform alcohol intoxicated eyewitnesses in a Lineup?

Although alcohol intoxicated eyewitnesses are common, there are only a few studies in the area. The aim of the current study is to investigate how different doses of alcohol affect eyewitness lineup identification performance. The participants (N = 123) were randomly assigned to a 3 [Beverage: control (0.0 g/kg ethanol) vs. lower (0.4 g/kg ethanol) vs. higher alcohol dose (0.7 g/kg ethanol)] X 2 (Lineup: target-present vs. target-absent) between-subject design. Participants consumed two glasses of beverage at an even pace for 15 minutes. Five minutes after consumption the participants witnessed a film depicting a staged kidnapping. Seven days later, the participants returned to the laboratory and were asked to identify the culprit in a simultaneous lineup. The result showed that overall, the participants performed better than chance; however, their lineup performance was poor. There were no significant effects of alcohol intoxication with respect to performance, neither in target-present nor target-absent lineups. The study’s results suggest that eyewitnesses who have consumed a lower (0.4 g/kg ethanol) or a higher (0.7 g/kg ethanol) dose of alcohol perform at the same level as sober eyewitnesses in a lineup. The results are discussed in relation to the alcohol myopia theory and suggestions for future research are made (AU)

Aunque los testigos presenciales con intoxicación alcohólica son frecuentes, sólo contamos con unos pocos estudios en esta área. El objetivo del presente estudio fue investigar cómo diferentes dosis de alcohol afectan la ejecución del testigo presencial en una rueda de identificación. Los participantes (N = 123) fueron asignados al azar a una de las condiciones de un diseño inter-sujetos 3 [Ingesta de alcohol: grupo control (0.0 g/kg etanol) vs. una dosis pequeña de alcohol (0.4 g/kg etanol) vs. una alta (0.7 g/kg etanol)] X 2 (Rueda de identificación: sospechoso presente vs. sospechoso ausente). Cinco minutos después de la ingesta, los participantes vieron una película que versaba sobre un secuestro. Siete días después, los participantes volvieron al laboratorio y se les pidió que identificaran al culpable en una rueda de identificación en formato de presentación simultáneo. Aunque la tasa de identificación era realmente pobre, los resultados mostraron que, en general, los testigos identificaban por encima al azar. No se encontró un efecto significativo del alcohol en la ejecución, tanto en ruedas como con el sospechoso presente como ausente. Estos resultados sugieren que los testigos presenciales que han consumido una tasa baja (0.4 g/kg etanol) o alta (0.7 g/kg etanol) de alcohol rinden al mismo nivel en una rueda de identificación que testigos sobrios. Se discuten los resultados en relación con la teoría de la miopía del alcohol y se sugieren futuras líneas de investigación (AU)

[Features of psychopharmacotherapeutic correction of alcohol dependence in the elderly].

The article is devoted to the actual in modern medicine problem as the study of the prevalence of alcohol dependence and its psyhofarmacological correction in the elderly. It is shown that elderly and old age as a result of reduction of the reserve capacity of the organism for clinical pathology becomes addictive specific psychopathological features that affect the course of disease and maintenance of preventive treatment. On the basis of empirical evidence the authors prove that at the border severity of alcohol withdrawal syndrome the drug "Cytoflavin" has a fairly pronounced psyhofarmacological activity for older people with alcohol dependence.

Subtipos de adictos a la cocaína con y sin consumo problemático de alcohol asociado: hacia una neuropsicología de la personalidad aplicada a la clínica / Subtypes of cocaine addicts with and without associated problematic alcohol use: towards a neuropsychology of personality applied to clinical practice

Resulta importante conocer qué factores de personalidad se asocian con la adicción para poder distinguir a los adictos que requieren un tratamiento especializado de quienes no llegan a necesitarlo, así como diferenciar a los que consiguen la abstinencia de quienes persisten en el consumo a pesar de las consecuencias negativas. El modelo de Cloninger incluye variables biológicas y psicosociales que pueden ser caracterizadas en términos neuropsicológicos. Se analizaron dos muestras, una de sujetos con adicción a cocaína que iniciaban tratamiento (n=183) y otra de población no-clínica (n=183), equiparadas en sexo, edad y nivel académico. Se controló el abuso/dependencia de alcohol como variable independiente. Se apreciaron diferencias significativas y con gran tamaño del efecto entre los adictos y la población no-clínica en Búsqueda de Novedad y Autodirección, y con menor magnitud, en Evitación del Daño. Estas diferencias se incrementan cuando existe consumo problemático de alcohol añadido. Se establecieron los subgrupos de adictos (clusters) según el perfil de rasgos y se obtuvieron las diferencias en variables como impulsividad funcional/disfuncional, sintomatología disejecutiva y estrés percibido. Se identificaron 6 subgrupos, algunos de poca gravedad, caracterizándose los más graves por mayores niveles de impulsividad disfuncional, más sintomatología disejecutiva y mayores niveles de estrés percibido. La Autodirección parece reflejar el déficit de los sistemas prefrontales en la regulación de la conducta, así como en el control emocional y de los impulsos. Se sugiere la evaluación de la personalidad como herramienta más útil que la mera evaluación de síntomas para clasificar a los adictos, determinar sus necesidades y trazar un itinerario terapéutico(AU)

It is important to know which personality factors are associated with addiction so to distinguish addicts that require specialized treatment from those who do not, and to identify those addicts who achieve abstinence from those who continue their substance use despite the negative consequences. Cloninger’s model includes biological and psychosocial variables that can be characterized in neuropsychological terms. Two samples were analyzed: individuals who had begun cocaine addiction treatment (n=183) and a non-clinical population sample (n = 183), matched for sex, age and educational level. Alcohol abuse/dependence was monitored as an independent variable. Significant differences and large effect size were found between addicts and non-clinical population in Novelty Seeking and Self-Directedness, and to a lesser extent, in Harm Avoidance. These differences increase when problematic use of alcohol is added. According to the profile of traits, clusters of addicts were established and differences were obtained in variables such as functional/dysfunctional impulsivity, dysexecutive symptoms and perceived stress. Six clusters were identified, some of minor severity, the most severely problematic clusters being characterized by higher levels of dysfunctional impulsivity, more dysexecutive symptoms and higher levels of perceived stress. Self-Directedness seems to reflect the deficit of prefrontal systems in the regulation of behavior, as well as in emotion and impulse control. It is proposed that evaluation of the personality is more useful than the mere assessment of symptoms for classifying addicts, determining their needs and designing a therapeutic itinerary(AU)

Adolescent brain development and underage drinking in the United States: identifying risks of alcohol use in college populations.

Alcohol use typically is initiated during adolescence, a period that coincides with critical structural and functional maturation of the brain. Brain maturation and associated improvements in decision making continue into the third decade of life, reaching a plateau within the period referred to as emerging adulthood (18-24 years). This particular period covers that of traditionally aged college students, and includes the age (21 years) when alcohol consumption becomes legal in the United States. This review highlights neurobiological evidence indicating the vulnerabilities of the emerging-adult brain to the effects of alcohol. Factors increasing the risks associated with underage alcohol use include the age group's reduced sensitivity to alcohol sedation and increased sensitivity to alcohol-related disruptions in memory. On the individual level, factors increasing those risks are a positive family history of alcoholism, which has a demonstrated effect on brain structure and function, and emerging comorbid psychiatric conditions. These vulnerabilities-of the age group, in general, as well as of particular individuals-likely contribute to excessive and unsupervised drinking in college students. Discouraging alcohol consumption until neurobiological adulthood is reached is important for minimizing alcohol-related disruptions in brain development and decision-making capacity, and for reducing the negative behavioral consequences associated with underage alcohol use.

Prevalencia del juego patológico en pacientes adictos: Un estudio exploratorio con el South Oaks Gambling Screen / Prevalence of pathological gambling in treatment-seeking addicted patients: An exploratory study with the South Oaks Gambling Screen

En este estudio se lleva a cabo un análisis de la prevalencia del juego patológico en 112 pacientes adictos (81 alcohólicos y 31 dependientes de la cocaína) que acuden en busca de tratamiento. Para ello, se utilizaron los criterios diagnósticos del DSM-IV-TR para el juego patológico y la versión española del Cuestionario de Juego Patológico de South Oaks (SOGS). Los resultados obtenidos mostraron que el 22,3% de los pacientes drogodependientes estudiados presentaba un diagnóstico comórbido de ludopatía. Además, un 11,6% adicional obtenía una puntuación en el SOGS indicadora de juego problemático. En suma, el 33,9% de la muestra presentaba síntomas de juego clínicamente significativos. La comparación entre los pacientes adictos con y sin ludopatía asociada mostró diferencias significativas en las variables relacionadas con el consumo de alcohol (evaluado mediante el EuropASI), los síntomas psicopatológicos (evaluados mediante el SCL-90-R) y algunas variables de personalidad (evaluadas mediante el MCMI-II). En todos los casos, las puntuaciones eran significativamente más altas en los pacientes ludópatas que en los que no tenían un problema de ludopatía asociado. Se comentan las implicaciones de este estudio para la práctica clínica y la investigación futura (AU)

In the current paper, the prevalence of pathological gambling in 112 treatment-seeking patients with substance addiction (81 alcoholics and 31 cocaine dependents) was estimated. The DSM-IV-TR diagnostic criteria for pathological gambling and the Spanish version of the South Oaks Gambling Screen (SOGS) were used. The results showed that 22.3% of substance-addicted patients had a comorbid diagnosis of pathological gambling. Furthermore, an additional 11.6% of the sample had relevant symptoms for problem gambling. In sum, 33.9% of the sample reported clinically significant gambling-related symptoms. From a socio-demographic point of view, all substance-addicted patients with gambling-related symptoms were men. A comparison between substance-addicted patients with and without pathological gambling showed significant differences in alcohol severity (assessed by the EuropASI), psychopathological symptoms (assessed by the SCL-90-R) and personality variables (assessed by the MCMI-II). In all cases, scores were significantly higher in gamblers than in non-gamblers. Finally, the implications of these results for further research and clinical practice are commented upon (AU)

The psycho-social rehabilitation of patients with alcohol-related brain damage in the community.

AIMS: To describe the clinical presentation, course and psycho-social outcome of patients with alcohol-related brain damage (ARBD) referred from acute general hospital inpatient settings to a newly commissioned community team. METHODS: A follow-up study of a consecutive series of 41 patients subjected to a developing, phased rehabilitation programme in community settings. RESULTS: Patients were followed for an average of 25 months. Thirty-two patients were either abstinent or categorized as 'controlled drinkers' and were placed in appropriate community settings. Acute hospital admissions were reduced by 85%. The various domains of a neuropsychiatric assessment tool, the health of the nation outcome scale-acquired brain damage, improved with the exception of concomitant mental illness and self-directed harmful behaviour. CONCLUSIONS: A community team with experience in working with younger people with cognitive impairment can provide a service for people with ARBD. Such a service is not dependent on pre-designated specialist institutions but relies on person-centred care planning, close follow-up and collaborative work with a variety of community agencies. A structured rehabilitation programme provides a framework for intervention.