Protocol for a Trial Assessing the Efficacy of a Universal School-Based Prevention Program for Addictive Behaviors.

BACKGROUND: "Juego de Llaves" [ Set of Keys ] is a universal school-based prevention program for adolescents aged 12-15. It is aimed at reducing drug use and other addictive behaviors. This paper describes the full protocol for the evaluation design, instruments, randomization procedure, follow-ups, and primary outcomes. METHOD: Non-Randomized Control Cluster Trial in a set of Spanish secondary schools, with follow-ups at 12-, 24- and 36-months. Participants will be allocated to an experimental or control group. Using a digital application designed for the study, a battery of instruments will be used to assess addictive behaviors, sociodemographic variables, school climate and other transdiagnostic psychological variables. RESULTS: A pilot test will be carried out to test the implementation protocol and to calculate the sample size needed for outcome evaluation. After implementing the program, longitudinal statistical approaches will be used to report intervention efficacy and potential moderators and mediators. CONCLUSIONS: There is a lack of assessments on the effectiveness of school prevention programs, and this paper is expected to improve monitoring and ongoing evaluation in prevention.

No evidence of the clinical utility of single-item breakpoint to inform on tobacco demand in persons with substance use disorders.

RATIONALE: Behavioral economics has shown that single-item demand indicators are promising for capturing crucial aspects of nicotine reinforcement. It is suggested that brief breakpoint measures perform comparably to full-length demand indices in characterizing nicotine dependence; however, there have been no thorough assessments of their validity in clinical settings. OBJECTIVES: This study aimed to assess the validity and accuracy of a single-item breakpoint in informing on tobacco demand. METHODS: The sample consisted of 88 treatment-seeking smokers (% males = 70.5%) enrolled in substance use treatment. Participants provided data on smoking characteristics and completed the Fagerström Test for Nicotine Dependence, a single-item breakpoint measure and a 14-item cigarette purchase task (CPT). Hierarchical regressions were performed to compare the predictive capability of a single-item breakpoint and full-length tobacco demand indicators in determining nicotine addiction severity. RESULTS: The single-item breakpoint was significantly correlated with all indices stemmed from the CPT and both latent factors (all r values = .250-.368). Neither the brief breakpoint nor the full-length breakpoint significantly predicted nicotine dependence. After controlling for sex and smoking variables, factor 2 [ß = .565, p < .001] and its observed variables Omax [ß = .279, p = .006], 1/elasticity [ß = .340, p = .001], and intensity [ß = .551, p < .001], robustly predicted nicotine dependence severity. CONCLUSIONS: Our findings do not support the validity of single-item breakpoint measures for characterizing nicotine dependence in substance users. In a bid to foster translational research, brief demand measures capturing Omax, intensity, and elasticity should be developed.

Concurrent validity of the Alcohol Purchase Task for measuring the reinforcing efficacy of alcohol: an updated systematic review and meta-analysis.

BACKGROUND AND AIMS: An early meta-analysis testing the concurrent validity of the Alcohol Purchase Task (APT), a measure of alcohol's relative reinforcing value, reported mixed associations, but predated a large number of studies. This systematic review and meta-analysis sought to: (1) estimate the relationships between trait-based alcohol demand indices from the APT and multiple alcohol indicators, (2) test several moderators and (3) analyze small study effects. METHODS: A meta-analysis of 50 cross-sectional studies in four databases (n = 18 466, females = 43.32%). Sex, year of publication, number of APT prices and index transformations (logarithmic, square root or none) were considered as moderators. Small study effects were examined by using the Begg-Mazumdar, Egger's and Duval & Tweedie's trim-and-fill tests. Alcohol indicators were quantity of alcohol use, number of heavy drinking episodes, alcohol-related problems and hazardous drinking. APT indices were intensity (i.e. consumption at zero cost), elasticity (i.e. sensitivity to increases in costs), Omax (i.e. maximum expenditure), Pmax (i.e. price associated to Omax ) and breakpoint (i.e. price at which consumption ceases). RESULTS: All alcohol demand indices were significantly associated with all alcohol-related outcomes (r = 0.132-0.494), except Pmax , which was significantly associated with alcohol-related problems only (r = 0.064). The greatest associations were evinced between intensity in relation to alcohol use, hazardous drinking and heavy drinking and between Omax and alcohol use. All the tested moderators emerged as significant moderators. Evidence of small-study effects was limited. CONCLUSIONS: The Alcohol Purchase Task appears to have concurrent validity in alcohol research. Intensity and Omax are the most relevant indices to account for alcohol involvement.

The synergistic effect of cigarette demand and delay discounting on nicotine dependence among treatment-seeking smokers.

From a behavioral economics standpoint, tobacco addiction can be conceptualized as a reinforcer pathology deriving from high cigarette demand and elevated delay discounting (DD) rates. The primary aim of this study was to assess the interactive effects of cigarette demand and DD on nicotine dependence (ND) and cigarette consumption among a sample of treatment-seeking smokers. Participants were 277 smokers (68.9% women) who completed the 19-item version of the Cigarette Purchase Task, a computerized version of the DD task and the Fagerström Test for Nicotine Dependence. To assess cigarette consumption, participants were also asked about their mean number of cigarettes smoked per day. Hierarchical multiple regressions were conducted to assess the interactive effects of demand indices and DD on ND and cigarettes smoked per day. The area under the curve for both demand and DD was used to explore the interactive effect of the 2 variables. Results showed that the interaction between cigarette demand and DD was significantly related to ND severity (p < .05) but not to cigarette consumption. This is the first study showing that the synergistic effect of cigarette demand and DD better accounts for ND in treatment-seeking smokers than the 2 isolated constructs. It also supports the utility of area under the curve as a proxy for cigarette demand, providing methodological convergence with other behavioral economic domains, such as DD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Cigarette demand among smokers with elevated depressive symptoms: an experimental comparison with low depressive symptoms.

RATIONALE: Individuals with depression smoke more than smokers without depression. Research has shown that cigarette demand is a useful tool for quantifying tobacco reinforcement and supposes a clinical predictor of treatment outcomes. Despite previous studies examining the relative reinforcing efficacy of nicotine among different populations of smokers, to date, no study has assessed cigarette demand among individuals with elevated depressive symptoms. OBJECTIVE: The aim of this study was to compare cigarette demand among samples of smokers with low and elevated depressive symptoms. Further, it also sought to examine the relationship between depressive symptomatology and the individual CPT demand indices. METHODS: Participants (80 non-depressed smokers and 85 depressed smokers) completed the 19-item version of the Cigarette Purchase Task (CPT). Depression symptomatology was assessed using the Beck Depression Inventory-Second Edition (BDI-II). Depressed smokers needed to present at least moderate depressive symptoms as indicated by scoring ≥ 20 on the BDI-II. RESULTS: Depressive symptomatology and nicotine dependence were significantly associated with elasticity of demand (R 2 = 0.112; F(2, 155) = 9.756, p = ≤ 0.001). Depressive symptoms, cigarettes per day, and years of regular smoking also predicted breakpoint scores (R 2 = 0.088; F(4, 153) = 3.697, p = 0.007). CONCLUSION: As smokers with elevated depressive symptoms are less sensitive to increases in cigarette prices than those with low depressive symptomatology, future studies should consider these cigarette demand indices when designing depression-focused smoking cessation treatments. Providing this difficult-to-treat population with interventions that promote both pleasurable and alternative reinforcing activities is highly encouraged.

Prevalence of Problem Gambling Among Adolescents: A Comparison Across Modes of Access, Gambling Activities, and Levels of Severity.

The high availability and accessibility of online gambling have recently caused public concern regarding the potential increase of gambling-related problems among young people. Nonetheless, few studies among adults and none among adolescents have explored specific characteristics of gamblers as a function of gambling venues to date. This study sought to analyze the prevalence of gambling among a sample of adolescents in the last year, as well as sociodemographic and gambling-related characteristics as possible predictors of at-risk and problem gambling. The sample comprised 1313 adolescents aged 14-18 years. Participants were asked to respond to several questions regarding their gambling behavior. Chi square and ANOVA tests were performed in order to explore differences between groups, and a set of multinomial regressions established significant severity predictors. The prevalence of at-risk and problem gambling was 4 and 1.2 %, respectively. Regression analyses showed that having a relative with gambling problems predicted at-risk gambling. Both living with only one parent or not living with parents at all, and the prevalence of Electronic Gambling Machines in the last year were associated with problem gambling. Mixed-mode gambling was a predictor of both at-risk and problem gambling. Our findings extend previous research on gambling among adolescents by exploring gambling behavior according to different modes of access. Although the prevalence of exclusive online gambling among the total sample was low, these results support the need to consider specific subgroups of gamblers and their concrete related features when conducting both indicated prevention and treatment protocols for adolescents.

The Relationship between Impulsivity and Problem Gambling in Adolescence.

Gambling has become one of the most frequently reported addictive behaviors among young people. Understanding risk factors associated with the onset or maintenance of gambling problems in adolescence has implications for its prevention and treatment. The main aim of the present study was to examine the potential relationships between impulsivity and problem gambling in adolescence. Participants were 874 high school students (average age: 15 years old) who were surveyed to provide data on gambling and impulsivity. Self-reported gambling behavior was assessed using the South Oaks Gambling Screen - Revised for Adolescents (SOGS-RA) and impulsivity was measured using the Impulsive Sensation Seeking Questionnaire (ZKPQ), the Barratt Impulsiveness Scale (BIS-11-A), and a delay discounting task. The data were analyzed using both a prospective-longitudinal and a cross-sectional design. In the longitudinal analyses, results showed that the impulsivity subscale of the ZKPQ increased the risk of problem gambling (p = 0.003). In the cross-sectional analyses, all the impulsivity measures were higher in at-risk/problem gamblers than in non-problem gamblers (p = 0.04; 0.03; and 0.01, respectively). These findings further support the relationship between impulsivity and gambling in adolescence. Moreover, our findings suggest a bidirectional relationship between impulsivity and problem gambling in adolescence. These results have consequences for the development of prevention and treatment programs for adolescents with gambling problems.

Contingency management for substance use disorders in Spain: Implications for research and practice.

OBJECTIVE: We provide a narrative review of published studies evaluating voucher-based contingency management (CM) treatment for cocaine, nicotine and cannabis use disorders in Spain and discuss the concerns and future challenges. METHOD: Published studies between 2008 and 2015 that evaluated the impact of incentives for SUD in Spain and included an appropriate control or comparison condition were identified and reviewed. RESULTS: Adding voucher-based CM to standard treatments obtained better treatment retention and cocaine abstinence than standard care alone. CM also improved psychosocial functioning. Economic status or depressive symptoms did not affect the results of CM treatment for cocaine dependence. The addition of a CM protocol to cognitive behavioral treatment (CBT) also improved treatment effectiveness for smoking cessation. Available data on the effect of CM on cannabis use disorders (CUD) with young people did not allow confirmation of its superiority to date. CONCLUSION: The research conducted to date in Spain confirms and expands the findings of studies conducted in the US supporting the effectiveness of CM in the context of community settings with cocaine- and nicotine-dependents. However, CM has not yet been readily adopted into general clinical practice in Spain or the rest of Europe. The limited effectiveness of CM for CUD is likely due to the scarcity of data and may change with more studies, taking into account recent research on this topic in the US. Continued efforts are warranted to further develop and disseminate incentive-based treatments for SUD across clinical settings and populations in Spain.

Contingency management for smoking cessation among treatment-seeking patients in a community setting.

BACKGROUND: Contingency management (CM) is an efficacious intervention for reducing cigarette smoking. However, CM is rarely adopted as a smoking cessation treatment in the community. This study analyzed the effectiveness of a CM procedure in combination with a cognitive-behavioral treatment (CBT) for smoking cessation among treatment-seeking patients from the general population. METHODS: A total of 92 patients were randomly assigned to one of two treatment conditions: CBT (N=49) or CBT+CM (N=43). The CM procedure included a voucher program through which nicotine abstinence was reinforced on a schedule of escalating magnitude of reinforcement with a reset contingency. Self-reported smoking status was confirmed with both carbon monoxide (CO) level in expired air and cotinine levels in urine. RESULTS: Of the patients who received CBT+CM 97.7%, completed 6 weeks of treatment, versus 81.6% of those who received CBT (p=.03). At the post-treatment assessment, 95.3% of the patients assigned to the CBT+CM condition achieved abstinence in comparison to the 59.2% in the CBT group (p=.000). At the one-month follow-up, 72.1% of the patients who received CBT+CM maintained smoking abstinence, versus 34.7% in the CBT group (p=.001). At the six-month follow-up, 51.2% of the patients who received CBT+CM maintained smoking abstinence in comparison to the 28.6% in the CBT group (p=.04). CONCLUSIONS: Results from this randomized clinical trial showed that adding CM to a CBT is effective, and is feasible as an intervention approach with treatment-seeking patients in a community setting.

Decreased delay discounting in former cigarette smokers at one year after treatment.

Current cigarette smokers exhibit greater delay discounting relative to ex-smokers. However, few studies have assessed longitudinal changes in delay discounting and cigarette smoking. The purpose of this study was to assess changes in delay discounting of hypothetical monetary rewards and smoking among treatment-seeking smokers (N=80) at baseline, after 6 weeks of behavioral treatment, and at 12-month follow-up. Results showed no changes in delay discounting in either smokers or abstainers at the end-of-treatment. In contrast, at 12-month follow-up, significant decreases in delay discounting were observed in abstainers while delay discounting remained the same for smokers. To our knowledge, this is the first study to observe significant decreases in delay discounting following prolonged smoking abstinence. Such findings provide evidence that delay discounting may have more state-like characteristics than previously believed.

Self-change among Spanish speakers with alcohol and drug use disorders in Spain and the United States.

OBJECTIVE: Few cross-cultural studies have investigated the self-change process with substance abusers. This study examined commonalities and differences related to the self-change process with Spanish speaking self-changers in Spain and the United States (U.S.) who reported recovering from an alcohol or drug problem on their own (i.e., without formal help or treatment) for ≥1 year. METHOD: Advertisements were primarily used to recruit participants. There were 56 participants in the final sample (Spain, n=29; US; n=27). Participants provided demographic and substance use history information and completed the Drug Use History Questionnaire, Reasons for Change Scale, the Life Events Checklist, and a checklist for maintenance factors after recovery. RESULTS: Significantly more self-changers from the U.S. met DSM IV-TR criteria for alcohol dependence, reported significantly more life events in the year prior to recovery and significantly more maintenance/support events in the year after their recovery than their counterparts in Spain. The majority of participants' recoveries involved abstinence. Some alcohol abusers, however, report successfully engaging in low-risk drinking with no consequences(50% Spain; 22% U.S.), and some drug abusers in Spain (23%) reported a few days per year of very little drug use. CONCLUSIONS: The two groups of Spanish speakers represented very different cultures, and those from the U.S. came from several countries in the Southern hemisphere. The results of this study suggest that even though people speak the same language that does not mitigate against cultural differences. Additional studies of the process of self change with larger participant samples are needed to better inform the development and provision of interventions for Spanish speakers with alcohol and drug use disorders across different cultures and countries.

Blood alcohol level tests in nightlife recreational settings as a preventive tool.

BACKGROUND: Getting drunk is a common practice in the nightlife context and is related to risk behaviors. One potentially preventive strategy would be to conduct breathalyzer (blood alcohol content level-BAC) tests in situ, encouraging the young people to take responsibility. The aim of this study is to evaluate the efficacy of such a measure. METHOD: A sample of 555 young people were interviewed in the most popular nightlife recreational areas in three Spanish cities. After they answered to a brief questionnaire, the breathalyzer test was done and they were then informed of the results and also informed about the results, telling them what the maximum authorized rate of alcohol in expired air was for driving. After, they were asked about their drinking intentions for the rest of the night, and if they we going to be driving. RESULTS: Only 21.6% stated that they would stop drinking or drink less, while a similar percentage (21.5%) said they would drink even more than they had intended after finding out their BAC. The logistic regression indicated that the decision to drink more or less was influenced by the BAC level, the amount they had planned to drink prior to the test and high scores on "sensation seeking." Those who decided to drive had lower BAC levels and had planned to drink less prior to the interview. CONCLUSIONS: Prevention strategies involving attempts to change behavior through informing drinkers of their own BAC are controversial, since although for some it leads to their drinking less, in other cases the young people end up drinking more than they had planned.

Alcoholemias en contextos recreativos nocturnos como sistema de prevención / Blood Alcohol Level tests in nightlife recreational settings as a preventive tool

INTRODUCCIÓN: Emborracharse es frecuente en la vida recreativa nocturna, relacionándose con comportamientos de riesgo. Una estrategia potencialmente preventiva sería realizar pruebas de alcoholemia in situ, alentando a los jóvenes a responsabilizarse. El objetivo de este estudio es evaluar la eficacia de tal medida. MÉTODO: Una muestra de 555 jóvenes fue entrevistada en zonas recreativas nocturnas populares en tres ciudades españolas. Tras responder a un cuestionario, realizaron la prueba de alcoholemia y se les informó del resultado, comentándoles cuál es la alcoholemia autorizada en España para conducir. Posteriormente se les preguntó sobre sus intenciones de beber para el resto de la noche y si pensaban conducir. RESULTADOS: Tras conocer su alcoholemia sólo el 21,6% declaró que dejaría de beber o bebería menos, mientras que un porcentaje similar (21,5%) dijeron que beberían aún más de lo previsto. La regresión logística indicó que la decisión de beber más o menos venía afectada por el nivel de alcoholemia, el alcohol que se había planeado beber previamente a la prueba así como por puntuaciones altas en "búsqueda de sensaciones". Por otro lado, las personas que deciden conducir tuvieron una menor tasa de alcoholemia y ya tenían planeado beber menos el resto de la noche antes de realizar la prueba de alcoholemia. CONCLUSIONES: La realización de pruebas de alcoholemia como método preventivo da lugar a resultados contradictorios, ya que si bien en algunos casos lleva a beber menos, en otros los jóvenes terminan bebiendo más de lo que habían planeado

BACKGROUND: Getting drunk is a common practice in the nightlife context and is related to risk behaviors. One potentially preventive strategy would be to conduct breathalyzer (blood alcohol content level-BAC) tests in situ, encouraging the young people to take responsibility. The aim of this study is to evaluate the efficacy of such a measure. METHOD: A sample of 555 young people were interviewed in the most popular nightlife recreational areas in three Spanish cities. After they answered to a brief questionnaire ,the breathalyzer test was done and they were then informed of the results and also informed about the results, telling them what the maximum authorized rate of alcohol in expired air was for driving. After, they were asked about their drinking intentions for the rest of the night, and if they we going to be driving. RESULTS: Only 21.6% stated that they would stop drinking or drink less, while a similar percentage (21.5%) said they would drink even more than they had intended after finding out their BAC. The logistic regression indicated that the decision to drink more or less was influenced by the BAC level, the amount they had planned to drink prior to the test and high scores on "sensation seeking." Those who decided to drive had lower BAC levels and had planned to drink less prior to the interview. CONCLUSIONS: Prevention strategies involving attempts to change behavior through informing drinkers of their own BAC are controversial, since although for some it leads to their drinking less, in other cases the young people end up drinking more than they had planned (AU)

Adding voucher-based incentives to community reinforcement approach improves outcomes during treatment for cocaine dependence.

This study compares the efficacy of the Community Reinforcement Approach (CRA) with and without an incentive program for cocaine-dependent patients in Spain. A total of 58 patients were randomly assigned to the CRA or CRA plus vouchers condition. In the CRA plus vouchers group, mean percentage of cocaine-negative samples was 97.07%, versus 79.76% in the no-voucher group. Those treated in the CRA plus vouchers condition also achieved greater improvements in psychosocial functioning than those treated in the CRA condition. The present results show that treatment outcome is better if incentives are delivered contingent upon the submission of cocaine-free urine specimens.

Evaluación de tests editados en España / No disponible

La utilización correcta de los tests psicológicos requiere por un lado que los instrumentos de medida tengan las propiedades psicométricasadecuadas, tales como fiabilidad y validez, y por otro, que los profesionales que los utilizan tengan la preparación técnica necesaria para usarlos. En el presente trabajo se presentan las primeras evaluaciones de tests editados en España, llevadas a cabo con un Modelo de Evaluación desarrollado por la Comisión Europea de Tests y adaptado al contexto español. El modelo permite llevar a cabo una evaluación tanto cualitativa como cuantitativa de las pruebas. Se evaluaron diez tests elegidos de entre los más utilizados por los profesionales españoles, cada uno de ellos se envió a dos revisores expertos para su evaluación, y a partir de dichos informes se elaboró el informe final. En líneas generales puede afirmarse que la calidad de los diez instrumentos de medida evaluados es buena, poniéndose de manifiesto sus puntos fuertes y débiles. A la vista de las revisiones se recomienda una mejora de las pruebas y sus Manuales para futuras ediciones, haciendo hincapié en la necesidad de incluir el mayor número posible de evidencias de validez sobre las pruebas. Finalmente se comentan los detalles del proceso de revisión seguido, y se analizan las posibles líneas de futuro en la evaluación de los tests en España (AU)

The proper use of psychological tests requires that the measuring instruments have adequate psychometric properties, such as reliabilityand validity, and professionals who use those instruments have the necessary expertise to utilize them. In this paper we present the first evaluation of tests published in Spain, carried out with an Assessment Model developed by the European Test Commission, and adapted to the Spanish context. The model allows conducting a qualitative and quantitative evaluation of the test. Ten tests were evaluated, elected from among the most used by Spanish professionals. Each test was sent to two peer reviewers for evaluation, based on these reports a final inform was prepared. In light of the revisions carried out some improvements are suggested for future editions of the tests, emphasizing the need to include in the Manuals as many as possible evidences of validity of the tests. Finally, we discuss the details of the review process followed, and analyze possible future directions for the evaluation of tests in Spain (AU)

Cannabis y Salud Mental / Cannabis and Mental Health

El Cannabis es actualmente la droga ilegal más consumida tanto en Europa como en Estados Unidos. Sus criterios de dependencia están definidos por los principales manuales diagnósticos (DSM-IV y CIE-10) y aunque no ocurre así con el síndrome de abstinencia, éste presenta ciertos síntomas significativos que la investigación comienza a concretar. Si bien no todos los consumidores de esta droga presentan problemas de salud mental, las revisiones de los últimos años apuntan a un mayor riesgo de diversos trastornos mentales entre los usuarios de cannabis. Riesgos que están asociados a la menor edad de inicio del consumo, la mayor frecuencia del mismo o a ciertas predisposiciones personales. La investigación no sólo ha desvelado alteraciones que van del espectro psicótico al afectivo, sino también deterioros cognitivos o su relación con la conducta antisocial, el consumo de otras drogas ilegales o con otros riesgos para la salud. Aunque los factores contaminantes y las dificultades de una evaluación precisa del grado e historia de consumo son un gran obstáculo para los avances en este campo, las investigaciones realizadas en los últimos años han proporcionado resultados concluyentes sobre los posibles riesgos del uso de esta droga. El presente artículo revisa los principales hallazgos científicos y conclusiones sobre la asociación entre el uso de cannabis y la salud mental (AU)

Cannabis is currently the most widely consumed illegal drug in both Europe and the United States. Cannabis dependence criteria are defined by the principal diagnostic manuals (DSM-IV and ICD-10), but not cannabis withdrawal syndrome, although cannabis withdrawal produces certain significant symptoms that are beginning to be typified by research. While not all cannabis users present mental health problems, recent reviews point to a greater risk of various mental disorders in cannabis users. The risks are associated with younger age at first use, greater frequency of use or certain personal predispositions. Research has revealed not only alterations in both the psychotic and affective spectra, but also cognitive deterioration and associations between cannabis use and antisocial behavior, use of other illegal drugs and other health risks. Although contaminating factors and the difficulty of accurately assessing the extent and history of cannabis use represent considerable obstacles to progress in this research field, studies carried out in recent years have contributed conclusive findings on the potential risks of cannabis use. The present article reviews the main scientific findings and conclusions with respect to the association between cannabis use and mental health (AU)

Cannabis and mental health.

Cannabis is currently the most widely consumed illegal drug in both Europe and the United States. Cannabis dependence criteria are defined by the principal diagnostic manuals (DSM-IV and ICD-10), but not cannabis withdrawal syndrome, although cannabis withdrawal produces certain significant symptoms that are beginning to be typified by research. While not all cannabis users present mental health problems, recent reviews point to a greater risk of various mental disorders in cannabis users. The risks are associated with younger age at first use, greater frequency of use or certain personal predispositions. Research has revealed not only alterations in both the psychotic and affective spectra, but also cognitive deterioration and associations between cannabis use and antisocial behavior, use of other illegal drugs and other health risks. Although contaminating factors and the difficulty of accurately assessing the extent and history of cannabis use represent considerable obstacles to progress in this research field, studies carried out in recent years have contributed conclusive findings on the potential risks of cannabis use. The present article reviews the main scientific findings and conclusions with respect to the association between cannabis use and mental health.

Long-term benefits of adding incentives to the community reinforcement approach for cocaine dependence.

BACKGROUND: The community reinforcement approach (CRA) with vouchers is a well-established program developed for the treatment of cocaine addiction. It involves an incentive program in which patients earn vouchers that can be exchanged for goods or services contingent upon abstinence from cocaine use. AIM: To examine the contributions of incentives to retention, abstinence, and psychosocial outcomes in the CRA+vouchers program at the 12-month follow-up. METHODS: 58 cocaine addicts were randomly assigned to CRA treatment with or without an added incentive program in a community setting for cocaine dependence in Spain. RESULTS: 65.5% of patients in the group with vouchers completed 12 months of treatment, versus 48.3% in the no-voucher group. In the CRA+vouchers group, mean percentage of cocaine-negative samples was 95.76%, versus 79.31% in the group without vouchers. There were significant improvements in psychosocial functioning in both treatments, but when differences were observed, they supported CRA with vouchers over CRA alone. CONCLUSION: Combining CRA with incentives improves treatment outcomes in cocaine-dependent outpatients. Additive benefits of vouchers remain 6 months after the incentive program ends.

Community reinforcement approach plus vouchers among cocaine-dependent outpatients: twelve-month outcomes.

The aims of this study were to assess the effectiveness of the Community Reinforcement Approach (CRA) plus vouchers treatment in a cohort of Spanish cocaine-dependent outpatients, and to examine the maintenance of treatment effects after the voucher intervention was discontinued. Sixty-four adult outpatients were randomly assigned to one of two treatment conditions, CRA plus vouchers or standard care. The vouchers program was implemented from weeks 1 to 24. Among patients assigned to the CRA plus vouchers condition, 65.5% completed 12 months of treatment versus 28.6% of those assigned to the standard care condition (p = .003). At the 12-month assessment, 58.6% of patients assigned to the CRA plus vouchers condition were abstinent, compared with 25.7% in the standard care condition (p = .008); furthermore, 34.5% of patients assigned to the CRA plus vouchers condition achieved twelve months of continuous cocaine abstinence, versus 17.1% in the standard care condition. Those treated in the CRA plus vouchers condition also achieved greater improvements in psychosocial functioning than those treated in the standard care condition. Overall, these results reveal an extension of the effectiveness of the CRA plus vouchers treatment to a community sample of cocaine-dependent outpatients, while also supporting the maintenance of treatment effects for 6 months after completion of the voucher program.

Smoking risk factors and gender differences among Spanish high school students.

The objectives of the present study were to analyze the pattern of tobacco use among Spanish adolescents, as well as to determine gender differences in specific risk factors of cigarette use. The study sample was made up of 1,483 boys and 1,358 girls, aged 12-16 (M = 14). Participants were asked to answer an ad-hoc instrument to evaluate the pattern of use, perceived availability, risk of harm, family- and peer-use, engagement in leisure activities, drive for thinness, and self-esteem. Results showed no gender differences in the pattern of use. With regard to risk and protector factors, a predictive analysis showed that peer-related variables were the most determinant for tobacco use both for boys and girls. Some gender differences were also detected: Playing sports was protective for boys only, and listening to music for girls only. Drive for thinness and self-esteem were not related to tobacco use for either boys or girls. These findings help increase our understanding of smoking risk factors in adolescence and to pay special attention to the group of friends when planning prevention programs to reduce risk factors.