Psychological recovery stages of alcohol dependent patients after an intensive outpatient treatment: A 4-year follow-up study. / Fases de la recuperación psicológica en pacientes dependientes del alcohol tras un tratamiento intensivo: Un seguimiento de 4 años.

The aim of this work is to determine if relapses can hinder the sequence of psychological recovery and to rebuild this sequence in patients with severe alcohol dependence that seek treatment. The sample was comprised of 159 patients seeking an intensive outpatient treatment of two years duration and who were subject to follow-up during four years after discharge. Patients were grouped according to the presence of relapse during follow-up, resulting in abstainers (n = 80) and relapsers (n = 79). Assessments were carried out in the following periods: baseline, at discharge, and at the second- and fourth-year follow-ups. The measurement variables were avoidance behavior, anxiety, depression, impulsivity and meaning in life (MiL). A control group (n = 74) was evaluated at the same periods as the patients. Results indicate a slower recovery in relapsers in comparison to abstainers in all psychological dimensions and periods assessed. At the second-year follow-up, the abstainers achieved similar scores in depression as the control participants, in addition to higher scores in Meaning in Life at the end of treatment. In patients with severe alcohol dependence, our data supports a sequence of recovery that could continue beyond the four years of follow-up after treatment. This sequence would begin with the avoidance of risk situations and continue with the rest of dimensions (anxiety, depression, impulsivity).

El objetivo de este trabajo es comprobar si las recaídas dificultan la secuencia de la recuperación psicológica y reconstruir la secuencia de la recuperación de pacientes graves que solicitan tratamiento. Los participantes fueron 159 pacientes tratados durante dos años en un programa ambulatorio intensivo y tras ser dados de alta fueron seguidos durante cuatro años. En función de la presencia o no de recaída durante el seguimiento se configuraron dos grupos, el de abstinentes (n = 80) y el de pacientes que recaen (n = 79). Las evaluaciones se realizaron: basal, al alta del tratamiento, al 2.º y 4.º año de seguimiento. Las variables fueron: conductas de evitación, ansiedad, depresión, impulsividad y sentido de la vida. Se incluyó un grupo de control (n = 74) que fue evaluado con la misma cadencia que los pacientes. Los resultados indican una recuperación más lenta en el grupo con recaídas frente a los abstinentes, en todas las dimensiones psicológicas y los períodos estudiados. A los dos años de seguimiento, los pacientes abstinentes obtuvieron puntuaciones en depresión similares a los controles, además de puntuaciones superiores en sentido de la vida (MiL) a partir del final del tratamiento. Al menos en pacientes con dependencia grave del alcohol, nuestros resultados apoyan una secuencia de recuperación que podría continuar más allá de los cuatro años de seguimiento. Se inicia con la evitación de situaciones de riesgo y continúa con el resto de las dimensiones (ansiedad, depresión, impulsividad).

Fases de la recuperación psicológica en pacientes dependientes del alcohol tras un tratamiento intensivo: Un seguimiento de 4 años / Psychological recovery stages of alcohol dependent patients after an intensive outpatient treatment: A 4-year follow-up study

El objetivo de este trabajo es comprobar si las recaídas dificultan lasecuencia de la recuperación psicológica y reconstruir la secuenciade la recuperación de pacientes graves que solicitan tratamiento.Los participantes fueron 159 pacientes tratados durante dos años enun programa ambulatorio intensivo y tras ser dados de alta fueronseguidos durante cuatro años. En función de la presencia o no derecaída durante el seguimiento se configuraron dos grupos, elde abstinentes (n = 80) y el de pacientes que recaen (n = 79). Lasevaluaciones se realizaron: basal, al alta del tratamiento, al 2.º y 4.ºaño de seguimiento. Las variables fueron: conductas de evitación,ansiedad, depresión, impulsividad y sentido de la vida. Se incluyó ungrupo de control (n = 74) que fue evaluado con la misma cadencia quelos pacientes. Los resultados indican una recuperación más lenta en elgrupo con recaídas frente a los abstinentes, en todas las dimensionespsicológicas y los períodos estudiados. A los dos años de seguimiento,los pacientes abstinentes obtuvieron puntuaciones en depresiónsimilares a los controles, además de puntuaciones superiores ensentido de la vida (MiL) a partir del final del tratamiento. Al menosen pacientes con dependencia grave del alcohol, nuestros resultadosapoyan una secuencia de recuperación que podría continuar másallá de los cuatro años de seguimiento. Se inicia con la evitaciónde situaciones de riesgo y continúa con el resto de las dimensiones(ansiedad, depresión, impulsividad). (AU)

The aim of this work is to determine if relapses can hinder thesequence of psychological recovery and to rebuild this sequence inpatients with severe alcohol dependence that seek treatment. Thesample was comprised of 159 patients seeking an intensive outpatienttreatment of two years duration and who were subject to follow-upduring four years after discharge. Patients were grouped accordingto the presence of relapse during follow-up, resulting in abstainers(n = 80) and relapsers (n = 79). Assessments were carried out in thefollowing periods: baseline, at discharge, and at the second- andfourth-year follow-ups. The measurement variables were avoidancebehavior, anxiety, depression, impulsivity and meaning in life (MiL).A control group (n = 74) was evaluated at the same periods as thepatients. Results indicate a slower recovery in relapsers in comparisonto abstainers in all psychological dimensions and periods assessed. Atthe second-year follow-up, the abstainers achieved similar scores indepression as the control participants, in addition to higher scoresin Meaning in Life at the end of treatment. In patients with severealcohol dependence, our data supports a sequence of recovery thatcould continue beyond the four years of follow-up after treatment.This sequence would begin with the avoidance of risk situations andcontinue with the rest of dimensions (anxiety, depression, impulsivity). (AU)

Brain oscillatory functioning after long-term alcohol abstinence.

The heterogeneity of the population with alcohol use disorder (AUD) sometimes makes the knowledge generated in areas such as neuroscience appear to be contradictory. One aspect that may help elucidate this apparent contradiction is controlling for certain variables that are not usually controlled, such as the abstinence time in people with AUD. This research aims to study the neuroelectrical oscillations in people with AUD with longer and shorter abstinence time in comparison with healthy individuals. We recruited twenty-nine individuals with AUD with abstinence time longer than fifteen days and shorter than six months (STA), twenty-six individuals with AUD with abstinence time longer than six months and shorter than thirteen months (LTA), and sixteen healthy individuals (HC). All participants underwent electroencephalographic recording in resting-state with eyes closed. The oscillatory activity obtained was analyzed to obtain the spectral power and phase synchronization level. Regarding the obtained spectral power results, these revealed that the STA group showed higher theta band power and lower alpha band power than the LTA and HC groups. The obtained results at the phase synchronization level also show two main results. On the one hand, the STA group showed lower alpha band phase synchronization than the LTA and HC groups. On the other hand, the HC group showed higher beta band phase synchronization than the STA and LTA groups. In conclusion, the obtained results reflect that abstinence maintenance for six or more months appears to produce an important oscillatory brain functioning normalization in people with AUD.

Effect of chronic alcohol consumption on brain structure in males with alcohol use disorder without a familiar history of alcoholism.

Structural brain damages caused by chronic alcohol consumption have been extensively reported. However, the neuroimaging findings in people with alcohol use disorder (AUD) are relatively inconsistent. This inconsistency may be due to the influence of different variables that are not always considered, such as the presence of a family history of alcoholism (FHA). The main aim of this research is to study the gray (GM) and white matter (WM) volumes in male participants with AUD without FHA compared to healthy control males (HC) without FHA. For this study, we included 19 participants with AUD without FHA and 18 HC males without FHA. T1-weighted images were acquired with a General Electric Signa Exite 1.5 T scanner. GM and WM tissues were calculated using Diffeomorphic Anatomical Registration Through Exponentiated Lie algebra (DARTEL). All analyses were controlled for age and total brain volume. The statistical threshold was calculated with AlphaSim and further adjusted to account for the non-isotropic smoothness of structural images, according to Hayasaka et al. (2004). The obtained main results showed that, relative to the HC group, the participants with AUD without FHA had significantly lower GM in several brain structures, reflecting relatively purely the effects of chronic alcohol intake on brain volume. GM structure integrity is relevant for the efficient functioning of low and high-order cognitive processes used in everyday life, and its damage seems to be related to the severity/intensity/chronicity of the AUD. As such, it becomes relevant to assess and follow brain structural changes through the dependence course.

Stop! - The automatic tendency of action, inhibition and frontal activation in individuals with alcohol-use disorder in abstinence.

Studying the functioning of the frontal lobe during the performance of an inhibitory activity according to automatic tendency of action would allow a better understanding of the relationship between the reflexive and impulsive system described in the dual-process models. This study aims to prove which is the inhibitory capacity and the underlying brain activity of people with alcohol-use disorder in abstinence with a greater avoidance tendency compared to those with a higher approach tendency and healthy controls. In order to group participants with AUD, the total approach/avoidance index (TAAI) - obtained from the modified alcohol approach/avoidance task - was used, therefore resulting in three groups: TAAI- (TAAI < Percentile 35: n = 20), TAAI± (TAAI = Percentile 35-65: n = 20) and TAAI+ (TAAI > Percentile 65: n = 20). In addition to this, 15 healthy controls were recruited. They all had an electroencephalographic recording while completing the modified stop-signal task. The results showed that the TAAI+ group had a worse inhibition compared to healthy controls. Moreover, the TAAI+ group showed a hyperactivation of the inferior frontal gyrus, precentral gyrus and orbital gyrus compared to the healthy controls group and the TAAI- group. The results obtained reflect that those people with AUD with a tendency to approach alcohol have a worse inhibitory capacity and a frontal hyperactivation. Moreover, people with AUD with an avoidance tendency to alcohol have also been found to have a similar inhibitory capacity and frontal activation to healthy controls.

Neuropsychophysiological Measures of Alcohol Dependence: Can We Use EEG in the Clinical Assessment?

Addiction management is complex, and it requires a bio-psycho-social perspective, that ought to consider the multiple etiological and developmental factors. Because of this, a large amount of resources has been allocated to assess the vulnerability to dependence, i.e., to identify the processes underlying the transition from substance use to dependence, as well as its course, in order to determine the key points in its prevention, treatment, and recovery. Consequently, knowledge \from neuroscience must be taken into account, which is why different initiatives have emerged with this objective, such as the "Research Domain Criteria" (RDoC), and the "Addiction Neuroclinical Assessment" (ANA). Particularly, neuropsychophysiological measures could be used as markers of cognitive and behavioral attributes or traits in alcohol dependence, and even trace clinical change. In this way, the aim of this narrative review is to provide an overview following ANA clinical framework, to the most robust findings in neuropsychophysiological changes in alcohol dependence, that underlie the main cognitive domains implicated in addiction: incentive salience, negative emotionality, and executive functioning. The most consistent results have been found in event-related potential (ERP) analysis, especially in the P3 component, that could show a wide clinical utility, mainly for the executive functions. The review also shows the usefulness of other components, implicated in affective and substance-related processing (P1, N1, or the late positive potential LPP), as well as event-related oscillations, such as theta power, with a possible use as vulnerability or clinical marker in alcohol dependence. Finally, new tools emerging from psychophysiology research, based on functional connectivity or brain graph analysis could help toward a better understanding of altered circuits in alcohol dependence, as well as communication efficiency and effort during mental operations. This review concludes with an examination of these tools as possible markers in the clinical field and discusses methodological differences, the need for more replicability studies and incipient lines of work. It also uses consistent findings in psychophysiology to draw possible treatment targets and cognitive profiles in alcohol dependence.

Resting-state connectivity and network parameter analysis in alcohol-dependent males. A simultaneous EEG-MEG study.

There is supporting evidence of alcohol negative effects on the brain: neuroimaging and psychophysiological studies finding anatomical and functional connectivity (FC) changes associated with the dependence process. Thus, the aim of this work was to evaluate brain FC and network characteristics of alcohol-dependent individuals in resting state. For this study, we included males diagnosed with alcohol dependence (N = 25) and a group of healthy individuals (N = 23). Simultaneous EEG-MEG (electroencephalographic and magnetoencephalographic) activity was recorded in 5 min of eyes-closed resting state. EEG-MEG activity was preprocessed and FC was computed through the leakage-corrected version of phase locking value (ciPLV). Additionally, local (degree, efficiency, clustering) and global (efficiency, characteristic path length) network parameters were computed. Connectivity analysis showed an increase in phase-lagged synchronization, mainly between frontal and frontotemporal regions, in high beta band, and a decrease in interhemispheric gamma, for alcohol-dependent individuals. Network analysis revealed intergroup differences at the local level for high beta, indicating higher degree, clustering, and efficiency, mostly at frontal nodes, together with a decrease in these measures at more posterior sites for patients' group. The hyper-synchronization in beta, next to the hypo-synchronization in gamma, could indicate an alteration in communication between hemispheres, but also a possible functional compensation mechanism in neural circuits. This could be also supported by network characteristic data, where local alterations in communication are observed.

Brain functional connectivity after cognitive-bias modification and behavioral changes in abstinent alcohol-use disorder patients.

The use of the cognitive-bias modification (CBM) method has emerged as a therapeutic complement in the treatment of alcoholism, producing changes at behavioral and brain level. Nevertheless, the impact of the CBM procedure could be improved by the memory retrieval-extinction process (REP). Different studies have demonstrated that the retrieval of drug memories before extinction training later reduced the reinstatement of drug-seeking behavior. The main aim of this work was to study the effect of the CBM procedure itself, as well as in combination with the activation of alcohol-related memories, on the brain oscillatory activity of abstinent patients with alcohol-use disorder. The study sample comprised 33 patients divided into three groups: A-CBM (alcohol-related memory activation + CBM), N-CBM (neutral memory activation + CBM) and N-INT (no-intervention) groups. A resting-state EEG was obtained before and after each protocol, along with the assessment of the automatic action tendencies. A-CBM group showed a general alpha synchronization increase after the protocol, while the other groups did not show any significant change. Besides, A-CBM group showed significant intra and inter-group differences in the automatic action tendencies after the protocol, reflected in higher avoidance bias toward appetitive, aversive and without context alcohol-related stimuli. The alpha phase synchronization increase could be the neural manifestation of the conditioning produced between the alcohol-related stimuli and the automatic avoidance response. Moreover, the activation of the alcohol-related memories favors this conditioning with those alcohol-related stimuli associated with the activated memories, because it increases their threat level for the abstinence maintenance.