Impulsivity, implicit attitudes and explicit cognitions, and alcohol dependence as predictors of pathological gambling.

Impulsivity, implicit attitudes and explicit cognitions regarding gambling, and alcohol abuse have been pointed out by past research as significant contributors to the development and maintenance of gambling disorders. In this study, we tested the relationship among these contributors and pathological gambling. Forty-four pathological gamblers (DSM-5 criteria), of whom 23 were active gamblers and 17 were alcohol dependent, were compared with 100 controls, consisting of patients with a lifetime history of alcohol use disorder in remission for at least 2 years. The following protocol was used for the comparison: National Opinion Research Center Diagnostic Screen for Gambling Disorders, Barratt Impulsiveness Scale Version 11 (BIS-11), Gambling Related Cognitions Scale (GRCS), Obsessive Compulsive Drinking Scale, Alcohol Use Disorders Identification Test, and Gambling Implicit Association Test (IAT). Impulsivity (BIS-11) and changes in implicit attitudes (IAT) were able to discriminate between pathological gamblers and controls, the latter being less impulsive and having fewer implicit attitudes towards gambling. Cognitive impulsivity (BIS-11), explicit gambling cognitions (GRCS), and alcohol dependence were able to discriminate between active and non-active pathological gamblers, the latter having less cognitive impulsivity and less explicit gambling cognitions and alcohol dependence. Using these simple tools can help clinicians in the assessment of pathological gambling.

Predictors of posttreatment drinking outcomes in patients with alcohol dependence.

AIM: This cohort study examined how predictors of alcohol dependence treatment outcomes work together over time by comparing pretreatment and posttreatment predictors. METHODS: A sample of 274 alcohol-dependent patients was recruited and assessed at baseline, 6 months after treatment initiation (end of the active intervention phase), and 18 months after treatment initiation (end of the 12-month research follow-up phase). At each assessment point, the participants completed a battery of standardized tests [European Addiction Severity Index (EuropASI), Obsessive Compulsive Drinking Scale (OCDS), Alcohol Timeline Followback (TLFB), Fagerström, and International Personality Disorder Examination (IPDE)] that measured symptom severity and consequences; biological markers of alcohol consumption were also tested at each assessment point. A sequential strategy with univariate and multivariate analyses was used to identify how pretreatment and posttreatment predictors influence outcomes up to 1 year after treatment. RESULTS: Pretreatment variables had less predictive power than posttreatment ones. OCDS scores and biological markers of alcohol consumption were the most significant variables for the prediction of posttreatment outcomes. Prior pharmacotherapy treatment and relapse prevention interventions were also associated with posttreatment outcomes. CONCLUSIONS: The findings highlight the positive impact of pharmacotherapy during the first 6 months after treatment initiation and of relapse prevention during the first year after treatment and how posttreatment predictors are more important than pretreatment predictors.

[Amisulpride for the treatment of alcohol dependence]. / Amisulpride en el tratamiento de la dependencia alcohólica.

BACKGROUND: 6-month naturalistic, open-label trial to compare amisulpride versus topiramate and naltrexone as a treatment for patients with alcohol dependence, with assessments at enrolment and after 3 and 6 months of treatment. METHODS: 274 alcohol-dependent patients who had been drinking heavily during the past month were included. Once detoxified, patients were assigned to one of three treatment groups (naltrexone 50 mgr per day, topiramate 200 mgr per day or amisulpride 100 mgr per day). Patients were assessed at baseline and after 3 and 6 months of follow-up. Outcome was measured using tools that assessed alcohol intake (EuropASI and Alcohol Timeline Followback), craving (OCDS), disability (WHO/DAS), and quality of life (EQ-5D); changes in biomarkers of alcohol intake were also noted. RESULTS: at the 6-month follow-up patients taking amisulpride had poorer results than those taking topiramate in direct measures of alcohol intake (OCDS, alcohol intake, number of drinks per day and heavy drinking days), but no significant differences were found in these measures on comparing the amisulpride patients with those taking naltrexone. CONCLUSIONS: in this study, amisulpride, at a dose of 100 mgr per day, was less effective than topiramate, at a dose of 200 mg per day, but as effective as naltrexone, at a dose of 50 mg per day, for reducing alcohol intake and craving over the period of the study.

Amisulpride en el tratamiento de la dependencia alcohólica / Amisulpride for the treatment of alcohol dependence

Objetivos: Estudio abierto, naturalístico de 6 meses de seguimiento, para comparar la eficacia de amisulpride frente a topiramato y naltrexona en pacientes con dependencia al alcohol. Métodos: se han incluido un total de 274 pacientes diagnosticados de dependencia al alcohol y con un consumo intenso de alcohol durante el último mes. Una vez desintoxicados los pacientes fueron asignados a diferentes grupos de tratamiento (naltrexona a 50 mgr por día, topiramato a 200 mgr por día o amisulpride a 100 mgr por día). Dichos pacientes fueron evaluados al inicio del tratamiento y a los 3 y 6 meses de seguimiento mediante instrumentos para medir el consumo de alcohol (EuropASI y Alcohol Timeline Followback), el craving (OCDS), la discapacidad (WHO/DAS) y la calidad de vida (EQ-5D); también se utilizaron marcadores biológicos de consumo de alcohol. Resultados: a los 6 meses los pacientes que tomaban amisulpride obtenían peores resultados en variables relacionadas directamente con el consumo de alcohol (OCDS, alcohol consumido, número de bebidas por día de consumo y días de consumo intenso), sin embargo no se encontraron diferencias significativas en esas variables al compararse con naltrexona. Conclusiones: en este estudio, amisulpride, a dosis de 100 mgr por día, fue menos eficaz que topiramato, a dosis de 200 mgr por día, pero demostró eficacia similar a la naltrexona, a dosis de 50 mgr por día, a la hora de reducir el consumo de alcohol y el craving (AU)

Background: 6-month naturalistic, open-label trial to compare amisulpride versus topiramate and naltrexone as a treatment for patients with alcohol dependence, with assessments at enrolment and after 3 and 6 months of treatment. Methods: 274 alcohol-dependent patients who had been drinking heavily during the past month were included. Once detoxified, patients were assigned to one of three treatment groups (naltrexone 50 mgr per day, topiramate 200 mgr per day or amisulpride 100 mgr per day). Patients were assessed at baseline and after 3 and 6 months of follow-up. Outcome was measured using tools that assessed alcohol intake (EuropASI and Alcohol Timeline Followback), craving (OCDS), disability (WHO/DAS), and quality of life(EQ-5D); changes in biomarkers of alcohol intake were also noted. Results: at the 6-month follow-up patients taking amisulpride had poorer results than those taking topiramate in direct measures of alcohol intake (OCDS, alcohol intake, number of drinks per day and heavy drinking days), but no significant differences were found in these measures on comparing the amisulpride patients with those taking naltrexone. Conclusions: in this study, amisulpride, at a dose of 100 mgr per day, was less effective than topiramate, at a dose of 200 mg per day, but as effective as naltrexone, at a dose of 50 mg per day, for reducing alcohol intake and craving over the period of the study (AU)

La escala breve de evaluación del Síndrome de Abstinencia de la Nicotina (NDSS-S) en fumadores españoles / The Short Nicotine Dependence Syndrome Scale (NDSS-S) in Spanish smokers

Se presenta una escala breve derivada de la Escala para la Evaluación del Síndrome de la Dependencia de la Nicotina (NDSS). A una muestra de 1.061 fumadores diarios, evaluados en Centros de Atención Primaria, Unidad de Alcoholismo y Unidad de Tabaquismo, se les aplicó la NDSS y la SCID para evaluar dependencia de la nicotina con criterios DSM-IV. Los resultados indican la existencia de un factor general de dependencia de la nicotina con la NDSS. Seleccionamos los ítems con mayor carga factorial (>0,50), obteniendo una escala corta de 6 ítems. Con ella obtenemos resultados semejantes a los de la escala total en las distintas variables del estudio (sociodemográficas y de consumo de cigarrillos). Su fiabilidad es buena (alfa= 0,79), la correlación entre la escala corta y la total es muy alta (r= 0,95, p<,001) y discrimina a los fumadores en función del consumo de cigarrillos y dependencia de la nicotina, tal y como hemos evaluado con la SCID. Su funcionamiento según las curvas ROC es excelente (área de 0,84 bajo la curva). Todo ello sugiere la utilidad de esta escala breve (NDSS-S) para evaluar la dependencia de la nicotina en fumadores (AU)

We present a brief scale derived from the Nicotine Dependence Syndrome Scale (NDSS). We used a sample of 1.061 daily smokers, which was obtained from fi ve Primary Care Health Centers, a Unit of Alcoholism, and a Smoking Cessation Unit. All smokers were evaluated with the NDSS and the SCID to assess nicotine dependence according to DSM-IV criteria. The results indicate the existence of a general factor of nicotine dependence according to the NDSS. We selected the items with a higher factor loading (>.50), obtaining a short scale of 6 items. With this brief scale, we obtained results similar to those of the total scale in the diverse variables (sociodemographic and smoking) of the study. Scale reliability is satisfactory (alpha= .79), the correlation between the short and the total scale is very high (r=.95, p<.001) and the short scale discriminates the smokers in terms of cigarette consumption and nicotine dependence, as assessed with the SCID. The operation under the ROC curve is excellent (area under the curve .84). The data indicate the usefulness of this brief scale (NDSS-S) to assess nicotine dependence in smokers (AU)

[The Short Nicotine Dependence Syndrome Scale (NDSS-S) in Spanish smokers]. / La escala breve de evaluación del Síndrome de Dependencia de la Nicotina (NDSS-S) en fumadores españoles.

We present a brief scale derived from the Nicotine Dependence Syndrome Scale (NDSS). We used a sample of 1.061 daily smokers, which was obtained from five Primary Care Health Centers, a Unit of Alcoholism, and a Smoking Cessation Unit. All smokers were evaluated with the NDSS and the SCID to assess nicotine dependence according to DSM-IV criteria. The results indicate the existence of a general factor of nicotine dependence according to the NDSS. We selected the items with a higher factor loading (>.50), obtaining a short scale of 6 items. With this brief scale, we obtained results similar to those of the total scale in the diverse variables (sociodemographic and smoking) of the study. Scale reliability is satisfactory (a= .79), the correlation between the short and the total scale is very high (r=.95, p<.001) and the short scale discriminates the smokers in terms of cigarette consumption and nicotine dependence, as assessed with the SCID. The operation under the ROC curve is excellent (area under the curve .84). The data indicate the usefulness of this brief scale (NDSS-S) to assess nicotine dependence in smokers.

Topiramate for the treatment of alcohol dependence: comparison with naltrexone.

BACKGROUND: A 6-month naturalistic, randomized and open-label, trial of topiramate versus naltrexone was conducted, with assessments at enrollment and after 3 and 6 months of treatment. 182 alcohol-dependent patients who had been drinking heavily during the past month were included. METHODS: Outcome was measured using tools that assessed alcohol intake, cravings, disability, and quality of life; changes in biomarkers of alcohol intake were also used. RESULTS: At the 6-month evaluation, patients taking topiramate had significantly lower scores on the OCDS (all subscales), the EuropASI (medical, alcohol, family/social, and psychiatric) and the WHO/DAS (employment/social). More patients taking topiramate remained in the abstinence group and the moderate drinking without problems group. CONCLUSIONS: Topiramate at a mean dose of 200 mg/day was better than naltrexone at a mean dose of 50 mg/day at reducing alcohol intake and cravings throughout the study.

[Psychometric properties of the Nicotine Dependence Syndrome Scale (NDSS) in a sample of smokers treated for their alcohol dependence]. / Propiedades psicométricas de la Escala del Síndrome de Dependencia de la Nicotina (NDSS) en una muestra de fumadores que solicitan tratamiento por su dependencia del alcohol.

The assessment of nicotine dependence with brief instruments is of great relevance for the better detection of this disorder. Here we present the results with the Nicotine Dependence Syndrome Scale (NDSS) by Shiffman, Waters and Hickcox (2004) in a sample of 183 patients treated at an Alcohol Dependence Unit who were also cigarette smokers. The results indicate that the general factor which evaluates nicotine dependence (NDSS-T) has good reliability (Cronbach's alpha = 0.80). Factor analysis identifies four of the five factors proposed in the original version, those of drive, priority, continuity and stereotypy. Reliability of the scales derived ranges from very good (0.80) to moderate (0.63). The NDSS-T correlates significantly with the Fagerström Tolerance Questionnaire (FTQ), with the DSM-IV criteria for nicotine dependence assessed through the SCID, and with the number of cigarettes smoked per day. The ROC curves indicate an NDSS-T score of 0.80 under the curve (0.70 for the FTND), showing that it adequately predicts nicotine dependence. This study confirms the utility of this new instrument for assessing nicotine dependence in smokers who also abuse or depend upon alcohol.

Propiedades psicométricas de la Escala del Síndrome de Dependencia de la Nicotina (NDSS) en una muestra de fumadores que solicitan tratamiento por su dependencia del alcohol / Psychometric properties of the Nicotine Dependence Syndrome Scale (NDSS) in a sample of smokers treated for their alcohol dependence

La evaluación de la dependencia de la nicotina con instrumentos breves es de gran relevancia para una mejor detección de este trastorno. En el presente estudio se presentan los resultados con la Escala del Síndrome de Dependencia de la Nicotina (Nicotine Dependence Syndrome Scale, NDSS) de Shiffman, Waters y Hickcox (2004) en una muestra de 183pacientes que demandaron tratamiento en una Unidad de Alcoholismo y que eran además fumadores de cigarrillos. Los resultados indican que el factor general que evalúa dependencia de la nicotina (NDSS-T) tiene una buena fiabilidad (coeficiente alfa de Cronbach = 0.80). El análisis factorial indica la existencia en esta muestra de cuatro de los cinco factores propuestos en la versión original: impulso, prioridad, continuidad y estereotipia. La fiabilidad de las escalas derivadas factorialmente oscilan de muy buenas (0.80) a moderadas (0.63). La NDSS-T correlaciona significativamente con el Cuestionario de Tolerancia de Fagerström (FTQ), con los criterios de dependencia de la nicotina del DSM-IV evaluados con la entrevista SCID y con el número de cigarrillos fumados diariamente. Las curvas ROC indican que la NDSS-T tiene una puntuación de 0.80 bajo la curva (0.70 para el FTQ), lo que indica que predice adecuadamente la dependencia de la nicotina. Este estudio confirma la utilidad de este nuevo instrumento para evaluar la dependencia de la nicotina en los fumadores que al mismo tiempo abusan o dependen del alcohol (AU)

The assessment of nicotine dependence with brief instruments is of great relevance for the better detection of this disorder. Here we present the results with the Nicotine Dependence Syndrome Scale (NDSS) by Shiffman, Waters and Hickcox (2004) in a sample of 183 patients treated at an Alcohol Dependence Unit who were also cigarette smokers. The results indicate that the general factor which evaluates nicotine dependence (NDSS-T) has good reliability (Cronbach’s alpha = 0.80).Factor analysis identifies four of the five factors proposed in the original version, those of drive, priority, continuity and stereotypy. Reliability of the scales derived ranges from very good (0.80) to moderate (0.63).The NDSS-T correlates significantly with the Fagerström Tolerance Questionnaire (FTQ), with the DSM-IV criteria for nicotine dependence assessed through the SCID, and with the number of cigarettes smoked per day. The ROC curves indicate an NDSS-T score of 0.80 under the curve (0.70 for the FTND), showing that it adequately predicts nicotine dependence. This study confirms the utility of this new instrument for assessing nicotine dependence in smokers who also abuse or depend upon alcohol (AU)

Polymorphisms of the IL-1 gene complex are associated with alcohol dependence in Spanish Caucasians: data from an association study.

BACKGROUND: There is growing evidence for involvement of pro-inflammatory cytokines in alcohol dependence. The aim of this study was to investigate whether 4 functionally relevant polymorphisms of the interleukin-1 (IL-1) and tumor necrosis factor-alpha genes were associated with alcohol dependence and with measures of clinical severity and treatment outcome. METHODS: Two hundred alcohol-dependent (AD) patients and 420 healthy controls from the same Spanish Caucasian population were genotyped using standard methods. Baseline and 6-month assessments included alcohol intake, addiction severity, and biomarkers of alcohol intake. RESULTS: Alcohol-dependent patients showed an excess of IL-1alpha-889 C/T [50.8% vs. 39.3%, chi(2) (df) = 7.30 (2), uncorrected p = 0.026, corrected p = 0.104] and IL-1RA (86 bp)(n) A1/A1 genotypes [64.8% vs. 50.8%, chi(2) (df) = 12.65 (3), corrected p = 0.020]. The A1/A1 excess was associated with alcohol dependence only in men [69.9% vs. 49.5%, chi(2) (df) = 15.72 (2), corrected p < 0.001]. Six-month clinical and hematological outcome measures did not vary by genotype of the 4 polymorphisms. Haplotype analysis revealed an excess of the IL-1alpha-889 C/IL-1beta +3953 C/IL-1RA A2 haplotype in the control group compared with AD patients [20.0% vs. 14.1%, chi(2) (df) = 7.25 (1), p = 0.007; odds ratio (OR) = 0.64, 95% confidence interval (CI) = 0.46-0.89] and in the abstainers after 6 months of treatment compared with nonabstinent patients [14.7% vs. 6.2%, chi(2) (df) = 5.65 (1), p = 0.017; OR = 2.56, 95% CI = 1.15-5.62]. CONCLUSIONS: Our findings provide further tentative evidence of the role of IL-1 in alcohol dependence as well as evidence that the nature of the associations may be direct, gender-specific, or involve haplotype effects. However, findings from single association studies constitute tentative knowledge and must be interpreted carefully and precise replication is required.

Association between the Stin2 VNTR polymorphism of the serotonin transporter gene and treatment outcome in alcohol-dependent patients.

AIMS: The aim of this study was to investigate the potential association between functional polymorphisms of dopaminergic [dopamine receptor D2 (DRD2), dopamine receptor D3 (DRD3) and dopamine transporter (SLC6A3)] and serotonergic [serotonin 2A receptor (HTR2A) and serotonin transporter (SLC6A4)] genes and treatment outcome in alcohol-dependent patients. METHODS: A total of 90 Spanish Caucasian alcohol-dependent outpatients (ICD-10 criteria) were enrolled in the study. The association between genotypes and drinking outcomes was measured over 6 months of treatment. Biomarkers of alcohol consumption, as well as alcohol consumption and its consequences, craving, disability and quality of life, were assessed. Based on those measures, we created a composite secondary measure to globally assess treatment outcome in alcoholism. RESULTS: No association was found between DRD2, DRD3, SLC6A3 or HTR2A gene variants and treatment outcome. However, SLC6A4 STin2 12/12 carriers showed poor 6-month time point treatment outcome [32.8% in the good outcome group versus 64.0% in the poor outcome group, chi(2) (df) = 7.20 (1), corrected P = 0.042, OR (95% CI) = 0.27 (0.10-0.72)]. Nevertheless, independent analysis of each treatment group reveals that the excess of 12/12 carriers in the poor outcome group was only found in the naltrexone-treated group [24.1% versus 64.7% chi(2) (df) = 7.41 (1), corrected P = 0.042, OR (95% CI) = 0.17 (0.05-0.64)]. In the whole sample, the L-10 repeats haplotype (5-HTTLPR-STin2 VNTR) is associated with good outcome (LRT = 3.88, df = 1, P = 0.049). CONCLUSIONS: Our findings suggest that functional polymorphism of the SLC6A4 gene may have an influence on treatment outcome in alcohol-dependent patients.

Using topiramate or naltrexone for the treatment of alcohol-dependent patients.

BACKGROUND: To compare topiramate versus naltrexone in the treatment of alcohol dependence. METHODS: A 6-month naturalistic, randomized and open-label, trial of topiramate versus naltrexone, with assessments at enrollment and after 3 and 6 months of treatment. The setting was an outpatient alcohol clinic. One hundred and two alcohol-dependent patients who had been drinking heavily during the past month were included. Two randomized groups were created. In one, naltrexone was used as the therapeutic agent and, in the other, topiramate was chosen as the therapeutic agent. Both groups received psychological relapse prevention therapy. Outcome was measured using tools that assessed alcohol intake, cravings, disability, and quality of life; changes in biomarkers of alcohol intake were also used. With all the data, a secondary composite measure was created in order to assess each patient's global alcohol intake and its consequences. RESULTS: Both groups showed substantial reduction in their drinking. Naltrexone patients had higher nicotine consumption throughout the study. Topiramate was better at reducing alcohol-related cravings throughout the study. Both treatments had a similar mean cost throughout the study. CONCLUSIONS: Both topiramate and naltrexone were efficacious in the treatment of alcohol dependence, and the treatment costs were similar. There is a trend for topiramate to be superior to naltrexone on critical measures of drinking; however, the study did not have adequate statistical power to establish this fact.