Effectiveness of the Brief Guided Self-Change Therapy Combined with Varenicline under "Real-Life" Conditions and Mediators for Smoking Cessation.

Background: Brief therapies have proven to reduce tobacco cost-effectively, however, unsuccessful quit attempts remain notable in real-life conditions, and the underlying mechanisms of treatment success are still unclear. Objectives: We aimed to analyze the effectiveness of the Guided Self-Change (GSC) therapy combined with varenicline (VAR+T) in public health services against varenicline alone (VAR), and to identify mediators of treatment outcomes. We conducted a two-arm quasi-experimental study with 126 treatment-seeking smokers (age=57.3±9.1 years; 59.5% women). Before treatment, and at weeks 12 and 24, we assessed tobacco use and five potential mediators: withdrawal, craving, motivation to quit, anxiety, and depression. Results: Only 25% of participants adhered to varenicline prescription, and 54% to GSC therapy. VAR+T group showed a greater proportion of abstainers compared to VAR group at week 12 (75% vs 57.4%; φc=0.21) and week 24 (62.9% vs 52.5%; φc=0.10). When controlling for weeks taking varenicline, motivation showed a significant indirect effect over abstinence rates in VAR+T compared with VAR (a1b1=1.34; 95%CI=0.04, 5.03). Conclusions: The GSC effectiveness seems to increase motivation which in turn contributes to reducing tobacco use. The implementation of GSC therapy in public health services could minimize treatment duration and increase smoking abstinence in 'real-life' conditions where varenicline adherence remains low.

Validation of the Glover-Nilsson Smoking Behavioral Questionnaire (GN-SBQ) to Evaluate Nicotine Dependence in Spanish Clinical Settings.

An assessment of the different aspects of tobacco addiction is central to adapting interventions to the profiles and needs of smokers. The Glover−Nilsson Smoking Behavioral Questionnaire (GN-SBQ) is one of the few and most used scales to evaluate the behavioral aspects of tobacco addiction. However, few studies involve the validation of the GN-SBQ in clinical settings. Thus, this study aimed to analyze the psychometric properties of the GN-SBQ in a sample of Spanish smokers. A total of 341 smokers attending clinical services in Spain participated in this cross-sectional study. Measures included the psychological factors related to tobacco addiction, assessed with the GN-SBQ, the physical factors of nicotine addiction, withdrawal symptoms, smoking-related variables, and alcohol use. Data analysis included descriptive statistics, internal consistency coefficients, confirmatory factor analyses, Spearman correlations, and the Kruskal−Wallis test. The GN-SBQ showed adequate reliability (α = 0.76 and ω = 0.76) and a unidimensional structure. GN-SBQ scores also provided evidence of convergent and concurrent validity. GN-SBQ scores significantly correlated with the physical symptoms of addiction, age, number of cigarettes, and withdrawal symptoms. The results of discriminant validity were also adequate, as no correlation was observed between GN-SBQ scores and CO levels or alcohol use. Significant differences were found between all levels of psychological addiction based on the GN-SBQ scores regarding physical nicotine addiction, withdrawal symptoms, and age. Thus, this questionnaire is a reliable and valid instrument to assess the psychological aspects of tobacco addiction in smokers in clinical settings. The short length of the GN-SBQ proves advantageous for its use in time-limited assessments, which are common in public health services.

Psychometric Validity of the Minnesota Tobacco Withdrawal Scale in Smokers Attempting to Quit: Longitudinal Invariance across Smokers and Abstainers.

Tobacco withdrawal symptoms vary during smoking cessation increasing relapse risk; therefore, a longitudinal invariant measure seems necessary to validly assess withdrawal changes. This study aimed to examine the psychometric properties of the 7-item Minnesota Tobacco Withdrawal Scale (MTWS) during cessation, and to analyze longitudinal invariance across smokers and abstainers. We conducted a longitudinal study with 309 Spanish smokers (56.2 ± 9.9 years; 52.4% women). We assessed withdrawal at three occasions: pre-treatment (T1), week-12 (T2), and week-24 (T3). Reliability, validity, and invariance analyses were performed. MTWS reliability remained adequate over time (ωT1 = 0.78; ωT2 = 0.68; ωT3 = 0.80) in both smokers and abstainers, with satisfactory temporal stability (ICC = 0.73). MTWS correlations with anxiety, depression, and nicotine dependence (rs > 0.3) supported convergent and concurrent validity. MTWS showed no correlation with craving at T2 (rs < 0.24), suggesting discriminant validity. Unifactorial structure proved partial scalar invariance across time (χ2 = 246.009; CFI = 0.91; IFI = 0.91; SRMR = 0.09), yet longitudinal invariance between abstainers and smokers was not supported. Across groups, partial scalar invariance was only achieved at T2. Noninvariance at T3 was mainly due to item irritability (dMACS = 0.93). The MTWS is reliable and valid measure to assess withdrawal changes during cessation. Long-term MTWS comparisons between smokers and abstainers should be taken with caution since different withdrawal patterns may exist.

Differential Experience of Interdose Withdrawal During Long-Term Opioid Therapy and its Association With Patient and Treatment Characteristics: A Latent Class Analysis in Chronic Pain Population.

Opioid withdrawal is characterized by a set of physical and psychological symptoms that depend on both opioid and patient specific characteristics. The present study aims to identify different latent classes of chronic pain patients according to the type of opioid withdrawal symptoms experienced, and to analyze the relationships between the classes and demographic, opioid therapy, psychological and substance use variables. This cross-sectional descriptive study included 391 chronic pain patients on long-term opioid therapy. A Latent Class Analysis (LCA) identified 3 classes (BIC = 7051.89, entropy = .87, LRTs P < .01). The mild withdrawal class showed low probabilities of presenting physical and psychological symptoms, the moderate withdrawal class was characterized by experiencing psychological symptoms, and the severe withdrawal class stood out for high probabilities of presenting both types of symptoms. The classes differed from each other, with higher rates of moderate-severe POUD, opioid misuse, anxiety, depression, and greater pain intensity and interference in more severe withdrawal classes (P < .05). The multinomial logistic regression showed that moderate-severe POUD and anxiety were the strongest variables related to moderate (ORPOUD = 3.34, ORAnxiety = 2.58) and severe withdrawal classes (ORPOUD = 4.26, ORAnxiety = 5.15). Considering that POUD and anxiety were strongly related to a more severe withdrawal syndrome, the inclusion of psychological interventions in pain management seems critical in this population. PERSPECTIVE: Although interdose opioid withdrawal is common in chronic pain patients, this study shows 3 different patterns in its experience (mild, moderate, and severe withdrawal). A more severe withdrawal may result in reduced effectiveness of opioids in relieving pain and increased negative consequences, such as higher risk of POUD. Findings that could help improve chronic pain management.

Predicting PTSS in general population during COVID-19 pandemic: The mediating role of health anxiety.

BACKGROUND: Despite health anxiety (HA) is associated with higher incidence of anxiety disorders, no studies have examined the association between this variable and the increased levels of Post-Traumatic Stress Symptoms (PTSS) reported during COVID pandemic. METHODS: This study was conducted online between April and May 2020. Data were collected from 468 men and women from the Spanish general population. Sociodemographic and COVID-19-related data, health anxiety, PTSS, fear of becoming infected, social support, sleep problems and past/current psychological/psychiatric history were assessed. The mediating effect of HA when predicting PTSS was explored with mediational analyses. Moderated mediational analyses were also performed to test if receiving psychological treatment during pandemic changes the mediating effect of HA. RESULTS: Prevalence of PTSS was higher in high-scorers in HA (p<.01). High HA was also more likely to be reported by women, individuals with sleep problems, frequently fear of getting infected, and those who have previously received psychological treatment (p<.01). HA mediates the relationship between PTSS and the following predictors of PTSS: sleep problems, psychiatric history and fear of getting infected. Being under psychological treatment did not moderate the mediating effect of health anxiety. LIMITATIONS: Further longitudinal studies with bigger sample sizes are needed to examine the causal relationship between HA and PTSS after COVID-19 pandemic. CONCLUSIONS: Our findings suggest that HA could influence the psychological consequences of the pandemic. Screening of HA could be useful to identify people with heightened risk of developing PTSS during pandemic.

The Moderating Role of Caregiving on Fear of COVID-19 and Post-Traumatic Stress Symptoms.

Caregiving has been associated with increased levels of fear and post-traumatic stress symptoms (PTSS) during COVID-19 pandemic. However, there is a lack of studies that analyze when the relationship between fear and PTSS occur, using informal caregiving as a moderator variable. To explore this moderating role, we conducted a cross-sectional online study between November 2020 and January 2021. A total of 503 men and women from the Spanish general population completed the survey. Sociodemographic and Covid-19-related data, fear of COVID-19, PTSS symptoms, and current psychological history were assessed. Prevalence of informal caregiving in the sample was 16.5%. Increased levels of fear and PTSS were found in caregivers compared to non-caregivers. Female gender and high number of COVID-19 related risk factors was also associated with fear and PTSS severity. The moderation analyses showed an interaction effect between caregiving and fear of COVID-19 when predicting PTSS symptoms. Particularly, results showed that informal caregivers reported greater PTSS symptoms, when compared to non-caregivers with same levels of fear of COVID-19. This evidence suggests that being a caregiver could increase the fear's impact on PTSS severity in the context of pandemics. Further studies with larger samples are needed to confirm these findings.

Clinical and psychological factors associated with interdose opioid withdrawal in chronic pain population.

BACKGROUND: The DSM-5 diagnostic criteria for Prescription Opioid-Use Disorder (POUD) have undergone some significant changes. One of the most controversial changes has been the elimination of the withdrawal symptoms criterion when opioid use is under appropriate medical supervision. For this reason, the goal of this study was to analyze factors associated with opioid withdrawal in patients with chronic non-cancer pain (CNCP). METHODS: This cross-sectional descriptive study involved 404 patients who use prescription opioids for long-term treatment (≥90 days) of CNCP. Measures included sociodemographic and clinical characteristics, POUD, withdrawal symptoms, craving, anxiety-depressive symptoms, and pain intensity and interference. RESULTS: Forty-seven percent (n = 193) of the sample reported moderate-severe withdrawal symptoms, which were associated with lower age, higher daily morphine dose and duration of treatment with opioids, moderate-severe POUD, use of psychotropic drugs, higher anxiety-depressive symptoms, and greater pain intensity and interference (p < .05). Binary logistic regression analysis showed that moderate-severe POUD (OR = 2.82), anxiety (OR = 2.21), depression (OR = 1.81), higher pain interference (OR = 1.05), and longer duration of treatment with opioids were the strongest factors associated with moderate-severe withdrawal symptoms (p < .05). CONCLUSION: Psychological factors seem to play a key role in the severity of withdrawal symptoms. Since greater intensity of these symptoms increases the risk of developing POUD, knowing the factors associated with withdrawal may be useful in developing preventive psychological interventions.

Brief version of the Pittsburgh Sleep Quality Index (B-PSQI) and measurement invariance across gender and age in a population-based sample.

The Pittsburgh Sleep Quality Index (PSQI) is the most widely used questionnaire in research and clinical practice to assess sleep quality. However, a brief version of this measure would improve its efficiency and applicability. This study aimed to develop a brief form of the PSQI and to study measurement invariance across gender and age in a nonclinical population. In total, 609 participants with a mean age of 37.3 years (standard deviation [SD] = 11.9) were recruited, of whom 71.8% (n = 437) were women. Participants completed online versions of the PSQI and the Insomnia Severity Index (ISI). Reliability analyses were performed to reduce the number of items, followed by validity and measurement invariance analyses for the new Brief Version of the PSQI (B-PSQI). Six questions were included in the B-PSQI out of the initial 18; the brief form had adequate internal consistency (α = .79 and ω = 0.91). Confirmatory factor analysis showed optimal fit of the B-PSQI (χ2(4) = 22.428; p < .01; comparative fit index (CFI) = 0.99; normed fit index (NFI) = 0.99; Tucker-Lewis index (TLI) = 0.98; root mean squared error of approximation (RMSEA) = 0.06; standardized root mean square residual (SRMR) = 0.04), achieving partial scalar invariance across gender-same factorial structure, loadings, and thresholds in the majority of the items. Invariance across age was only achieved for model structure. Additionally, the B-PSQI yielded favorable sensitivity (75.82%) and specificity (76.99%) for classifying poor sleepers, similar to values for the full PSQI. In conclusion, the B-PSQI is a brief, reliable, and valid measure that can be used as a screening tool, allowing valid score comparisons between men and women of similar age. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Adjective Rating Scale for Withdrawal: Validation of its ability to assess severity of prescription opioid misuse.

BACKGROUND: Withdrawal symptoms have been widely shown to be a useful indicator of the severity of opioid dependence. One of the most used instruments to assess them is the Adjective Rating Scale for Withdrawal (ARSW). However, there is a lack of adaptations and validations for its use with prescription opioids, even less for chronic pain patients under treatment with these analgesics. Thus, the aims of this study were to analyse the psychometric properties and invariance across gender of the ARSW in a sample of chronic noncancer pain patients. METHODS: Data were collected from 208 consumers of opioid medication, chronic noncancer pain patients. Participants completed sociodemographic, ARSW, prescription opioid dependence (DSM-IV-TR) and prescription opioid-use disorder (DSM-5) measurements. Gender invariance was assessed through multigroup confirmatory factor analysis (CFA). RESULTS: The ARSW showed a unidimensional factor structure and high internal consistency (Cronbach's alpha = 0.85). Multigroup CFA showed configural, metric, scalar and strict invariances of ARSW across gender. Predictive validity analyses indicated that ARSW has good capacity for identifying the severity of prescription opioid-use disorder, using both DSM-IV-TR and DSM-5 criteria. CONCLUSIONS: These findings show that the ARSW is a valid and reliable tool for use in the assessment of the withdrawal of prescription opioids in chronic pain patients under treatment with these analgesics, regardless of their gender. SIGNIFICANCE: Findings supported the reliability and validity of the ARSW to assess withdrawal of prescription opioids in individuals with chronic noncancer pain. The instrument can be applied indistinctly in men and women. An increase in the ARSW scores could be used as an indicator of potential risk of prescription opioid-use disorder during long-term treatments.

Withdrawal symptoms predict prescription opioid dependence in chronic pain patients.

BACKGROUND: The last version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes substantial changes for prescription opioid-use disorder (POUD). After its removal as a criterion, the goal of this study was to estimate the prevalence of withdrawal symptoms in long-term users of prescription opioids and its association with the new DSM-5 POUD classification. METHODS: Data were collected from 215 long-term consumers of opioid medication who were chronic non-cancer pain patients. Participants completed sociodemographic, Adjective Rating Scale for Withdrawal (ARSW), opioid treatment characteristics, POUD criteria (DSM-5), and pain intensity measurements. RESULTS: 26.6% of the participants were classified with moderate to severe POUD. Higher intensity of withdrawal symptoms was found in patients with moderate/severe POUD, younger age, and higher pain intensity (p < .01). Anxiolytics (p < .01) and antidepressants use (p < .05) and percentage of smokers (p < .05) were significantly higher in patients with severe withdrawal. Logistic regression analyses suggested moderate [odds ratio (OR) = 3.25] and severe (OR = 10.52) withdrawal as the strongest predictor of POUD. Age, anxiolytics use, and smoking were also associated with POUD, but multilevel analysis showed that these variables do not moderate the association between withdrawal intensity and POUD. CONCLUSION: Escalation of withdrawal intensity during opioid treatment can be used to identify patients with POUD. Further studies are needed to assess the clinical implications of these findings during long-term opioid therapy for chronic pain.

Academic outcomes and cognitive performance in problematic Internet users. / Rendimiento académico y cognitivo en el uso problemático de Internet.

Only few studies have examined the relationship between problematic Internet use (PIU) and cognitive and academic performance in adolescents. The aim of this study was to analyze the differences in academic and cognitive performance (perception, attention, memory, verbal fluency and abstract reasoning) between adolescents with and without PIU. A total of 575 students from different high schools of the region of Alicante participated. Students were divided into two groups: adolescents with and without PIU (PIU and NPIU, respectively). Several questionnaires were administered to assess problematic Internet use, as well as students' academic performance. Substance use (alcohol / cannabis) was also assessed as exclusion criteria. A battery of neuropsychological tests was used to assess cognitive abilities. On the one hand, PIU users group obtained poorer academic results than NPIU, in terms of lower marks and more failed subjects. On the other hand, PIU group had a better hit ratio in the perception test than NPIU group. However, PIU adolescents got higher error rates for the abstract reasoning test. This greater number of errors, plus a similar number of hits compared to the NPIU group, could indicated a higher response rate for the PIU group, which may might be associated with greater impulsivity. As occurs in other addictive and non-substance-related problems studies, these results could mean difficulties in impulse control and regulation of response inhibition circuits in PIU users group. Future research is needed to analyze in depth the results presented in this paper.

Son escasos los estudios que hayan analizado la relación entre el uso problemático de Internet (UPI) y el rendimiento cognitivo y académico en adolescentes. El objetivo de este estudio fue analizar las diferencias en rendimiento académico y cognitivo (percepción, atención, memoria, fluidez verbal y razonamiento abstracto) en una muestra de estudiantes de Secundaria con y sin UPI. Participaron un total de 575 estudiantes de diferentes institutos de la provincia de Alicante, que fueron divididos en dos grupos: adolescentes con y sin uso problemático de Internet (UPI y NUPI, respectivamente). Se administraron varios cuestionarios para evaluar el uso problemático de Internet de los sujetos, su rendimiento académico, su consumo de sustancias (alcohol/cannabis) como criterios de exclusión, así como una batería de pruebas neuropsicológicas para evaluar sus habilidades cognitivas. Por un lado, los adolescentes con UPI mostraron un peor rendimiento académico que los estudiantes del grupo NUPI, presentando una nota media más baja y un mayor número de asignaturas suspendidas. Por otro lado, el grupo UPI obtuvo una mayor tasa de aciertos en el test de percepción que el grupo NUPI. Sin embargo, los adolescentes con UPI obtuvieron una mayor tasa de errores para el test de razonamiento abstracto. Este mayor número de errores, sumado a un número similar de aciertos que NUPI, indicaría una mayor tasa de respuesta total para el grupo UPI, que podría estar asociada a mayor impulsividad. Concretamente, tal y como se ha observado en otros problemas adictivos con y sin sustancia, estos resultados podrían indicar en los sujetos del grupo UPI dificultades en el control de impulsos y en la regulación de los circuitos de inhibición de respuesta. Resultan necesarios, no obstante, futuros estudios que profundicen en las conclusiones presentadas en este trabajo.

Rendimiento académico y cognitivo en el uso problemático de Internet / Academic outcomes and cognitive performance in problematic Internet users

Son escasos los estudios que hayan analizado la relación entre el uso problemático de Internet (UPI) y el rendimiento cognitivo y académico en adolescentes. El objetivo de este estudio fue analizar las diferencias en rendimiento académico y cognitivo (percepción, atención, memoria, fluidez verbal y razonamiento abstracto) en una muestra de estudiantes de Secundaria con y sin UPI. Participaron un total de 575 estudiantes de diferentes institutos de la provincia de Alicante, que fueron divididos en dos grupos: adolescentes con y sin uso problemático de Internet (UPI y NUPI, respectivamente). Se administraron varios cuestionarios para evaluar el uso problemático de Internet de los sujetos, su rendimiento académico, su consumo de sustancias (alcohol/cannabis) como criterios de exclusión, así como una batería de pruebas neuropsicológicas para evaluar sus habilidades cognitivas. Por un lado, los adolescentes con UPI mostraron un peor rendimiento académico que los estudiantes del grupo NUPI, presentando una nota media más baja y un mayor número de asignaturas suspendidas. Por otro lado, el grupo UPI obtuvo una mayor tasa de aciertos en el test de percepción que el grupo NUPI. Sin embargo, los adolescentes con UPI obtuvieron una mayor tasa de errores para el test de razonamiento abstracto. Este mayor número de errores, sumado a un número similar de aciertos que NUPI, indicaría una mayor tasa de respuesta total para el grupo UPI, que podría estar asociada a mayor impulsividad. Concretamente, tal y como se ha observado en otros problemas adictivos con y sin sustancia, estos resultados podrían indicar en los sujetos del grupo UPI dificultades en el control de impulsos y en la regulación de los circuitos de inhibición de respuesta. Resultan necesarios, no obstante, futuros estudios que profundicen en las conclusiones presentadas en este trabajo

Only few studies have examined the relationship between problematic Internet use (PIU) and cognitive and academic performance in adolescents. The aim of this study was to analyze the differences in academic and cognitive performance (perception, attention, memory, verbal fluency and abstract reasoning) between adolescents with and without PIU. A total of 575 students from different high schools of the region of Alicante participated. Students were divided into two groups: adolescents with and without PIU (PIU and NPIU, respectively). Several questionnaires were administered to assess problematic Internet use, as well as students' academic performance. Substance use (alcohol / cannabis) was also assessed as exclusion criteria. A battery of neuropsychological tests was used to assess cognitive abilities. On the one hand, PIU users group obtained poorer academic results than NPIU, in terms of lower marks and more failed subjects. On the other hand, PIU group had a better hit ratio in the perception test than NPIU group. However, PIU adolescents got higher error rates for the abstract reasoning test. This greater number of errors, plus a similar number of hits compared to the NPIU group, could indicated a higher response rate for the PIU group, which may might be associated with greater impulsivity. As occurs in other addictive and non-substance-related problems studies, these results could mean difficulties in impulse control and regulation of response inhibition circuits in PIU users group. Future research is needed to analyze in depth the results presented in this paper

Barriers for identification and treatment of problem drinkers in primary care / Barreras para la identificación y la intervención en bebedores problemáticos en atención primaria

Objective: Due to the lack of studies in the Spanish population, this study aims to analyze the barriers perceived by health professionals from different Spanish health centers when attempting to identify and treat problem drinkers and the importance given to this aspect, as well as analyzing the possible differences as a function of the professionals’ health teams. We also analyze the psychometric properties of the questionnaire used to assess these barriers. Method: The participants included 107 health professionals: 62.7% belonged to the medical team and 32.4% to the nursing team. After we had reviewed previous studies, collecting the main barriers referred to in them, participants completed an ad hoc questionnaire. Results: The main barriers found were the belief that patients will lie about their actual consumption and will not identify its negative consequences, and the belief that they will reject participating in an intervention for their alcohol consumption. No significant differences between doctors and nurses were found in any of the barriers assessed. The results provide empirical evidence of the reliability of the test for the assessment by both teams of professionals. Conclusions Studies are needed to examine in greater depth these conclusions, extending the number of variables studied to determine a more complete profile of the health professionals who are reluctant to incorporate the assessment and treatment of problem drinkers in their consultation. This could help to improve the design of programs to facilitate and encourage its implementation in primary care (AU)

Objetivo: Ante la falta de estudios en población española, el objetivo de este estudio fue analizar las barreras percibidas por los profesionales sanitarios de los centros de salud españoles en la identificación y el tratamiento de los bebedores problemáticos, y la importancia otorgada a su realización, analizando las posibles diferencias existentes en función del equipo sanitario al que pertenecen; y también analizar las propiedades psicométricas del cuestionario utilizado para evaluar dichas barreras. Método: Participaron 107 profesionales sanitarios, un 62,7% del equipo médico y un 32,4% del equipo de enfermería. Tras una revisión de estudios previos, fueron evaluados con un cuestionario ad hoc que recogía las principales barreras mencionadas en aquellos. Resultados: Creer que el paciente mentirá sobre lo que realmente bebe, que no identificará las consecuencias negativas de su consumo y que no accederá a recibir intervención sobre su consumo de alcohol son las principales barreras encontradas. No se encontraron diferencias significativas entre médicos/as y enfermeros/as en ninguna de las barreras evaluadas. Los resultados aportan evidencia empírica a favor de la fiabilidad de la prueba para la evaluación de ambos equipos profesionales. Conclusiones: Resultan necesarios estudios que profundicen en las conclusiones presentadas, ampliando el número de variables estudiadas para determinar un perfil más completo del profesional sanitario reticente a la hora de incorporar la identificación y la intervención de bebedores problemáticos en su consulta. De esta forma se podría ayudar a mejorar el diseño de programas que faciliten e incentiven su implementación en atención primaria (AU)

Barriers for identification and treatment of problem drinkers in primary care.

OBJECTIVE: Due to the lack of studies in the Spanish population, this study aims to analyze the barriers perceived by health professionals from different Spanish health centers when attempting to identify and treat problem drinkers and the importance given to this aspect, as well as analyzing the possible differences as a function of the professionals' health teams. We also analyze the psychometric properties of the questionnaire used to assess these barriers. METHOD: The participants included 107 health professionals: 62.7% belonged to the medical team and 32.4% to the nursing team. After we had reviewed previous studies, collecting the main barriers referred to in them, participants completed an ad hoc questionnaire. RESULTS: The main barriers found were the belief that patients will lie about their actual consumption and will not identify its negative consequences, and the belief that they will reject participating in an intervention for their alcohol consumption. No significant differences between doctors and nurses were found in any of the barriers assessed. The results provide empirical evidence of the reliability of the test for the assessment by both teams of professionals. CONCLUSIONS: Studies are needed to examine in greater depth these conclusions, extending the number of variables studied to determine a more complete profile of the health professionals who are reluctant to incorporate the assessment and treatment of problem drinkers in their consultation. This could help to improve the design of programs to facilitate and encourage its implementation in primary care.

Evaluación psicológica del abuso de fármacos opioides / Psychological assessment of opioid drug abuse

El incremento de la preinscripción de fármacos analgésicos opioides se ha asociado a un aumento de las tasas de abuso y las consecuencias negativas asociadas a su uso inadecuado. Diversos organismos sanitarios internacionales recomiendan la realización de una evaluación global y multidisciplinar del paciente durante todo el proceso terapéutico con opiáceos, con el fin de identificar un posible abuso. Ante la ausencia de quías específicas en el ámbito sanitario español, el objetivo de este artículo ha sido presentar una propuesta de evaluación psicológica, en base a los principales instrumentos de evaluación, disponibles actualmente para evaluar el abuso de opioides. Se establecen pautas para el proceso de evaluación en función de las variables psicológicas que puedan predecir y mantener dicho abuso, clasificando todo ello en función del momento del proceso terapéutico en el que los pacientes se encuentren, Aunque existen instrumentos con buenas propiedades psicométricas, son necesarias futuras investigaciones para la adaptación, traducción y validación de éstos a población española. Al mismo tiempo son necesarios futuros estudios que profundicen en estrategias de prevención e intervención para reducir la probabilidad de abuso en pacientes tratados con fármacos opioides

The increase in opioid analgesics prescription is related to increased opioid abuse rates and medication misuse negative consequences. Several international health organizations recommend a comprehensive and multidisciplinary patient assessment throughout opioid treatment in order to identify and prevent abuse of medication. Due to the lack of specific clinical guidelines in the Spanish National Health System, the aim of this paper to present a psychological assessment proposal regarding to the main psychological tools currently available to assess opioid abuse. The assesment guidelines have been stablished based on the psychological variables that can predict and prolong the abuse, classifying all depending on the moment of the therapeutic process in which patients are. Although there are instruments with good psychometric properties, future researches are necessary to adapt, translate and validate these for its use in the Spanish population. Future studies are also needed to delve into intervention and prevention strategies to reduce the likelihood of abuse in patients treated with opioids