Department of Clinical and Experimental Psychology and Research Center for Natural Resources, Health and the Environment, University of Huelva, Facultad de Ciencias de la Educación, 21071 Huelva, Spain.
Department of Clinical and Experimental Psychology, University of Huelva, Facultad de Ciencias de la Educación, 21071 Huelva, Spain.
J Subst Abuse Treat. 2019 Jan;96:33-38. doi: 10.1016/j.jsat.2018.10.004. Epub 2018 Oct 18.
Impulsivity has been consistently associated with poorer addiction treatment outcomes. However, impulsivity is a multifaceted construct and current evidence have failed to unravel which specific aspects explain this relationship. There is also limited research examining long-term outcomes. We aimed to examine the longitudinal association between baseline performance on a comprehensive battery of impulsivity measures and retention and relapse at the end of treatment.
The sample comprised 68 participants with miscellaneous diagnoses of substance use disorders and polysubstance use patterns, enrolled in public residential therapeutic communities in Andalusia (Spain). At baseline, we applied measures of selective attention (Stroop), response inhibition (Affective Go/No Go), delay discounting (Monetary Choice Questionnaire; MCQ), and decision-making (Iowa Gambling Task; IGT). At the end of treatment (mean = 148.36 days, range = 22-289 days), we collected outcome measures of retention (coded by the clinical team as completion or dropout based on statewide practice guidelines) and relapse (defined as at least two separate alcohol/drug use episodes based on urine analyses).
Cox regression models showed that poorer decision-making in the IGT was associated with premature treatment dropout, whereas elevated commission errors in the Affective Go/No Go were associated with higher relapse rates. Selective attention and delay discounting were unrelated to outcomes.
Long-term based decision-making skills are important to commit to the complex and intensive treatment programs of therapeutic communities. The ability to withhold behavioural responses under positive affect is relevant to prevent relapse. Both skills should be assessed and potentially trained during therapeutic community treatment.
冲动性与较差的成瘾治疗结果密切相关。然而，冲动性是一个多方面的概念，目前的证据未能阐明哪些具体方面解释了这种关系。关于长期结果的研究也很有限。我们旨在检验基线时综合冲动性测量的表现与治疗结束时保留和复发之间的纵向关联。
该样本包括 68 名患有各种物质使用障碍和多种物质使用模式的患者，他们参加了安达卢西亚（西班牙）的公共住宿治疗社区。在基线时，我们应用了选择性注意（Stroop）、反应抑制（情感 Go/No Go）、延迟折扣（货币选择问卷；MCQ）和决策（爱荷华赌博任务；IGT）的测量。在治疗结束时（平均为 148.36 天，范围为 22-289 天），我们收集了保留（根据全州实践指南，临床团队根据是否完成或退出治疗进行编码）和复发（根据尿液分析定义为至少两次单独的酒精/药物使用事件）的结果测量。
Cox 回归模型显示，IGT 中较差的决策能力与提前治疗退出有关，而在情感 Go/No Go 中较高的错误率与较高的复发率有关。选择性注意和延迟折扣与结果无关。
基于长期的决策技能对于承诺接受治疗社区的复杂和密集治疗计划很重要。在积极情感下抑制行为反应的能力与预防复发有关。在治疗社区治疗期间，应评估和潜在地训练这两种技能。
