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Clinical and Translational Science Award (CTSA) TL1 trainees and KL2 scholars were surveyed to determine the immediate impact of the COVID-19 pandemic on training and career development. The most negative impact was lack of access to research facilities, clinics, and human subjects, plus for KL2 scholars lack of access to team members and need for homeschooling. TL1 trainees reported having more time to think and write. Common strategies to maintain research productivity involved time management, virtual connections with colleagues, and shifting to research activities not requiring laboratory/clinic settings. Strategies for mitigating the impact of the COVID-19 pandemic on training and career development are described.
To evaluate the effect of pregabalin as a tapering therapy over the subjective sleep quality of patients who underwent a benzodiazepine withdrawal program.
This was a secondary analysis of a 12-week, prospective, and observational study carried out in patients aged 18 years or over, who met DSM-IV-TR criteria for benzodiazepine dependence without other major psychiatry disorder. Evaluations included the Benzodiazepine Withdrawal Symptom Questionnaire, the Hamilton Anxiety Rating Scale, the Clinical Global Impression scale, and the MOS-Sleep Scale. Changes from baseline to the endpoint in the different scales’ scores as well as correlations of these changes with those of the MOS-Sleep scores were calculated.
282 patients met the criteria for analysis. Mean pregabalin dose was 315 (166) mg/day at end-of-trial. We observed a significant and clinically relevant improvement in sleep outcomes at the study endpoint as measured with the MOS-Sleep Summary Index, that was reduced from 55.8 (18.9) pts at baseline to 25.1 (18.0) pts at week 12 (55% reduction), as well as with the six dimensions of the MOS-Sleep Scale. Moderate correlations were observed between Summary Index and sleep domains with improvements in the anxiety symptoms and in the disease severity as well. Also, sleep ameliorations were observed in the 52% successfully benzodiazepines withdrawals but, although to a lesser extent, in the remaining failures as well.
Pregabalin treatment improves subjective sleep quality in patients who underwent a benzodiazepine withdrawal program and this effect appears partly independent of the improvement of anxiety or withdrawal symptoms.
Benzodiazepines are widely used drugs. However, their chronic use has revealed that they can lead to dependence. The objective of this study is to review the different pharmacological strategies used in the management of benzodiazepine dependence and new trends in pharmacological interventions.
We searched in MEDLINE and in the Cochrane Database System Review, selecting studies from 1980 until the present, in which a pharmacological intervention was made for benzodiazepine detoxification in mono-dependence cases.
There is a consensus about gradual rather than abrupt tapering benzodiazepines in benzodiazepine discontinuation. Other extended traditional strategy has been switching from short half-life to long half-life benzodiazepines before gradual taper. A great variety of agents have been used as adjuvant medication in Benzodiazepine Withdrawal Syndrome (BWS) with varying degrees of success. In the last years research has focus in the use of anticonvulsant drugs. Both carbamzepine and valproate, have demonstrated to be beneficial in benzodiazepine discontinuation. Also, preliminary data suggest that new anticonvulsant agents (gabapentin, pregabalin, oxcarbazepine and topiramate) could be helpful.
Although multiple drugs have been investigated for pharmacological management of BWS, only few have demonstrated significant efficacy. Anticonvulsant drugs are one of them. Both, carbamazepine and valproate, have shown benefits in reducing withdrawal severity. The available data currently support the use of new anticonvulsant (gabapentin, pregabalin, oxacarbazepine and topiramate), in the treatment of different drug-dependences such as alcohol, cocaine and opiate dependence. Moreover, there is a growing trend in the literature toward the use of these agents in benzodiazepine mono-dependence.
Startle reflex (SR) is a defensive response to sudden, intense stimuli. Prepulse inhibition (PPI) refers to the ability of innocuous sensory events to reduce SR. PPI has been described as an operational measure of sensorimotor gating that is reduced in several neuropsychiatric disorders, such as schizophrenia, but there is no extensive experience in addictions and alcoholism. The objective of this study was to examine the existence of impairments on SR and PPI in abstinent alcoholic males.
Subjects were 40 abstinent alcoholic males, aged 18 to 65 years (mean age 44.73), who had met DSM-IV criteria for Alcohol Dependence, being abstinent for more than a month at the moment they were tested. Participants underwent testing for PPI. Subjects were then compared with 35 equal controls.
Magnitudes of the SR were lower in abstinent alcoholic males when compared with controls. This differences were significant (p< 0,05) in trials with prepulse presented 30, 60 or 120 msec before the onset of startle stimulus. There was a significant less percentage of PPI when prepulse was presented 30 msec before the startle stimulus (p< 0,05).
Abstinent alcoholic males exhibit a decrease in the startle response magnitude and in the PPI of the SR. These data suggest that sensory information processing mechanisms could be damaged in abstinent alcoholic patients. The fact that these findings are common to other psychiatric disorders, could indicate the existence of a common vulnerability marker, and could explain the important comorbidity between alcoholism and other mental illness.
Impulsivity is associated with different types of disorders, included substance used disorders. The purposed of this study is get to know if alcohol and cocaine affect in the same way to the impulsivity paradigms or if they strength each other or if there are specific bias associated to each one of the substances.
Material and methods
This is a 380 heavy drinker patient's sample recruited from twelve primary care centers. The patients were screened using The Alcohol Use Disorders Identification Test (AUDIT > 8). Neuropsicological tests done at the base line and after the 4 years of the study were the Continous Performance Test (CPT) and the Barrat Impulsivity scale. The alcohol and cocaine consume accumulated along the four years was also study.
The two variables of the CPT (ommission and commission errors) had a significant correlation with the alcohol and cocaine use accumulated in these four years. The variable that was associated with a greater risk of making more commission and ommission errors was the cocaine risk consumption. The years of study were protective variable.
The most important conclusion of this study is that alcohol and cocaine use produces a modification in the conductual paradigm of impulsivity characterized by the inhibition difficulties measured by the CPT. Also, the cocaine use effects are added respect to the alcohol ones and finally that cocaine plus alcohol effects over the number of ommission and commission errors are more potent that the ones made only with alcohol.
Impulsivity has been considered as a risk factor for alcohol dependence. Recent research is focusing on paradigms of the startle response (SR), specifically prepulse inhibition (PPI) and startle habituation (SH), as vulnerability markers for alcoholism. It has been demonstrated impairments in the PPI and the SH in offspring of alcoholics. It has also been shown, using personality questionnaires, that faster habituation may be associated with tendency toward impulsivity and behavioral disinhibition. Our goal is to study the correlation between impulsivity laboratory measures and the SR paradigms, in order to see if they could share a common base as endophenotypes for alcoholism.
The subjects were 40 abstinent alcoholic males, aged 18 to 65 years (mean age 44.73) and who had met DSM-IV criteria for Alcohol Dependence, being abstinent for more than a month at the moment they were tested. Participants underwent testing for PPI and habituation of the acoustic startle response. Impulsivity was assessed with three different laboratory measures: Continuous Performance Test (CPT), Stop-Signal Task and Differential Reinforcement for Low-Rate Responding (DRL6). Analyses were performed using SPSS v.10.0.
We found a significant positive correlation between CPT-tasks and SH (p< 0,01), and Stop-Signal Task-tasks and SH (p< 0,05), but not with DRL6-tasks. No significant correlation was demonstrated between impulsivity measures and PPI.
Our findings suggest the existence of a common base between impulsivity and SH as vulnerability markers for alcohol dependence. Further studies are needed to assess if both could share a common genetic origin.
Presence of A1 allele of the DRD2 gene has been associated with a predisposition for alcoholism although there are limited data about its phenotypic expression in alcoholism.
To determine the importance of the A1 allele in clinical variables of alcohol dependence.
A sample of 103 alcohol-dependent males was studied. All patients were recruited consecutively from the general hospital and community settings. The diagnostics were made with the structured clinical interview for DSM-III-R (SCID); and the International Personality Disorder Examination (IPDE). Diagnosis of family alcoholism was made by direct interview or with the Research Diagnostic Criteria-Family History (RDC-FH). The Addiction Severity Index (ASI) and the Severity of Alcohol Dependence Scale (SADS) were used to assess alcohol dependence severity. Genotyping was done by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) methods.
Approximately 39% of the sample carried the A1 allele (A1+ group). This group had higher prevalences of antisocial personality disorder (60% vs. 15.9%); and alcoholism family history (72.5% vs. 52.4%). Also A1+ had early onset alcohol abuse and more drinking problems. The presence of A1+ was the main factor to explain the diagnosis of antisocial personality disorder, but the weight of this factor was not sufficient to explain the complications assessed by the ASI.
Our results support the existence of an association between the A1 allele and factors resulting from dopaminergic deficiency, otherwise denominated reward deficiency syndrome.
Alcoholism is a chronic relapsing disorder characterized by compulsive drinking, alcohol seeking, loss of control over alcohol consumption, and impaired social and occupational functioning. Treatment of Alcohol Dependence (AD) comprises two steps, detoxification and relapse prevention (RP). Traditionally, long half-life benzodiazepines have been the most widely used agents for alcohol detoxification. On the other hand, disulfiram, naltrexone and acamprosate are the three drugs that have been approved for relapse prevention. In the last decades, nevertheless, there is a growing interest in the use of anticonvulsant drugs in the management of both, detoxification and relapse prevention of alcohol.
To review the different pharmacological strategies in which an anticonvulsant was used in the management of AD.
We searched in MEDLINE and in the Cochrane Database System Review, selecting all studies from 1980 until present, in which a pharmacological intervention with anticonvulsant agents was made for alcohol detoxification or RP.
The most tested anticonvulsant drugs are the classical Carbamazepine and Valproate. Both have demonstrated to be efficacious in Alcohol Withdrawal Syndrome and RP. However, the use of these agents has been limited by their hepatic and hematologic toxicity. Novel anticonvulsants such as Gabapentin, Pregabalin, Topiramate, Oxcarbazepine and Zonisamide have also been found to be effective, with the advantage of rapid onset of action, lower toxicity and fewer side effects.
Anticonvulsants are efficacious and safe agents in the management of AD. Further randomized, double-blind, placebo-controlled trials are warranted to increase the evidence of the use of these agents.
In different areas of Therapy, included Psychiatry, herbal medicine has had an increasing interest during the last years. Plants are traditional uses, but only a few have been approved therapeutically. However, we do not know any bibliometric analysis about herbs that are used in Psychiatry.
We have conducted a bibliometric study regarding scientific publications related to phytotherapy in the Psychiatry area during 1986-2006 period. Using the platform Embase.com (Elservier, Amsterdam), including EMBASE and MEDLINE database, we selected those documents whose included the descriptors plant, herb, phytotherap, and psychiatr (with all diagnostic criteria). Plants' indications had been selected according to PDR for Herbal Medicines. As bibliometric indicator of the production, Price's Law was applied.
A total of 21.409 original documents were obtained. Our data confirm a fulfilment of the Price' Law related to scientific production about medicinal plants in Psychiatry. We had observed it after carring out a lineal adjustment (y=135,08x-466,38 r=0.92) an another adjustment exponential curve (y=132,26e0.1497x; r=0.99). The plants more mentioned in the psychiatric literature have been St. John's Wort (Hypericum perforatum; n=937) and Ginkgo (Ginkgo biloba; n=694). The countries with more percentage of documents were the Unites States (29,44%), Germany (9,41%) and Japan (8,75%), and the country with highest Index of Participation (number of documents per country / number of documents in our repertory) was India (IPa= 0,935) and China (IPa=0,721).
Productivity medicinal plants in the Psychiatry area increased during the period 1986-2006. Nevertheless, documents about therapeutic herbs in this field are rather little.
Two laboratory paradigms identifying two behavioral processes have been used to measure impulsivity. The first relates to behavioral inhibition, i.e., the ability to inhibit thoughts or actions appropriately. The second pertains to the degree to which immediate rewarding consequences have more control over behavior than delayed consequences. Behavioral impulsivity disorders have been associated with alcohol dependence. Topiramate has been used to treat many disorders characterized by impulsivity symptoms. Reports also suggest that topiramate has utility in treating a variety of addictive disorders. Little is known, however, about whether its anticraving effects are related to its impulsivity-reducing actions. The aim of this preliminary study was to investigate which type/dimension of behavioral impulsivity was associated with topiramate's anticraving effects. A 12-week, double-blind, placebo-controlled pilot study of topiramate for treating alcohol dependence was conducted. Subjects were men recruited from alcoholism treatment units (topiramate=21; placebo=20). The continuous performance test and stop-signal task assessed behavioural inhibition. Differential reinforcement for low-rate responding was used to evaluate the delay discounting dimension. Alcohol craving and the amount of alcohol consumed during the study also were assessed. Topiramate-treated patients had lower rates of alcohol consumption and significantly lower alcohol craving scale scores than controls, and exhibited greater improvements in the behavioural inhibition and delay discounting paradigms. Improvement in alcohol craving was associated with better performance on the behavioural inhibition paradigm. Our findings suggest that topiramate's anticraving actions could be related to its effects on behavioural inhibition. More studies are needed to confirm and understand this link.
The main problem of depression is not only the high prevalence of the disorder but also its serious consequences on the patient’s quality of life and the associated social costs in terms of health care resource utilization and productivity losses. In recent years, there has been a considerable improvement in the knowledge of depression from the pathogenic, clinical and therapeutic perspectives. The present study analyzes whether such advances are reflected in a positive evolution of the treatment of depression in Spain. To this effect we have contrasted the results of two socio-sanitary studies published in this country: the White Book editions of 1982 and 1997 (WB82 and WB97, respectively). From the methodological perspective, the physician selection criteria employed were very uniform (structured questionnaires delivered to 128 (WB82) and 300 (WB97) randomly selected psychiatrists). The origin of patients consulting for specialized care has varied over this 15-year period. In effect, WB82 patients were essentially referred by friends (87.5%) and from the primary care setting (44.5%), whereas in the WB97 study referral from primary care predominated (50.1%), followed by the patient’s personal decision (24.8%). In turn, 40.7% and 51.7% of the psychiatrists in WB97 respectively considered the diagnostic and therapeutic means available in primary care to be insufficient. The priorities for improving patient quality of life, as reflected by both editions of the study, were the training of primary care physicians and the adequate provision of means in the mental health care centers. On the other hand, fewer problems for establishing a correct diagnosis were referred in the 1997 edition of the study (28.7%) than in 1982 (48.4%). In this sense, the main problem reported in WB82 was the lack of specialized training, whereas the masking of depression by some other disease process or symptoms was the main problem in WB97 (67.6% vs 21.1% according to WB82). The main symptoms upon which the diagnosis of depression are based do not seem to have evolved much in the past 15 years. The most frequently cited manifestations were a worsening of mood, loss of interest and leisure capacity, sleep alterations and diminished vitality. A comparative analysis of the therapeutic resources used was not possible, for prior to 1982 the only drugs available to physicians were the classical tricyclic agents and some MAO inhibitors; the selective serotonin reuptake inhibitors (SSRIs) – possibly the greatest advance in the treatment of depression in these 15 years – had not yet been introduced. Nevertheless, it should be pointed out that 98% of the psychiatrists consulted in WB97 considered pharmacologic treatment to be the most widely adopted form of management once depression has been diagnosed.
The study of the acoustic startle reflex modulation in alcoholics subjects in the presence of positive, aversive, neutral images and images related to alcohol consumption will allow us to measure the implicit affective valence of theses cues.
To compare the emotional valence of the stimuli related to alcohol consumption between two groups of alcoholic patients (abstainers vs relapsers).
55 alcoholic patients (29 abstainers and 26 relapsers) were exposed to acoustic startle test after three weeks of detoxification treatment. Difference between the amplitude of the startle reflex associated to images related to alcohol and the one associated to neutral images was used as dependent variable (motivational value of alcohol cues=startle amplitude in the presence of alcohol images-startle amplitude of neutral images).
Abstainers patients showed a decrease of the startle reflex in the presence of visualization of alcohol associated stimuli compared to the registered ones in the presence of neutral stimuli (μ=-0.041). For the group of relapsers an increase (μ=0.034) of the amplitude of the startle reflex when they were exposed to alcohol related images was registered in contrast with the amplitude registered in the presence of neutral images. Differences between groups were significant (p<0.01).
Abstainers process alcohol-related images as positive stimuli. Conversely, relapsers will stop processing alcohol-related images as appetizing or positive stimuli.
Naltrexone (NTX), an opioid antagonist, blocks intrinsic properties of substances that act on the mu, kappa and delta opioid receptor sites by competitive occupation. It is ascertained that alcohol acts on the opioid receptor sites. By blocking these sites, NTX prevents the reinforcing effects of alcohol consumption. Recent reviews of the effectiveness of NTX in the treatment of alcohol dependence agree that: a) NTX is effective in the treatment of alcohol dependence, especially with regard to the primary outcome parameter, i.e. relapse into heavy or uncontrolled drinking; b) NTX compliance probably is pivotal for successful alcohol treatment; c) There is some evidence that the combination of NTX and CBT (cognitive-behavioural oriented program) is somewhat more effective than NTX combined with supportive therapy; d) Also, there is some evidence that NTX can be of benefit to subgroups of alcoholics characterized by dual diagnosis, Type-II alcoholism or subjects with low level of clinical depression and alcohol dependence severity. Several strategies and hypothesis have been brought up in the literature, in which NTX compliance is subject of debate. Results of a current research about strategies to improve the effectiveness of NTX suggest that interventions aimed at enhancing medication adherence were more efficacy than strategies to increase the likelihood of taking NTX (“pill-count”).
The TaqIA polymorphism linked to the DRD2 gene has been associated with alcoholism. The aim of this work is to study attention and inhibitory control as per the continuous performance test and the stop task in a sample of 50 Spanish male alcoholic patients split into two groups according to the presence of the TaqIA1 allele in their genotype. Our results show that alcoholics carrying the TaqIA1 allele present lower sustained attention and less inhibitory control than those patients without such allele.
Different neuropsychological studies have consistently found an attention, memory and executive function deficit in schizophrenic patients. The Positive and Negative Syndrome Scale (PANSS) evaluates different clinical aspects of schizophrenia. Factor analyses of this scale suggest the existence of a “cognitive factor”, constituted by several items pertaining to the different subscales. In order to have an acceptable concurrent validity, this “cognitive factor” should correlate with the execution of neuropsychological tasks. Our objective was to study the correlation between the PANSS “cognitive factor” and the execution of neuropsychological tasks evaluating attention, memory and executive functions.
Thirty-five schizophrenic patients were evaluated using the Continuous Performance Test (CPT), the Rey-Osterrieth Complex Figure Test (Rey CFT) and the Wisconsin Card Sorting Test (WCST). Bivariate partial correlation between the neuropsychological variables and the PANSS “cognitive factor” was examined. In order to obtain this cognitive component, and based on previous studies, items P2, N5, PG10 and PG11 were used.
The PANSS “cognitive factor” was significantly correlated to CPT omission errors (r=0.45; p=0.006), Rey CFT recall after 5 minutes (r=-0.34; p=0.049), Rey CFT recall after 30 minutes (r=-0.40; p=0.020), WCST perseverative responses (r=0.36; p=0.035), and WCST perseverative errors (r=0.35; p=0.041).
The existence of significant correlations between the PANSS “cognitive factor” and performance on neuropsychological tasks evaluating attention (CPT), memory (Rey CFT) and executive functions (WCST) supports the concurrent validity of this factor.
A high prevalence of childhood attention-deficit/hyperactivity disorder (ADHD) history has been found in alcoholic patients. Patients with this history have an earlier onset and greater intensity of alcohol use, more polysubstance use and a poorer prognosis. Our objective was to study differences in neuropsychological functioning in a group of alcoholic patients according to the presence or absence of a history of childhood ADHD.
A sample of 136 male alcoholic patients and 56 male control subjects were evaluated using the Continuous Performance Test (CPT); execution in both groups was compared. The sample of alcoholic patients was then divided into two subgroups according to the presence or absence of a history of childhood ADHD, namely the ADHD+ OH subgroup (61 patients with childhood ADHD history) and the ADHD- OH subgroup (75 patients without this history); CPT execution in these two subgroups was also compared.
The group of alcoholic patients made more omission (p=0.008) and commission (p=0.009) errors in the CPT than the control group. When comparing subgroups, ADHD+ OH patients made more omission and commission errors than ADHD- OH patients, although the differences did not reach statistical significance.
Alcoholic patients perform more poorly on the CPT than control subjects. In the sample of alcoholic patients, a history of childhood ADHD was not associated to significant differences in the execution of this test.
To describe the physical health profile of patients with drug use disorders who were included in the study of adaptation-validation of the Addiction Severity Index 6th version (ASI-6) into Spanish.
Multicentre, observational, longitudinal, prospective study. A total of 194 substance dependent/abuser individuals were included. Assessments were made with the Spanish ASI-6.
Men were 79.9%, mean ages were 41.08 (SD 11.64), 42.3% were single and 87.6% were acute patients. The severity score in the Physical Health area was 44.32 (SD 9.51). The most prevalent diseases were: 25.3% hepatitis, 11.9% had high blood pressure, 8.2% cirrhosis or hepatic disease, 6.7% epilepsy or convulsions and 5.7% tuberculoses. No statistically significant differences were found according to gender. Acute patients had statistically significant higher proportion of pregnant woman (2.3% vs. 0% p< 0.05) and lower proportion of diabetes (3.5% vs. 12.5% p= 0.05).
Patients with drug use disorders have a mild-moderate severity of physical health. Physical health is not influenced by gender, but it is by the clinical state.
Different types of behavioural impulsivity have been associated with the development of substance use disorders but little is know about what type of impulsivity is provoked by the effect of chronic use of substances.
Determine what type of behavioural impulsivity was associated with the use of alcohol and cocaine.
Design and measurements:
A prospective cohort study was conducted to identify changes on behavioural impulsivity. Non-dependent heavy drinkers (N=471) were recruited from primary care centres. The following assessments were used at baseline and at the end of the 4-year follow-up period: The continuous performance test (CPT) and stop-signal task (SST) assessed behavioural inhibition. Differential reinforcement for low-rate responding (DRLR) was used to evaluate the delay discounting dimension. Diagnoses were rendered using the Structured Interview for DSM-IV.
Amounts on alcohol and cocaine consumption during follow-up correlated positively with changes on all impulsivity measures. Logistic regression analysis indicated that cocaine used was associated specifically with poor performance on CPT and SST and amount of alcohol used during follow-up was related to changes on DRLR.
Substances provoke different pattern of behavioural impulsivity: chronic cocaine use provokes changes mainly on behavioural inhibition dimension and alcohol use induces changes on delay discounting paradigm.
Alcohol Craving Scale-3Factors (ACS-3F) retrospectively assesses the period during which the subject consumed alcohol. It includes 33 descriptions grouped in three scales: positive reinforcement, negative reinforcement and impaired control. Tiffany emphasized the poor correlation between self-reported drug urges and the physiological effects of drug-associated stimuli. Our main objective in this project was to investigate the psychophysiological relationship between ACS-3F and the startle reflex modulation.
We hypothesized that the assessment of self-reported craving with ACS-3F would correlate with the non-conscious emotional response to these cues represented by the modulation of the acoustic startle response.
Sample and Methods:
55 alcoholic patients (29 abstainers and 26 relapsers) were exposed to acoustic startle test after three weeks of detoxification treatment. In this study, the difference between the amplitude of the startle reflex associated to images related to alcohol and the one associated to neutral images was used as dependent variable (motivational value of alcohol cues [MVAC]=startle amplitude in the presence of alcohol images-startle amplitude of neutral images).
The abstainer group showed a significant inverse correlation (r=-0.475, p<0.05) between craving total score in ACS-3F and the motivational value of alcohol cues [MVAC]. With regards to craving, the group of relapsers did not correlate with startle modulation.
ACS-3F has adequate properties of concurrent validity. Results in abstainers showed a good correlation between retrospective craving self-reported and non-conscious emotional response to alcohol cues.
To identify the differences in the ASI-6 scores according to main substance of consumption among patients with drug use disorder who were included at the study of adaptation-validation of the Addiction Severity Index 6th version (ASI-6) into Spanish.
Multicentre, observational, longitudinal, prospective study. 186 substance dependent/abuser individuals were included. Assessments were made with the Spanish ASI-6.
Main substance of consumption: 57% alcohol, 19.9% cocaine and 19.4% opiates. Men were 77.4% vs. 81.1% vs. 83.3% (p n.s.), mean ages were 47.12 (SD 10.18) vs. 32.62 (SD 8.20) vs. 36.47 (SD 8.04) years (p< 0.001), and 25.5% vs. 64.9% vs. 55.6% were single (p< 0.001). The greatest severity was found in the Alcohol area in the case of alcohol users (56.86) and in the Family/Social Partner Problems area in the case of cocaine and the opiate users (50.43 and 51.22). Alcohol users had statistically significant greater severity than the other two groups in the Alcohol area (56.86 vs. 49.38 vs. 45.17, p< 0.001) and tended to have lower severity in the Legal area than cocaine users (46.78 vs. 48.43, p 0.079).
Cocaine users were the youngest and used to be single. The ASI-6 only differentiated in the severity of the Alcohol area. Further studies including a higher proportion of cocaine and opiate users are needed.