Subtyping of individuals undergoing treatment for cocaine
Contents
1. Subtype A Subtype B n n la Gender Man 31 83 8 68 87 2 0 24 Woman 6 16 2 10 12 8 Treatment subtype requested Psychotherapy 2 32 4 50 64 1 13 80 Therapeutic community 1 29 7 12 15 4 Other 8 21 6 4 5l Principal source of income Work 8 48 6 66 84 6 22 06 Family 8 21 6 10 12 8 Other 1 29 7 2 2 6 Employment situation Employed 2 32 4 46 59 0 7 84 Unemployed 8 48 6 26 33 3 Other 7 18 9 6 Te Partner No 6 16 2 30 38 5 Ai Yes 31 83 8 48 61 5 Emergency hospital treatment ever required No 24 66 7 68 87 2 6 65 Yes 12 33 3 10 12 8 Previous treatments for drug dependence No 6 16 2 57 73 1 32 73 Yes 31 83 8 21 26 9 HIV infection No 27 73 0 38 48 7 15 38 Yes 3 8 1 0 0 0 Not known 7 18 9 40 51 3 Consumption of other drugs during treatment alcohol No 25 67 6 34 43 6 5 77 Yes 12 32 4 44 56 4 Consumption of other drugs during treatment methadone No 31 83 8 78 100 5 77 Yes 6 16 2 0 0 0 Because of cocaine use problems my relationships with Not at all or hardly at all 0 0 0 13 16 7 8 02 my family have been affected A little or quite a lot 9 24 3 22 28 2 A lot or a great deal 28 75 7 43 55 1 Because of my cocaine use problems I ve had problems Not at all or hardly at all 20 54 1 63 80 8 9 40 with the law A little or quite a lot 11 29 7 8 10 3 A lot or a great deal 6 16 2 7 9 0 Current alcohol consumption Never drink alcohol 6 16 2 5 6 4 19 69 Drinking alcohol currently 15 40 5 48 61 5 Only drink alcohol when taking co2. J 2003 Understanding polydrug use Review of heroin and cocaine co use Addiction 98 7 22 Lizosa n I amp Moro M A 1998 Coca na II dependencia S ndrome de abstinencia En Lorenzo P Ladero J M Leza J C y Lizosa n I Eds Drogodependencias Farmacolog a Patolog a Psicolog a Le gislaci n pp 123 134 Madrid Editorial M dica Panamericana L pez A amp Beco a E 2006 Patrones y trastornos de personalidad en personas con dependencia de la coca na en tratamiento Psicothema 18 578 583 Millon T 1999 MCMI II Manual Spanish version vila Espada A Jim nez F eds Madrid TEA Muga F 2001 Y ahora la coca na Medicina Cl nica 117 584 585 Mu oz J J Navas E Gra a J L y Mart nez R 2006 Subtipos de drogodependientes en tratamiento apoyo emp rico para una distinci n entre tipo A y tipo B Psicothema 18 43 51 Ochoa E 2000 Coca na y comorbilidad psiqui trica Actas Espa olas de Psiquiatr a 28 40 52 O Leary T A Rohsenow D J Martin R Colby S M Eaton Ch A amp Monti P M 2002 The relationship between anxiety levels and out come of cocaine abuse treatment American Journal of Drug and Al cohol Abuse 26 179 194 Rivera A 2005 Tratamiento hospitalario residencial de la adici n a co ca na Adicciones 17 Supl 1 46 47 Saunders J Aasland O Babor T De la Fuente J amp Grant M 1993 Development of t
3. days in subtype B tq13 3 02 p lt 01 In subtype A 67 of subjects had not at some time needed emergency hospital treatment related to drug use versus 87 of subjects in subtype B Mean lifetime number of emergency visits was 0 66 in subtype A versus 0 16 in subtype B fq13 2 92 p lt 01 In subtype A 83 of subjects had previously been treated for problems related to drug abuse versus 26 9 of subjects in subtype B X X a 32 75 p lt 001 Mean number of previous treatments for drug dependence was 2 21 in subtype A versus 0 43 in subtype B t113 7 07 p lt 001 All subjects with confirmed HIV infection were in subtype A However it should be stressed that 51 of subtype B subjects had not undergone HIV testing versus only 19 of subtype A subjects O a 15 36 p lt 001 Since the start of the treatment programme 68 of subtype A subjects had not consumed alcohol versus 44 of subtype B subjects x 1 5 77 p lt 05 The reasons for alcohol consumption behaviour likewise differed between the two subtypes x 4 19 69 p lt 01 16 of subtype A subjects had never drunk alcohol versus 6 of subtype B subjects 11 of subtype A subjects were not drinking at the time of evaluation following medical advice versus 26 of subtype B subjects 26 of subtype A subjects were not drinking at the time of evaluation because they were in a therapeutic community in which drinking was banned versus 4 of subtype B subjects 41 o
4. 12 62 1 58 11 06 9 88 General Symptomatic Index store 0 90 0 79 0 93 0 57 0 56 p lt 05 p lt 01 p lt 001 Table 2 Categorical variables considered in the cluster analysis for identification of subtypes showing number of subjects in each category in each of the subtypes obtained Subtype A Subtype B n 37 n 78 N N e 160 Have you ever taken heroin No 4 4 9 78 95 1 97 56 Yes 33 100 0 0 0 How often were you taking cocaine over the 6 months before treatment started Less than once a week 4 26 7 11 73 3 4 54 Once or more a week 11 22 9 37 77 1 Every day 22 42 3 30 37 7 Principal route of consumption Snorting 11 12 5 77 87 5 66 69 Smoking 11 91 7 1 8 3 Injection 15 100 0 0 0 p lt 05 p lt 01 p lt 001 Exact test of Fisher when indicated SUBTYPING OF INDIVIDUALS UNDERGOING TREATMENT FOR COCAINE DEPENDENCE 541 lifetime heroine use cocaine injection cocaine smoked cocaine snorted years taking cocaine age at onset of cocaine consumption age 32 22 100 m SUBTYPE A USUBTYPE B Figure 1 Variables showing significant differences between the two subtypes considering the ten variables used in the cluster analysis subtype A 8 9 years in subtype B tq3 6 68 p lt 001 some time heroin consumption 89 of subjects in group A 0 of subjects in group B x 1 97 56 p lt 001 and principal route of administration roughly 1 3 each route in grou
5. 2 of the Symptoms Checklist Revised SCL 90 R for evaluation of subjective feelings of malaise and certain specific symptoms A 10 item self administered scale to assess cravings specifically designed for the present study alpha coefficient 86 hereinafter the Cravings Scale Procedure Subjects were a consecutive series of patients consulting for psychological treatment in several publicly run Drug Dependence Centers in Galicia NW Spain between September 2003 and April 2005 For all patients thought to meet the criteria for inclusion in the study an appointment was made for consideration by us All subjects participating in the study gave written informed consent Data analysis Subtypes were identified using two step cluster analysis as implemented by SPSS for Windows version 12 0 with log likelihood distance measure as required for analyses considering both continuous and categorical variables and automatic determination of number of clusters using the Schwartz Bayesian Criterion A total of 10 variables were considered in this analysis Age This is a key variable in drug dependence younger people have generally been consuming drugs for less time and the negative consequences of the drug use are generally less severe than in older drug users 540 ANA L PEZ DUR N AND ELISARDO BECO A IGLESIAS Aspects related to drug use a Age at which cocaine consumption commenced negatively correlated with the severity of probl
6. Psicothema 2008 Vol 20 n 4 pp 538 544 www psicothema com ISSN 0214 9915 CODEN PSOTEG Copyright O 2008 Psicothema Subtyping of individuals undergoing treatment for cocaine dependence Ana L pez Dur n y Elisardo Beco a Iglesias Universidad de Santiago de Compostela To identify subtypes among individuals undergoing treatment for cocaine dependence we evaluated 115 people with regard to sociodemographic drug related and psychopathological characteristics Ten variables were preselected as the basis for a two step cluster analysis with the aim of identifying sub types Two subtypes were identified Type A N 37 and Type B N 78 subjects The variable that best discriminated the two subtypes was occasional heroin consumption In addition there were sig nificant differences in mean age mean age at onset of cocaine consumption mean number of years consuming cocaine and principal route of ingestion None of the psychopathological variables con sidered significantly differentiated the two groups Subtipos entre las personas con dependencia de la coca na en tratamiento Evaluamos en 115 perso nas con dependencia de la coca na las caracter sticas sociodemogr ficas aspectos relacionados con el consumo de drogas y determinadas caracter sticas psicopatol gicas con el objetivo de identificar la existencia de subtipos entre las personas que est n en tratamiento por dependencia de la coca na Se leccionamos diez variables para re
7. alizar un an lisis de conglomerados en dos fases identific ndose dos subtipos A 37 sujetos y B 78 sujetos La variable m s importante para diferenciar entre los dos sub tipos es el consumo de hero na alguna vez en la vida Adem s hay diferencias significativas en la me dia de edad en la edad de inicio en el consumo de coca na en la media de a os de consumo de coca na y en la v a principal de consumo Ninguna de las variables psicopatol gicas utilizadas en el an lisis result significativa para diferenciar entre los dos grupos The identification of subtypes among drug users began in alcoholism research Jellinek 1946 Babor et al 1992 reported the existence of two subtypes of alcohol dependent subject denominated subtypes A and B Subtype A is characterized by late onset of alcohol consumption paucity of childhood risk factors lack of familial antecedents lower severity of dependence low impulsivity and sensation seeking scores and high harm avoidance scores Subtype B is characterized by early onset of alcohol consumption presence of childhood risk factors and or familial antecedents more severe dependence consumption of other drugs psychiatric comorbidity and high impulsivity sensation seeking and antisocial behaviour scores More recent is the research of Carpenter Liu amp Hasin 2006 In the field of cocaine dependence a noteworthy study was performed by Ball Carroll Babor and Rounsaville 1995 b
8. ased on the alcoholic subtyping of Babor et al 1992 These authors established two subtypes of cocaine user independently of whether or not they were undergoing treatment as a function of premorbid risk factors age at onset of drug consumption familial drug use etc variables related to drug abuse years duration frequency etc psychiatric problems depression symptoms Fecha recepci n 21 9 07 Fecha aceptaci n 20 2 08 Correspondencia Ana L pez Dur n Facultad de Psicolog a Universidad de Santiago de Compostela 15782 Santiago de Compostela Spain E mail alduran usc es personality disorders etc and sociodemographic variables In a sample of cocaine users they found that 67 were subtype A and 33 subtype B In line with Babor et al s classification subtype B subjects showed more premorbid risk factors greater severity of drug and alcohol dependence greater psychosocial decline related to drug abuse and antisocial behaviour and psychiatric problems The two most important variables explaining the differences between the two groups were severity of alcohol consumption and antisocial personality The two subtypes did not differ as regards treatment compliance or abstinence rates Heil Badger amp Higgins 2001 classified cocaine users in terms of route of cocaine ingestion and presence or absence of concurrent alcohol consumption They concluded that subjects who generally use the snorting route tend to ha
9. caine 2 5 4 2 2 6 Have stopped drinking alcohol 4 10 8 20 25 6 Alcohol prohibited in therapeutic community 20 25 6 3 3 8 13 917 Therapist s evaluation of work academic situation Normal functioning 8 23 5 22 29 7 Some difficulties 7 20 6 28 37 8 Moderate difficulties 7 20 6 13 65 0 Major difficulties 7 20 6 11 61 1 Very severe alterations 7 100 0 0 0 p lt 05 p lt 01 p lt 001 1 Exact test of Fisher when indicated Psychopathological characteristics Of the psychopathological variables evaluated in the present study significant differences between subtypes A and B were observed only on four of the scales of the MCMI II Within the Moderate Personality Disorder scales subtype A subjects had a lower mean score than subtype B subjects on the Dependent scale 52 8 versus 63 6 100 2 36 p lt 05 a higher mean score on the Antisocial scale 77 4 versus 67 5 t 100 2 41 p lt 05 and a lower mean score on the Compulsive scale 38 9 versus 50 6 t 100 1 99 p lt 05 Within the Moderate Clinical Syndrome scales subtype A subjects had a higher mean score than subtype B subjects on the Drug Dependence scale 78 1 versus 71 7 190 1 99 p lt 05 Differences were not observed in trait anxiety or in Positive Symptoms Total and Positive Symptoms Distress Index of SCL 90 R SUBTYPING OF INDIVIDUALS UNDERGOING TREATMENT FOR COCAINE DEPENDENCE 543 Therapist s evaluation Therapists rate
10. d 28 April 2005 on the basis of the following criteria under treatment for abuse of cocaine as principal drug cocaine dependence as defined by DSM IV TR SCID I questionnaire of First Spitzer Gibbson and Williams 1998 between 3 and 6 weeks abstinence from cocaine consumption at the onset of the study absence of severe psychotic alterations and capacity to respond to the evaluation instruments used A total of 119 subjects were initially included in the study but one subject was excluded because he did not meet criterion 2 not cocaine dependent and three subjects were excluded because they did not meet criterion 3 they had been abstinent for more than 6 weeks Instruments The admission sheet of the drug dependence treatment programme which collects diverse information about patients starting the programme including sociodemographic information and various aspects related to drug consumption An instrument specially designed for the present study designed to evaluate characteristics of cocaine consumption and its consequences A global evaluation of the patient performed by your therapist For this evaluation the therapist rated the patient s psychopathological familial social work and judicial status on five point 0 4 scales In the case of psychopathological status O indicated absence of symptoms 1 mild symptoms 2 moderate symptoms 3 severe psychopathological disorder and 4 severe psychopathological disorder with
11. d patients psychopathological familial social work and judicial status Significant differences were observed only in work status since all subjects showing major alterations in this area were of subtype A x 4 13 91 p lt 01 Discussion The two step cluster analysis performed in the present study indicates the existence of two subtypes among subjects undergoing treatment for cocaine dependence subtype A about 30 of subjects in the present study comprises older subjects who typically started using cocaine at a younger age and who have been using it for longer who typically ingest their cocaine by injection or smoking who have at some time taken heroin who have needed emergency hospital treatment related to drug use and who have a relatively high risk of HIV infection Subjects in this subtype are more likely to show antisocial personality This finding is in line with Weiss et al 1996 who found that combined cocaine and opiate users are more likely to show antisocial personality and to have been using cocaine for longer than cocaine only users Subtype B about 70 of 78 subjects in the present study are typically younger started cocaine consumption at a later age and have been consuming for a shorter period and typically ingest their cocaine by snorting These subjects are less likely to show negative consequences associated with cocaine abuse Personality subtype is more likely to be dependent or compulsive Thus the di
12. ems due to cocaine consumption b Time since onset of cocaine consumption i e current age minus age at onset positively correlated with the severity of problems due to cocaine consumption c Heroin consumption at some stage in life in some cases heroin is consumed at the same time as cocaine with the aim of moderating the latter drug s intense stimulatory effects while in other cases the subject was at one stage heroin dependent but currently does not consume this drug heroin consumption is generally associated with higher cocaine consumption by the smoked or injected routes and thus with more severe negative consequences Leri Bruneau amp Stewart 2003 Ochoa 2000 Weiss Mart nez Raga amp Hufford 1996 d Frequency of consumption in the 6 months prior to treatment onset subjects who consume cocaine every day can be expected to show more severe negative consequences than subjects who consume only once a week Kasarabada Anglin Khalsa Denison amp Paredes 1998 e Principal route of cocaine consumption in the 6 months prior to treatment onset again expected to be related to the severity of negative consequences smoking or injection is typically associated with higher consumptions and higher risk of diseases related to needle sharing Psychopathological characteristics a AUDIT score cocaine consumption is in many cases related to significant alcohol consumption and in many subjects there is suspicion of alcohol d
13. ependence Brown Seraganian amp Tremblay 1994 Abuse of additional drugs like alcohol can be expected to be associated with more severe negative consequences Carroll Rounsaville amp Bryant 1993 Gossop Mardsen amp Stewart 2002 b BDI score depressive symptoms in a recently abstinent subject are often initially related to the abstinence but as abstinence symptoms decline may be increasingly attributable to the longer term negative consequences of drug use and subjects with drugs related problems are likely to have high BDI scores c STAI State score the State subscale of this instrument measures anxiety at the moment of administration reflecting the subject s current anxiety and thus directly influenced by the negative consequences of cocaine abuse O Leary Rohsenow Martin Colby Eaton amp Monti 2000 d The General Symptomatic Index of the SCL 90 R evaluates the subject s general feelings of malaise over the preceding week in terms of 90 symptoms a high score indicates higher malaise Thus the ten variables considered in the cluster analysis were age years age at onset of cocaine consumption years time since onset of cocaine consumption years some time heroin consumption yes or no frequency of cocaine consumption over the 6 months before start of treatment daily weekly or occasional principal route of cocaine administration snorting smoking or injection severity of alcohol abuse over the
14. f subtype A subjects were drinking alcohol at the time of evaluation versus 62 of subtype B subjects None of the subtype B subjects was taking part in a methadone maintenance programme versus 16 of subtype A subjects x 1 5 77 p lt 05 this is despite the fact that all subjects were cocaine dependent and considered cocaine to be their principal problem drug The mean maximum reported amount of cocaine consumed in a single day was 6 47 g in subtype A versus 3 88 g in subtype B La13y 3 43 p lt 01 Mean reported financial outlay on cocaine before the start of the treatment programme was 2735 in subtype A versus 1325 in subtype B tq13 2 33 p lt 05 Mean score on the Cravings Scale was higher in subtype A 3 86 than in subtype B 2 87 t113 2 15 p lt 05 In the evaluation of impact of cocaine abuse on relationships with family 76 of subjects in subtype A rated the impact as severe or very severe versus 55 of subjects in subtype B 2 9 8 02 p lt 05 None of the subjects in subtype A rated the impact as zero or nearly zero There were also differences between subtypes as regards problems with the law only 54 of subtype A subjects reported little or no impact of cocaine abuse on problems of this type versus 81 of subtype B subjects x 2 9 04 p lt 01 542 ANA L PEZ DUR N AND ELISARDO BECO A IGLESIAS Categorical variables showing significant differences between subtypes A and B Table 3
15. fferences between the two subtypes are basically sociodemographic and drug use related with psychopathological variables showing only minor differences between the two groups Similar results are obtained if we take into account the other variables considered in the study Subjects in subtype A typically request entry into a therapeutic community or some other non psychotherapy treatment while subjects in subtype B typically request psychotherapy Subjects in subtype A probably have a partner In both groups the main source of income is work but a higher proportion of subjects in subtype Continuous variables showing ae ro between subtypes A and B Subtype A n 37 Subtype B n 78 Mean S D Mean S D t Time since start of current treatment days 457 70 994 61 103 56 208 10 3 02 Lifetime number of emergency hospital visits 0 66 1 33 0 16 0 49 2 92 Number of previous treatments for drug dependence 2 21 1 85 0 43 0 84 T QT Maximum cocaine consumption in a single day g 6 47 5 14 3 88 2 92 3 43 Total monthly outlay on cocaine 2735 16 3659 87 1324 65 2686 62 2 33 Dependent personality score TB 52 79 22 41 63 60 21 38 2 36 Antisocial personality score TB 77 35 19 93 67 49 19 26 2 41 Compulsive personality score TB 38 88 26 22 50 62 18 65 2 60 Moderate Clinical Syndromes Drug Abuse score TB 78 12 13 74 71 72 16 01 1 99 Cravings Scale score 3 86 2 56 2 87 2 18 2 15 p lt 05 p lt 01 p lt 001 A have fa
16. he AUDIT WHO collaborative project on early de tection of persons with harmful alcohol consumption II Addiction 88 791 804 Schuckit M A Tipp J E Smith T L Shapiro E Hesselbrock V M Bucholz K K Reich T amp Nurnberger J I 1995 An evaluation of Type A and B alcoholics Addiction 90 1189 1203 Spielberger C D Gorsuch R L amp Luchene R E 1971 Cuestionario de ansiedad estado rasgo Manual de la adaptaci n espa ola revised 4th edition Madrid TEA V zquez C amp Sanz J 1997 Fiabilidad y valores normativos de la ver si n espa ola para el inventario para la depresi n de Beck de 1978 Cl nica y Salud 8 403 422 Weiss R D Mart nez Raga J amp Hufford C 1996 The significance of coexisting opioid use disorder in cocaine dependence An empiri cal study American Journal of Drug and Alcohol Abuse 22 173 184
17. ing for treatment for drug abuse for the first time Principal route of ingestion snorting cocaine consumption generally associated with social recreational contexts and thus with other drugs including alcohol Have never used heroin Psychopathological scores lower than in the other two subtypes Subtype 2 Age generally 25 30 years First or second consultation for treatment for drug abuse Principal route of ingestion snorting cocaine consumption generally commenced in a social recreational context but in many cases has become a solitary habit Consumption generally remains associated with alcohol use Have never used heroin Psychopathological scores higher than in the general population and personality traits include dependence histrionicism and narcissism Subtype 3 Age generally more than 30 years Have previously received treatment for drug abuse Principal route of ingestion injection or smoking cocaine consumption generally solitary Consumption not generally associated with alcohol use although alcohol problems may be present Most subjects have taken heroin at some stage Psychopathological scores high with highly destructured functioning Personality traits include antisocial behaviour Method Participants The participants in the study were 115 subjects 99 men 16 women under treatment in six public Centers of Drug Dependence in the region of Galicia in NW Spain The sample was selected between 23 September 2003 an
18. mily or other as main source of income Subjects in subtype A are more likely to be working Subjects in subtype A are more likely to have required emergency hospital treatment related to drug use to have previously received treatment for drug use and to be HIV infected although note that in the present study a higher proportion of subjects in subtype B had never undergone HIV testing Subjects in subtype B are more likely to be alcohol drinkers because a larger proportion of these subjects have never drunk and a smaller proportion enter therapeutic communities in which drinking is prohibited In the present study all subjects in the methadone maintenance programme belonged to subtype A In general subtype A subjects consider their cocaine consumption to have had more severe effects on family relationships and problems with the law Subtype A subjects are more likely to show an antisocial personality subtype than subtype B subjects who are more likely to show dependent or compulsive personality subtype Finally the therapists evaluation of subtype A subjects is more likely to indicate severe impacts of drug abuse in the work study sphere The two subtypes identified in the present study show a close correspondence with subtypes 2 and 3 proposed in the Introduction However there were no differences in psychopathological characteristics between subtypes A and B in contrast with the subtyping hypothesized a priori and in contras
19. p A almost exclusively snorting in group B see table 3 66 96 p lt 001 Thus subtype A subjects are generally older started to consume cocaine younger have consumed cocaine for longer generally use the injection route and have consumed heroin at some stage in their life There were no significant differences between the two subtypes in AUDIT score STAI state anxiety score BDI score General Symptomatic Index score or frequency of consumption of cocaine over the six months prior to treatment We next compared the two subtypes as regards the remaining variables with the results shown in tables 4 and 5 and summarized in what follows Sociodemographic variables Principal source of income was work for only 49 of subtype A subjects versus 85 of subtype B subjects 2 22 06 p lt 001 In line with this only 32 of subtype A subjects versus 59 of subtype B subjects were in work at the start of treatment XoF 7 84 p lt 05 Of the subtype A subjects 84 had a partner at the start of treatment versus only 62 of subtype B subjects x2 gt 5 77 p lt 05 Variables related to drug use Of the subtype A subjects only 32 requested psychotherapy on admission to the treatment programme versus 64 of subtype B subjects admission to a therapeutic community was requested by 30 of subtype A subjects versus only 15 of subtype B subjects Mean duration of previous treatment was 458 days in subtype A versus 104
20. preceding year AUDIT score state anxiety score on State subscale of the STAD depressive symptoms BDI score and general malaise score on General Symptomatic Index of SCL 90 R Results Subtypes In view of the variables considered our results indicate that there are two subtypes of subjects undergoing treatment for cocaine dependence Of the 115 subjects included in the present study 37 fell into the first subtype A and 78 into the second subtype B Significant between subtype differences were found in five of the ten variables considered see tables 1 and 2 figure 1 mean age 34 2 years in subtype A 29 4 years in subtype B 1 113 4 02 p lt 001 mean age at onset of cocaine consumption 18 4 years in subtype A 20 5 years in subtype B tq 3 2 23 p lt 05 mean time since onset of cocaine consumption 16 0 years in Table 1 Continuous variables considered in the cluster analysis for identification of subtypes showing mean values for each variable in each of the subtypes obtained Subtype A Subtype B n 37 n 78 Mean S D Mean S D t Age years 34 22 29 37 4 02 5 58 6 22 Age at onset of cocaine consumption years 18 43 20 50 2 23 2 72 5 31 Time since onset of cocaine consumption years 16 03 8 88 6 68 5 50 5 28 AUDIT score over preceding year 9 67 12 25 1 55 8 08 8 43 State anxiety STAI S score 23 45 22 29 0 45 15 36 11 62 Depressive symptoms BDI score 15 86
21. significant distortion of reality and or communication deficit In the case of familial social status 0 indicated normal functioning 1 minor difficulties 2 moderate difficulties 3 severe difficulties and 4 severe incapacity to maintain familial and social relations In the case of work status 0 indicated normal functioning 1 minor difficulties 2 moderate difficulties 3 severe difficulties and 4 severe incapacity for work In the case of judicial status problems with the law 0 indicated absence of judicial problems 1 accusation of a minor offense 2 accusation of a major offense 3 on remand and 4 currently in prison The Spanish version First et al 1998 of the Structured Clinical Interview for DSM IV SCID for evaluation of cocaine dependence The Spanish version Contel Gual amp Colom 1999 of the Alcohol Use Disorders Identification Test AUDIT of Saunders Aasland Babor De la Fuente and Grant 1993 for evaluating the existence of excessive alcohol consumption and alcohol dependence The Spanish version Vazquez amp Sanz 1997 of the Beck Depression Inventory BDI Beck Rush Shaw amp Emery 1979 The Spanish version of the State Trait Anxiety Inventory STAD Spielberger Gorsuch amp Luchene 1971 The Spanish version of the Millon Clinical Multiaxial Inventory MCMI II for evaluating personality characteristics and certain clinical syndromes Millon 1999 The Spanish version Derogatis 200
22. t with the suggestions of previous studies Bobes et al 2001 Lizosain amp Moro 1998 Muga 2001 A possible explanation for our non identification of the subtype 1 hypotethesized is that younger subjects have generally been consuming heroin for a shorter time and have not yet reached clinically diagnosed dependence see Barrio Anta et al 1997 thus such subjects were not included in the present study In conclusion the differences between the two subtypes identified in the present study are related to variables describing cocaine abuse not psychopathological variables These results indicate that cocaine dependent subjects who have taken heroin at some stage in their life and who generally ingest cocaine by smoking or injection do not have more psychopathological 544 ANA L PEZ DUR N AND ELISARDO BECO A IGLESIAS difficulties than cocaine dependent subjects who have never consumed heroin and who ingest cocaine by snorting this is despite the fact that a priori one would expect the former pattern to be more damaging Leri et al 2003 Ochoa 2000 Weiss et al 1996 and thus more likely to lead to psychopathological problems These results indicate that in the design and adaptation of assistance programmes for subjects undergoing treatment for cocaine dependence it is important to take into account that sociodemographic characteristics and drug consumption behaviour may differ markedly between individuals Independently of
23. these characteristics however it is necessary to individually evaluate the psychopathological characteristics of all subjects In next studies we must analyze variables like severity of dependence impulsivity or sensation seeking Similar to studies of Babor et al 1992 and Schuckit et al 1995 Acknowledgements We thank the directors and staff of the following Centers of Drug Dependence of Galicia Spain for facilitating the present study Alborada Vigo ACLAD A Coru a UAD Concello de Pontevedra Pontevedra and CEDRO Vigo References Babor T F Hoffman M Del Boca F K Hesselbrock V Meyer R E Dolinsky Z A amp Rounsaville B 1992 Types of alcoholics I Evi dence for an empirically derived typology based on indicators of vul nerability and severity Archives of General Psychiatry 49 599 608 Ball S A Carroll K M Babor T F amp Rounsaville B J 1995 Subty pes of cocaine abusers Support for a type A type B distinction Jour nal of Consulting and Clinical Psychology 63 115 124 Barrio Anta G L pez Gigosos R de la Fuente L amp Rodr guez Ar talejo F 1997 Patrones de uso de la coca na en un grupo de con sumidores de esta droga sin consumo de hero na captados fuera de los servicios asistenciales Medicina Cl nica 10 364 369 Beck A T Rush A J Shaw B F amp Emery G 1979 Cognitive The rapy of Depression New York Guildford Press Spanish transla
24. tion in Bilbao Descl e de Brouwer 1983 Bobes J S iz P A Gonz lez M P amp Bascar n M T 2001 Epide miolog a del uso abuso de coca na Adicciones 13 Supl 2 23 36 Brown T G Seraganian P amp Tremblay J 1994 Alcoholics also de pendent on cocaine in treatment Do they different from pure alco holics Addictive Behaviors 19 105 112 Calafat A Juan M Beco a E Fern ndez E Gil E Palmer A Sure da P amp Torres M A 2000 Salir de marcha y gesti n del consumo Madrid Delegaci n del Gobierno para el Plan Nacional sobre Drogas Carpenter K M Liu X amp Hasin D S 2006 The Type A Type B clas sification in a community sample of problem drinkers Structural and predictive validity Addictive Behaviors 31 15 30 Carroll K M Rounsaville B J amp Bryant K J 1993 Alcoholism in treatment seeking cocaine abusers Clinical and prognostic signifi cance Journal of Studies on Alcohol 54 199 209 Contel M Gual A amp Colom J 1999 Test para la identificaci n de trastornos por uso de alcohol AUDIT traducci n y validaci n del AUDIT al catal n y castellano Adicciones 11 337 347 Derogatis L R 2002 SCL 90 R Cuestionario de 90 s ntomas revisado Manual Madrid Tea Esparcia M amp Celorrio M L 2005 Perfil del paciente cocain mano que acude al equipo de atenci n a drogodependencias en la provincia de Albacete Adicciones 17 S
25. upl 1 77 Garc a Rodr guez O Secades Villa R lvarez H R o A Fern ndez Hermida J R Carballo J L Errasti J M amp Al Halab S 2007 Efecto de los incentivos sobre la retenci n en un tratamiento ambula torio para adictos a la coca na Psicothema 19 134 139 First M B Spitzer R L Gibbson M Williams J B W amp Smith Benja min L 1998 Gu a del usuario de la entrevista cl nica estructurada para los trastornos del eje I del DSM IV SCID I Barcelona Masson Gossop M Mardsen J amp Stewart D 2002 Dual dependence Assess ment of dependence upon alcohol and illicit drugs and the relationship of alcohol dependence among drug misusers to patterns of drinking illicit drug use and health problems Addiction 97 169 178 Heil S H Badger G J amp Higgins S T 2001 Alcohol dependence among cocaine dependent outpatients Demographics drug use treat ment outcome and other characteristics Journal of Studies on Alcohol 62 14 22 Jellinek E M 1946 Phases in the drinking histories of alcoholics Analysis of a survey conducted by the official organ of Alcoholics Anonymous Quarterly Journal of Studies on Alcohol 7 1 88 Kasarabada N D Douglas M Khalsa Denison E amp Paredes A 1998 Variations in psychosocial functioning associated with patterns of progression in cocaine dependent men Addictive Behaviors 23 179 189 Leri F Bruneau J amp Stewart
26. ve more problems with alcohol and consume alcohol mainly in social situations whereas subjects who generally use the smoking route are less likely to have alcohol problems Although there have been few studies aimed at subtyping subjects undergoing treatment for cocaine dependence the clinical evidence available suggests that relevant subtypes exist Determination of subtypes among subjects undergoing treatment is likely to prove useful for optimizing the treatment strategy to be used in each case The aim of the present study was to identify subtypes among subjects undergoing treatment for cocaine dependence in the Centers of Drug Dependences in Galicia NW Spain Subtyping was based on the following variables sociodemographic characteristics aspects related to drug use and psychopathological characteristics SUBTYPING OF INDIVIDUALS UNDERGOING TREATMENT FOR COCAINE DEPENDENCE 539 On the basis of previous studies of cocaine users in Spain Barrio Anta L pez Gigosos de la Fuente de Hoz amp Rodr guez Artalejo 1997 Bobes Saiz Gonz lez amp Bascar n 2001 Calafat et al 2000 Esparcia amp Celorrio 2005 Garc a Rodr guez et al 2007 Lizosa n amp Moro 1998 L pez amp Beco a 2006 Muga 2001 Mu oz Navas Gra a amp Mart nez 2006 Rivera 2005 we hypothesized that subjects undergoing treatment for cocaine dependence can be classified into three subtypes Subtype 1 Age generally below 25 years Consult
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