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Background: Individuals with bipolar disorder (BD) often have co-occurring substance use disorders (SUD), which substantially impoverish the course of illness. Despite the importance of this dual diagnosis, the evidence of the efficacy and safety of adjuvant treatments is mostly unknown. Objective: To perform a meta-analysis to evaluate the efficacy and safety of adjuvant drugs in patients with co-occurring BD and SUD. Methods: We searched PubMed, Scopus, and Web of Knowledge until 30thApril 2022 for randomized clinical trials (RCT) evaluating the efficacy and safety of adjuvant drugs compared to placebo in patients with a dual diagnosis of BD and SUD. We meta-analyzed the effect of adjuvant drugs on general outcomes (illness severity, mania, depression, anxiety, abstinence, substance craving, substance use, gamma-GT, adherence, and adverse events) and used the results to objectively assess the quality of the evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. For completeness, we also report the specific effects of specific adjuvant drugs in patients with specific substance disorders. Results: We included 15 RCT studies (9 alcohol, 3 cocaine, 2 nicotine, and 1 cannabis) comprising 628 patients allocated to treatment and 622 to placebo. There was low-quality evidence that adjuvant drugs may reduce illness severity (g=-0.25, 95%CI: -0.44, -0.06), and very-low quality evidence that they may decrease substance use (g=-0.23, 95%CI: -0.44, -0.02) and increase substance abstinence (g=0.21, 95%CI: 0.04, 0.38). Discussion: There is low-quality evidence that adjuvant drugs may help reduce illness severity, probably via facilitating abstinence and lower substance use. However, the evidence is weak; thus, these results should be considered cautiously until better evidence exists.

Fumar constituye un grave problema de salud pública, siendo la primera causa evitable de morbimortalidad en el mundo. En las últimas décadas se ha observado una elevada prevalencia de consumo de tabaco en personas con diferentes trastornos psicopatológicos. Se ha propuesto la existencia de factores de vulnerabilidad psicológica como, por ejemplo, la sensibilidad a la ansiedad, la anhedonia o la tolerancia al malestar, que podrían explicar, al menos en parte, la relación entre fumar y la ansiedad y otros trastornos emocionales. Este trabajo es una revisión descriptiva de la literatura que se centra en analizar el papel de la sensibilidad a la ansiedad en relación con el consumo de tabaco, concluyéndose que existe evidencia de que esta variable influye en varios aspectos relacionados con la conducta de fumar, su mantenimiento y en el proceso de dejar de fumar.

Second-hand tobacco smoke (SHS) is a major indoor pollutant that causes serious health problems for all exposed, especially children. Children are often exposed to SHS at home, due to parental or other households’ or guests’ smoking. This study describes Portuguese children's exposure to SHS at home (total and by Portuguese main regions).

To assess the prevalence of children's exposure to second-hand smoke in the family car; to compare exposure among children with smoking and non-smoking parents.

Presence of depression in cocaine-dependent users is relevant for treatment of these persons. This study assessed the presence of depressive symptomatology with a published Spanish translation of the Beck Depression Inventory for a sample of 115 Spanish cocaine-dependent users who were in outpatient treatment at Centers of Drug Dependence of Galicia, Spain. The mean score was 13.7 (SD=10.3), with 24.3% of the sample having scores which indicate clinical depression (cut off ≥ 21). These data underscore the need to assess the presence of depression in cocaine-dependent users who require treatment.

Some self-help programmes for smoking cessation obtain abstinence data entirely from participants' self-reports. This may lead to overestimation of efficacy. In the present study, the relationship between self-reported abstinence and expired-air carbon monoxide was evaluated at the 12-mo. follow-up in 200 smokers who had participated in a self-help programme for smoking cessation conducted by mail. Analysis indicated a close relationship between carbon monoxide levels and self-reports of smoking status; concordance was about 90%. Studies of the efficacy of self-help programmes for smoking cessation should include some sort of objective verification of self-reported abstinence.

Relationships between cigarette smoking and depressive symptoms were analysed in a representative random sample of 1447 secondary-school children aged 11 to 16 years in Galicia (NW Spain). The sample comprised 797 boys (55.1%) and 650 girls (44.9%). Their mean age was 12.8 yr. (SD =1.2). Depressive symptoms, evaluated with the Children's Depression Inventory, were reported by 11.0% of children who responded they had never smoked, versus 23.7% of those who said they sometimes smoked, and 44.2% of those who identified themselves as current daily smokers. These results indicate an association between smoking and depression among children in this age group.

This research tested a multicomponent self-help manual that contained nicotine fading and some behavioral techniques. It also evaluated the incremental effects of using higher amounts of therapist contact on quitting rates. 114 smokers were randomly assigned to one of four treatment groups: (1) A 10-session multicomponent program (n= 25); (2) a 5-session multicomponent program (n= 31); (3) a 5-session multicomponent plus a self-help manual program (n= 25); and (4) a self-help-manual-only program (n= 33). A control group (n= 48) did not receive any treatment. The distinctive characteristic of the treatments was the different amount of therapist contact. Common components of the programs were a refundable deposit, self-monitoring, information on smoking, stimulus control, CO feedback, nicotine fading, and strategies to avoid withdrawal symptoms. End-of- treatment quit rates ranged from 36% (self-help manual) to 68% (10-session multicomponent program). At 12-month follow-up there were significant differences between groups, and the most effective group was the 5-session plus manual group, with an abstinence rate of 48%.

The Fagerström Test for Nicotine Dependence was developed to improve the reliability and validity of the Fagerström Tolerance Questionnaire. In this study, we examined the applicability of the Spanish version of such test as well as its relationship to sex, age, and consumption of cigarettes, in a representative sample of smokers from Galicia, Spain (N= 646).

The aim of this study was to assess the effectiveness of relapse prevention taught as a problem-solving procedure in increasing the efficacy of a behavioral program for smoking cessation at short- and longer-term, 12-mo. follow-up. 75 smokers were assigned randomly to two treatment groups, using an additional 40 smokers who attended an information session but did not receive any treatment session as a control group. The first group (n= 40) received the standard behavioral multicomponent program of Becoña. The program included motivational contract, self-monitoring, information on smoking, nicotine fading, stimulus control, avoidance of withdrawal symptoms, physiological feedback, and progressive self-control. The second group (n= 36), the relapse prevention group, were given the above program and an additional component of relapse prevention using a problem solving procedure. Both groups had 8 sessions of treatment. Analysis showed that at the end of treatment abstinence in the two groups was 80.0% and 61.1%, respectively, at the 12-mo. follow-ups 30.0% and 36.1%. These differences were not significant; however, both groups were significantly different from the control group at the end of treatment (0% abstinence) and at 12-mo. follow-ups (2.5% abstinence). These results show that the addition of this relapse prevention does not increase the number of smokers who quit or decrease the number who relapse. Further research should focus on the process of relapse and develop more effective procedures to help maintain abstinence.

Several studies have shown a high prevalence of pathological gamblers among adults in Spain (between 1.5% and 1.7%) of the population (18 years and older). In other countries the prevalence of pathological gambling in children and adolescents has been higher than in adults. Here some results of the first studies conducted in Spain concerning the prevalence of pathological gambling in school children and adolescents (11–16 years) are presented for two cities located in different northern regions of Spain, A Coruña (Galicia) and Gijón (Asturias), with representative samples of school children. The prevalence was 2.2% (n= 1,200) and 1.6% (n= 2,185), respectively, for the use of slot machines, using the 1993 DSM-IVJ Questionnaire of Fisher, and 2.4% in the first city with the South Oaks Gambling Screen-Revised Adolescent for all types of gambling. The analyses suggest there is an emerging problem among children and adolescents in Spain perhaps leading to an increased number of pathological gamblers as adults.

We tested a multicomponent behavioural package to stop smoking that contained nicotine fading and smokeholding techniques. 73 smokers were randomly assigned to one of five treatment programmes: (1) nicotine fading and cigarette fading, (2) nicotine fading and concurrent smokeholding, (3) nicotine fading and subsequent smokeholding, (4) a nonintensive smokeholding programme, and (5) an intensive smokeholding programme (daily sessions). Common components of the programmes were self-monitoring, information on smoking, stimulus control, CO feedback, and strategies to avoid withdrawal symptoms. Each treatment was carried out during a total of 10 sessions over 4 weeks (Treatments 1–4) or 2 weeks (Treatment 5). End-of-treatment quit rates ranged from 85% to 91%. At 12-mo. follow-up, the most effective package proved to have been nicotine fading and cigarette fading, with an abstinence rate of 57% as against 25 to 37% for the other treatments.

Nicotine may be the agent responsible for tobacco addiction. A noninvasive, easy measure for evaluating addiction is Fagerström's 1978 Tolerance Questionnaire. Present results are based on responses of 732 Spanish smokers to the Spanish version of the questionnaire. The questionnaire has a moderate reliability, and some items are more important than others. Among the Spanish smokers, the questionnaire differentiated the groups of 327 light, 275 normal, and 130 heavy smokers.

Since 1977, when gambling was legalized in Spain, the amount of money spent on it has increased each year. Expenditures on gambling are now more than 3 billion pesetas per year. This paper provides the results of a study on the prevalence of pathological gambling in the Galicia region of northwest Spain, with a representative random sample (N=1,615) from the seven largest cities of Galicia. The prevalence of pathological gambling was 1.7% utilising the DSM-III-R diagnostic criteria. An additional 1.6% were problem gamblers, 0.6% excessive social gamblers and 1% exexcessive gamblers. The results suggest that slot machines are the most addictive form of gambling. Pathological gamblers are homogeneously distributed in the population with the exception that males and upper income family membership are overrepresented. Alcohol and cigarette consumption were higher among pathological gamblers than in the general population.

This study assessed the weight gain for the short- and long-term (36 mo. follow-up) in a sample of 158 smokers (71 men and 87 women), who participated in a multicomponent behavioral smoking-cessation program. Weight was evaluated with a self-reported questionnaire, with an over-all mean pretreatment weight of 65.3 Kg (SD= 12.6). All individuals tended to gain weight. Afterwards, the mean for quitters (n= 42) increased by 2.0 Kg at 36-mo. follow-up and the mean for nonquitters (n= 116) by 0.6 Kg. Among abstinent people no significant differences were found by sex at 36 mo. but significant mean differences were found in those subjects (quitters) older than 35 yr. who gained 4.1 Kg compared with 1.2 Kg in the group 35 yr. or younger.

We compared the 1981 Self-efficacy scales of Diclemente and Condiotte and Lichtenstein for a sample of 29 Spanish smokers who participated in a stop-smoking program and throughout a 12-mo. follow-up. Analysis indicated the major predictive utility of the Confidence Questionnaire (self-efficacy) of Condiotte and Lichtenstein for rate of smoking and for smoking status.

The aim of this study is to examine relapse of 72 smokers who stopped smoking with a behavioral smoking cessation program and relapse in the period from the end-of-treatment to the 36-mo. follow-up. The relapse occurred fundamentally between the end-of-treatment and the 6- (53.7% relapse) and the 12-mo. follow-up (61.1% relapse), and more slowly beyond 12-mo. follow-ups with 72.2% and 70.4% relapse at the 24- and 36-mo. follow-up.

It is very important to have objective measurements of nicotine dependence or tobacco addiction, especially in the treatment of smokers. The most utilized physiological assessment is the carbon monoxide (one of the components of tobacco smoke) in expired air. A noninvasive measure of nicotine dependence is the Fagerström's Tolerance Questionnaire. In our study we compared responses on the Tolerance Questionnaire of 217 smokers who participated in a treatment to stop smoking and also measurements of carbon monoxide in expired air (evaluated with a Mini Smokerlyzer EC-50). Analysis showed the utility of the Tolerance Questionnaire in the discrimination of number of cigarettes smoked prior to and after treatment and at follow-up.

A number of previous studies have indicated that pathological gambling is often associated with depression. Equally, a number of theoretical models of pathological gambling have included depression as a key variable. Here we report a study of depression in pathological gamblers identified within a random sample of 1,615 adults living in the major cities of Galicia (northwest Spain). Pathological gamblers were identified on DSM–IV diagnostic criteria. Depression was evaluated with the Beck Depression Inventory, subjects being classified ‘depressive’ if they obtained a score of 18 or more. Of 19 pathological gamblers who completed the Beck Depression Inventory, 21% were depressive; by contrast, only 9% of the other subjects were depressive. The Beck scores of pathological gamblers were positively correlated with the severity of their addiction as indicated by the number of DSM–IV-specified symptoms reported.

AbstractLack of motivation for the treatment of drug addiction is associated with dropout and relapses. Further, personality disorders (PD) have traditionally been linked to low motivation and therapeutic failure. Thus, the present study aims to analyze the structure of the Motivation for Treatment Questionnaire(MTQ–8), as well as to determine differences in motivation due to the presence of PD and the impact of psychological adjustment on motivation. The sample included 125 patients (84% male) who started a treatment for their addiction to cocaine and alcohol. Rasch analysis was applied for the first objective, and means contrast and regression analysis for the others. The two subscales of the MTQ–8 fit the Rasch model, with appropriate psychometric characteristics when merging Items 5 and 7. The presence of PD was not associated with reduced motivation. Motivation for treatment was greater when abstinence was less than three weeks, and psychological distress predicted motivation for treatment. The present study confirms that MTQ–8 subscales are suitable for measuring motivation for treatment and readiness for change in drug-dependent patients. It is noted that the presence of PD should not be associated with a lower level of motivation, and that psychological distress influences motivation.

In this study we analysed the average age at which smokers in Spain seek treatment. The sample of 485 smokers who sought to participate in a smoking cessation program by mail had a mean age of 37.5 yr. and the mean reported number of cigarettes smoked per day was 26.3. Subjects' age was significantly associated with gender, marital status, and the number of cigarettes smoked before treatment.

In this study was evaluated the relationship between self-reported smoking rate and expired air carbon monoxide in 208 smokers who had attended a behavioral program for smoking cessation. A close relationship between carbon monoxide levels and self-reports was found at the end of treatment and in all follow-ups (6 and 12 mo.), around 100% concordance. Thus, support was found for the use of an expired air carbon monoxide measure as a valid and easy way of corroborating self-report data when required.

AbstractThe aim of the present study is to examine the relationship between cigarette smoking and personality patterns in the general population, taking into account the possible influence of nicotine dependence. We used a stratified random sample of 1,081 adults from the general population (519 smokers and 562 non-smokers) in the region of Galicia (Spain). Personality patterns were assessed with the Millon Clinical Multiaxial Inventory-III (MCMI-III). The results indicated that nicotine-dependent smokers had a higher probability of obtaining a PREV >75 in the histrionic and antisocial personality patterns and non-nicotine-dependent smokers are more likely to present a PREV >75 in paranoid personality pattern than non-smokers. On the contrary, non-smokers are more likely to have a PREV >75 on the compulsive personality scale. Our findings suggest that there are different personality patterns according to smoking status (smoker/non-smoker) and according to the presence of nicotine dependence. We concluded that it is necessary to identify the personality characteristics of smokers, since these characteristics could be key variables in increased risk of being a smoker and of difficulties for quitting smoking.

AbstractRelapse is common during the process of giving up smoking. The aim of the present study is to explore the relapse situations, according to Marlatt’s relapse taxonomy, in a sample of 428 smokers (43.9% men and 56.1% women) who participated in a cognitive-behavior psychological treatment for quitting smoking. At the end of the treatment, 221 participants were abstinent, of whom 119 (41.2% men and 58.8% women) relapsed in the course of the 12-month follow-up, the majority in the first 3 months (69.74%). Most of the relapses were attributed to intrapersonal and environmental determinants (61.33%), the most common of which were “coping with negative emotional states” (38.65%), followed by “giving in to temptations or urges” (9.24%) and “testing personal control” (8.40%). Interpersonal determinants occurred in 38.66% of relapses, this percentage being made up mostly of “social pressure”, which was the relapse situation in 34.46% of all relapses. These results, similar to those of Marlatt’s original studies and others, contribute to improving our knowledge of the relapse situations process, with a view to interventions that may help to avoid it.