RESUMEN
BACKGROUND: Impaired inhibition of conditioned response plays a significant role in relapse in addictive behaviors. Although patients and their relatives frequently discuss this behavioral deficit when seeking treatment, no instrument is yet available to measure its severity. The aim of this study was to develop the Impaired Response Inhibition Scale for Alcoholism (IRISA) to assess this impairment in alcohol-dependent patients. METHODS: A preliminary version of the IRISA was administered to a group of 151 patients under treatment at our center. Exploratory factor analysis was conducted using principal component analysis. The validity and reliability of the IRISA were examined. RESULTS: Factor analysis and item refinement led to a definitive 16-item IRISA that accounted for 61.6% of the total variance and revealed Impaired Response Inhibition as a single factor. Psychometric properties of this version of the IRISA scale showed excellent internal consistency (Cronbach's alpha: 0.96), good test-retest reliability (intraclass correlation coefficient: 0.81), and satisfactory convergent, discriminant, and predictive validity. The IRISA has a good correlation with alcohol craving, the severity of alcoholism, and alcohol consumption during the recovery process. CONCLUSIONS: Our initial results with the IRISA suggest that it is a reliable and valid tool to measure impairment in response inhibition to drinking behavior. The IRISA assesses a potentially important aspect of treatment process and outcome.
Asunto(s)
Alcoholismo/psicología , Inhibición Psicológica , Índice de Severidad de la Enfermedad , Anciano , Consumo de Bebidas Alcohólicas/psicología , Alcoholismo/terapia , Condicionamiento Psicológico , Análisis Factorial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Psicometría , Reproducibilidad de los Resultados , Centros de Tratamiento de Abuso de Sustancias , Resultado del TratamientoRESUMEN
BACKGROUND: A 12-week, double-blind, randomized, parallel-group clinical trial, comparing olanzapine and placebo treatment together with cognitive-behavioral psychotherapy, was carried out to determine the efficacy, safety, and tolerability of olanzapine in the treatment of alcoholism. METHODS: A total of 60 alcohol-dependent patients were assigned to 12 weeks' treatment with either olanzapine or placebo. The primary variable relapse to heavy drinking rate was evaluated by means of intention-to-treat analyses. Alcohol consumption, craving, adverse events, and changes in the biochemical markers of heavy drinking and possible toxicity were also evaluated. RESULTS: We did not find significant differences in the survival analysis between placebo and olanzapine-treated patients (Kaplan-Meier log rank = 0.46, df = 1, p = 0.50). Eleven (37.9%) patients treated with olanzapine relapsed compared with 9 (29%) of those receiving placebo (chi = 0.53, df = 1, p = 0.5). Although some adverse events (weight gain, increased appetite, drowsiness, constipation, and dry mouth) were found more frequently in the olanzapine group, differences did not reach statistical significance in comparison with the placebo group. CONCLUSIONS: Olanzapine was well tolerated, as the rate of adverse events was low, and it was safe, because it did not interfere with the normalization of biochemical markers of heavy drinking or alter liver function markers. Alcohol-dependent patients showed good adherence and compliance with the treatment protocol, but we found no differences in relapse rate or other drinking variables when comparing olanzapine with placebo-treated patients.