Efecto del tratamiento sobre el descuento temporal y probabilístico en participantes con trastorno por uso de crack
Contenido principal del artículo
Resumen
Introducción: diversos estudios han mostrado que individuos con dependencia de drogas psicoactivas muestran un descuento temporal pronunciado de recompensas monetarias en contraste con no consumidores. Este hallazgo resulta de utilidad clínica como una característica conductual susceptible a modificación por tratamientos psicológicos.
Objetivo: evaluar modificaciones pre-post en descuento temporal y probabilístico, sintomatología somática, ansiedad, depresión, psicosis y autoeficacia, en participantes con trastorno por uso de crack severo que recibieron una de dos modalidades de tratamiento psicológico y en un grupo control sin consumo.
Método: se trabajó con 92 participantes, 31 en cada uno de los tratamientos y 30 en el grupo control. Se evaluó a los tres grupos de manera pre-post; el post se llevó a cabo después de 40 días para los tres grupos, tiempo durante el cual recibían alguna de las dos modalidades de atención, a excepción del grupo control, al cual se le dio cita para la evaluación post.
Resultados: las mediciones pre-post de descuento temporal y probabilístico no cambiaron en ninguno de los tres grupos. En contraste, ambas modalidades de tratamiento incrementaron la autoeficacia y disminuyeron síntomas somáticos como ansiedad, depresión y psicoticismo.
Discusión y conclusiones: se demostró la estabilidad de las mediciones de descuento ante el tratamiento psicológico; otras variables sí fueron susceptibles de modificación debido al tratamiento, por lo que la utilidad clínica del descuento, como una variable que indique el éxito de la intervención, debe seguir explorándose en futuras investigaciones.
Detalles del artículo

Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.
Citas
American Psychiatric Association. (2013).Diagnostic and statistical manual of mental disorders (DSM-5). Washington: American Psychiatric Association.
Barragán, L., Flores, M., Medina-Mora, M. E., & Ayala, H. (2007). Modelo integral de satisfacción cotidiana en usuarios dependientes de alcohol y otras drogas.Salud Mental, 30(3), 29-38.
Bickel, W. K., Yi, R., Landes, R. D., Hill, P. F., & Baxter, C. (2011). Remember the future: working memory training decreases delay discounting among stimulant addicts. Biological Psychiatry, 69(3), 260-265. doi: 10.1016/j.biopsych.2010.08.017
Black, A. C., & Rosen, M. (2011). A money management-based substanceuse treatment increases valuation of future rewards.Addictive Behaviors, 36(1), 125-128. doi: 10.1016/j.addbeh.2010.08.014.
Blevins, C. E., Stephens, R. S., Walker, D. D., & Roffman, R. A. (2014). Situational determinants of use and treatment outcomes in marijuana dependent adults. Addictive Behaviors,, 39(3), 546-552. doi: 10.1016/j.addbeh.2013.10.031
Chang, L., & Chronicle, E. P. (2007). Functional imaging studies in cannabis users. The Neuroscientist,13(5), 422-432. doi: 10.1177/1073858406296601
Chang, L., Yakupov, R., Cloak, C., & Ernst, T. (2006). Marijuana use is associated with a reorganized visual-attention network and cerebellar hypoactivation. Brain,129(5), 1096-1112. doi: 10.1093/brain/awl064
Coffey, S. F., Gudleski, G. D., Saladin, M. E., & Brady, K. T. (2003). Impulsivity and rapid discounting of delayed hypothetical rewards in cocaine-dependent individuals. Experimental and Clinical Psychopharmacology, 11(1), 18-25. doi: 10.1037/1064-1297.11.1.18
Connor, J., Gullo, M., Chan, G., Young, R., Hall, W., & Feeney, G. (2013).Polysubstance use in cannabis users referred for treatment: druguse profiles,psychiatric comorbidity and cannabis-related beliefs. Frontiers in Psychiatry,4(79),1-7. doi: 10.3389/fpsyt.2013.00079
Cross, C. P., Copping, L. T., & Campbell, A. (2011). Sex differences in impulsivity:a meta-analysis. Psychological Bulletin,137(1), 97-130. doi: 10.1037/a0021591
Cruz, C., López, L., Blas, C., González, L., & Chávez, R. (2004).Datos sobre la validez y confiabilidad de la Symptom Check List 90 (SCL-90) en una muestra de sujetos mexicanos.Salud Mental,28(1), 72-81.
Dallery, J., & Raiff, B. (2007). Delay discounting predicts cigarette smoking ina laboratory model of abstinence reinforcement.Psychopharmacology,190(4),485-496. doi: 10.1007/s00213-006-0627-5
De Wilde, B., Bechara, A., Sabbe, B., Hulstijn, W., & Dom, G. (2013).Risky decision-making but not delay discounting improves during inpatient treatment of polysubstance dependent alcoholics.Frontiers in Psychiatry, 4(91), 1-7. doi: 10.3389/fpsyt.2013.00091
Dennhardt, A. A., Yurasek, A. M., & Murphy, J. G. (2015). Change in delay discounting and substance reward value following a brief alcohol and drug use intervention. Journal of the Experimental Analysis of Behavior, 103(1), 125-140. doi: 10.1002/jeab.121
Echeverría, L., & Ayala, H. (1977).Cuestionario de confianza situacional:traducción y adaptación.México: Universidad Nacional Autónoma de México.
Engel, K., Schaefer, M., Stickel, A., Binder, H., Heinz, A., & Richter, C. (2015). The role of psychological distress in relapse prevention of alcohol addiction. Can high scores on the SCL-90-R predict alcohol relapse? Alcohol and Alcoholism, 51(1), 27-31. doi: 10.1093/alcalc/agv062
Epstein, L., & Roemmich, J. (2001). Reducing sedentary behavior: Role in modifying physical activity. Exercise & Sports Sciences Reviews 29(3), 103-108. doi: 0091-6631/2903/103–108
Fiorentine, R., & Hillhouse, M. P. (2003). Why extensive participation intreatment and twelve-step programs is associated with the cessation of addictive behaviors:an application of the addicted-self model of recovery. Journal of Addictive Diseases 22(1),35-55. doi: 10.1080/10550490390226932
Fuchs, R. A., Branham, R. K., & See, R. E. (2006). Different neural substratesmediate cocaine seeking after abstinence versus extinction training:a critical role for the dorsolateral caudate–putamen.The Journal of Neuroscience, 26(13), 3584-3588. doi: 10.1523/JNEUROSCI.5146-05.2006
García-Rodríguez, O., Secades-Villa, R., Weidberg, S., & Yoon, J. (2013).A systematic assessment of delay discounting in relation to cocaineand nicotine dependence.Behavioral Processes, 99, 100-105. doi: 10.1016/j.beproc.2013.07.007
Heil, S., Johnson, M., Higgins, S., & Bickel, W. (2006).Delay discounting in currently using and currently abstinent cocaine-dependent outpatients and non-drug-using matched controls.Addictive Behaviors, 31(7), 1290–1294. doi: 10.1016/j.addbeh.2005.09.005.
Hollander, J. A., & Carelli, R. M. (2007). Cocaine-associated stimuli increasecocaine seeking and activate accumbens core neurons after abstinence.The Journal of Neuroscience, 27(13), 3535-3539. doi: 10.1523/JNEUROSCI.3667-06.2007
Holt, D., Green, L., & Myerson, J. (2012). Estimating the subjective value of future rewards: comparison of adjusting amount and adjusting delay procedures.Behavioural Processes,90(3), 302- 310. doi: 10.1016/j.beproc.2012.03.003
Hser, Y. I. (2007). Predicting long-term stable recovery from heroin addiction:Findings from a 33-year follow-up study.Journal of Addictive Diseases, 26(1),51-60. doi: 10.1300/J069v26n01_07
Jariani, M., Saaki, M., Nazari, H., & Birjandi, M. (2010). The effect of Olanzapineand Sertraline on personality disorder in patients with methadone maintenance therapy. Psychiatria Danubina, 22(4), 544-547.
Jones, C. (2013).Delay discounting rates, relapse, and treatment satisfactionin young adults.(Doctoral dissertation). Minnesota:Capella University.http://search.proquest.com/docview/1492338109
Kazdin, A. E. (2011).Single-case research designs: Methods for clinical and applied settings.Oxford: Oxford University Press.
Krishnan-Sarin, S., Reynolds, B., Duhig, A. M., Smith, A., Liss, T.McFetridge,A.Potenza, M. N. (2007). Behavioral impulsivity predicts treatment outcome in a smoking cessation program for adolescent smokers.Drug and Alcohol Dependence88(1), 79-82. doi: 10.1016/j.drugalcdep.2006.09.006
Landes, R. D., Christensen, D. R., & Bickel, W. K. (2012). Delay discounting decreases in those completing treatment for opioid dependence. Experimental and Clinical Psychopharmacology, 20(4), 302-309. doi: 10.1037/a0027391
Lejuez, C. W., Bornovalova, M. A., Reynolds, E. K., Daughters, S. B., & Curtin, J. J. (2007). Risk factors in the relationship between gender and crack/cocaine. Experimental and Clinical Psychopharmacology, 15(2), 165-175. doi: 10.1037/1064-129.15.2.165
Linage, L., & Lucio, E. (2013). Propiedades psicométricas del ASSIS Ten una muestra de estudiantes mexicanos. Revista Española de Drogodependencias,38(1), 37-51.
López, A. A. (2014).Examining delay discounting and response to incentive-based smoking-cessation treatment among pregnant women. (Doctoral dissertation). Estados Unidos: The University of Vermont.
López, A., Becoña, E., Vieitez, I., Cancelo, J., Sobradelo, J., García, J. M.,Lage, M. T. (2008). ¿Qué ocurre a los 24 meses del inicio del tratamiento en una muestra de personas con dependencia de la cocaína? Adicciones, 20(4), 347-356. doi: 10.20882/adicciones.258
López, A., Fernández, E., & Becoña, E. (2009). Comparación de las puntuacionesdel SCL-90-R entre personas con dependencia de la nicotina y personas con dependencia de la cocaína al inicio del tratamiento.Revista de Psicopatología y Psicología Clínica14(1), 17-23. doi: 10.5944/rppc.vol.14.num.1.2009.4063
López-Torrecillas, F., Nieto-Ruiz, A., Velasco-Ortuño, S., Lara-Fernández, M., López-Quirantes, E. M., & Castillo-Fernández, E. (2014). The role of impulsivity in dropout from treatment for cigarette smoking.Comprehensive Psychiatry 55(7),1609-1613. doi: 10.1016/j.comppsych.2014.06.004
López-Torrecillas, F., Perales, J. C., Nieto-Ruiz, A., & Verdejo-García, A. (2014).Temperament and impulsivity predictors of smoking cessation outcomes.PLoS ONE,9(12), 1-18. doi: 10.1371/ journal.pone.0112440
Lu, L., Grimm, J. W., Shaham, Y., & Hope, B. T. (2003). Molecular neuroadaptations in the accumbens and ventral tegmental area during the first 90 days of forced abstinence from cocaine selfadministration in rats.. Journal of Neurochemistry, 85(6), 1604-1613. doi: 0.1046/j.1471-4159.2003.01824.x
MacKillop, J., & Kahler, C. W. (2009). Delayed reward discounting predictstreatment response for heavy drinkers receiving smoking cessation treatment.Drug and Alcohol Dependence, 104(3), 197-203. doi: 10.1016/j.drugalcdep.2009.04.020
Manwaring, J., Green, L., Myerson, J., Strube, M., & Wilfley, D. (2011). Discountingof various types of rewards by women with and without binge eating disorder:evidence for general rather than specific differences.The Psychological Record,61(4), 561-582.
Manzardo, A. M., Pendleton, T., Poje, A., Penick, E. C., & Butler, M. G. (2015). Change in psychiatric symptomatology after benfotiamine treatmentin males is related to lifetime alcoholism severity.Drug and Alcohol Dependence,152, 257-263. doi: 10.1016/j.drugalcdep.2015.03.032
Marín-Navarrete, R., Templos-Nuñez, L., Eliosa-Hernández, A., Villalobos-Gallegos,L., Fernández-Mondragón, J., Pérez-López, A., Horigian, V. E. (2014). Characteristicsof a treatment-seeking population in outpatient addiction treatment centers in Mexico. Substance Use & Misuse, 49(13), 1784-1794. doi: 10.3109/10826084.2014.931972.
Martinotti, G., Di Nicola, M., Frustaci, A., Romanelli, R., Tedeschi, D., Guglielmo, R.,Di Giannantonio, M. (2010). Pregabalin, tiapride and lorazepam in alcohol withdrawal syndrome: a multi‐centre, randomized, single‐blind comparison trial. Addiction, 105(2),288-299. doi: 10.1111/j.1360-0443.2009.02792.x
Mejía, D. (2012).Efectividad de una intervención grupal para la dependencia al alcohol en pacientes con diagnostico dual reporte de experiencia profesional. (Tesis de Maestría). Ciudad de México: Facultad de Psicología, UNAM.
Mejía, D., Morales, S., & Nieto, J. (2015). Descuento temporal asociado al uso de cocaína.Revista Mexicana de Análisis de la Conducta, 41(1), 86-101.
Morrison, K., Madden, G., Odum, A., Friedel, J., & Twohing, M. (2014). Altering impulsive decision making with an acceptance-based procedure.Behavior Therapy, 45(5), 630-639.doi: 10.1016/j.beth.2014.01.001
Myerson, J., Green, L., & Warusawitharana, M. (2001). Area under the curve as a measure of discounting.. Journal of the Experimental Analysis of Behavior, 76(2), 236-243. doi: 10.1901/jeab.2001.76-235
Myerson, J., Green, L., van den Berk-Clark, C., & Grucza, R. A. (2015). Male, but not female, alcohol-dependent African Americans discount delayed gains more steeply than propensity-score matched controls.Psychopharmacology, 232(24), 4493-4503. doi: 10.1007/s00213-015-4076-x
Öhlin, L., Hesse, M., Fridell, M., & Tätting, P. (2011). Poly-substance use and antisocial personality traits at admission predict cumulative retention in a buprenorphine programme with mandatory work and high compliance profile. BMC Psychiatry 11(1), 1-8. doi: 10.1186/1471-244X-11-81
Ohmura, Y., Takahashi, T., Kitamura, N., & Wehr, P. (2006). Three-month stability of delay and probability discounting measures.Experimental and Clinical Psychopharmacology, 14(3), 318-328. doi: 10.1037/1064-1297.14.3.318
Passetti, F., Clark, L., Davis, P., Mehta, M. A., White, S., Checinski, K.,Abou-Saleh, M. (2011). Risky decision-making predicts short-term outcome of community but not residential treatment for opiate addiction. Implications for case management. Drug and Alcohol Dependence, 118(1), 12-18. doi: 10.1016/j.drugalcdep. 2011.02.015
Peters, E. N., Petry, N. M., LaPaglia, D. M., Reynolds, B., & Carroll, K. M. (2013). Delay discounting in adults receiving treatment for marijuana dependence. Experimental and Clinical Psychopharmacology, 21(1), 46-54. doi: 10.1037/a0030943
Secades-Villa, R., Weidberg, S., García-Rodríguez, O., Fernández-Hermida, J. R., & Yoon, J. H. (2014). Decreased delay discounting in former cigarettesmokers at one year after treatment.Addictive Behaviors,, 39(6), 1087-1093. doi: 10.1016/j.addbeh.2014.03.015
Secretaría de Salud, Centro Nacional para la Prevención y el Control de las Adicciones Comisión Nacional contra las Adicciones, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Instituto Nacional de Salud Pública. (2012). Encuesta Nacional de Adicciones 2011 México: Autor. Recuperado de http://www.conadic.salud.gob.mx/pdfs/ENA_2011_DROGAS_ILICITAS_.pdf
Sheehan, D., Lecrubier, Y., & Sheehan, K. (1998). The Mini-InternationalNeuropsychiatric Interview (MINI): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59(20), 22-33
Sheffer, C., MacKillop, J., McGeary, J., Landes, R., Carter, L., Yi, R., … Bickel, W. (2012). Delay discounting, locus of control, and cognitive impulsiveness independently predict tobacco dependence treatment outcomes in a highly dependent, lower socioeconomic group of smokers.The American Journal on Addictions, 21(3), 221-232. doi: 10.1111/j.1521-0391.2012.00224.x
Skinner, H. (1982). The Drug Abuse Screening Test.Addictive Behaviors, 7(4), 363-371. doi: 10.1016/0306-4603(82)90005-3
Stanger, C., Ryan, S. R., Fu, H., Landes, R. D., Jones, B. A., Bickel, W. K., … Budney, A.J. (2012). Delay discounting predicts adolescent substance abuse treatment outcome. Experimental and Clinical Psychopharmacology, 20(3), 205-212. doi: 10.1037/a0026543
Stein, J. A., Zane, J. I., & Grella, C. E. (2012). Impact of abstinence self-efficacy and treatment services on physical health-related behaviors and problems among dually diagnosed patients.Journal of Dual Diagnosis, 8(1), 64-73. doi: 10.1080/15504263.2012.647470
Stevens, L., Verdejo-García, A., Roeyers, H., Goudriaan, A. E., & Vanderplasschen, W. (2015). Delay discounting, treatment motivation and treatment retention among substance-dependent individuals attending an in inpatient detoxification program.Journal of Substance Abuse Treatment49, 58-64. doi: 10.1016/j.jsat.2014.08.007
Tulsky, D., & Zhu, J. (2003).Escala de Inteligencia Wechsler para adultos III: Manual técnico.México: Manual moderno.
Villalobos-Gallegos, L., Pérez-López, A., Mendoza-Hassey, R., Graue-Moreno, J., & Marín-Navarrete, R. (2015). Psychometric and diagnostic properties ofthe Drug Abuse Screening Test (DAST): Comparing the DAST-20 vs. the DAST-10. Salud Mental, 38(2), 89-94.
Washio, Y., Higgins, S. T., Heil, S. H., McKerchar, T. L., Badger, G. J., Skelly, J. M., Dantona, R.L. (2011). Delay discounting is associated with treatment response among cocaine-dependent outpatientsExperimental and Clinical Psychopharmacology> 19(3), 243-248. doi: 10.1037/a0023617
Weidberg, S., García-Rodríguez, O., Yoon, J. H., & Secades-Villa, R. (2015).Interaction of depressive symptoms and smoking abstinence on delay discounting rates. Psychology of Addictive Behaviors, 29(4), 1041-1047. doi: 10.1037/adb0000073
Weidberg, S., Landes, R. D., García-Rodríguez, O., Yoon, J. H., & Secades-Villa, R. (2015). Interaction effect of contingency management and sex on delay-discounting changes among treatment-seeking smokers.Experimental and Clinical Psychopharmacology, 23(5), 361-368. doi: 10.1037/pha0000043
Weidel, J. J. (2013). The relationship of temporal discounting and working alliance to substance abuse treatment process in hispanic adolescents. (Doctoral dissertation). Florida, Estados Unidos: The University of Miami. http://scholarlyrepository.miami.edu/oa_dissertations/1088
WHO ASSIST Working Group. (2002). The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): development, reliability and feasibility. . Addiction, 97(9), 1183-1194. doi: 10.1046/j.1360-0443.2002.00185.x
Wong, E. C., & Longshore, D. (2008). Ethnic identity, spirituality, and self-efficacy influences on treatment outcomes among Hispanic American methadone maintenance clients. Journal of Ethnicity in Substance Abuse 7(3), 328-340.doi: 10.1080/15332640802313478
Worley, M. J., Trim, R. S., Tate, S. R., Roesch, S. C., Myers, M. G., & Brown, S. A. (2014). Self-efficacy and social networks after treatment for alcohol or drug dependence and major depression: Disentangling person and time-level effects. .Psychology of Addictive Behaviors, 28(4), 1220- 1229. doi: 10.1037/a0037901
Yi, R., & Landes, R. D. (2012). Temporal and probability discounting by cigarette smokers following acute smoking abstinence. Nicotine & Tobacco Research, 14(5), 547-558. doi: 10.1093/ntr/ntr252
Yi, R., Johnson, M. W., Giordano, L. A., Landes, R. D., Badger, G. J., & Bickel, W. K. (2008). The effects of reduced cigarette smoking on discounting future rewards: an initial evaluation. The Psychological Record,58(2), 163-174.