Caracterización neuropsicológica de la impulsividad funcional y disfuncional en adictos a sustancias: implicaciones clínicas

Abstract

Impulsivity is a stable correlate throughout the course of drug addiction.However, it has always been studied as a negative condition, linked to psychopathology. Dickman (1990) proposed two subdimensions of impulsivity, dysfunctional (DI) and functional (FI). He defines the latter as the tendency for rapid, goal-oriented decision-making characterized by well calculated risks. Only a few studies have attempted to differentiate between these two subdimensions using classical neuropsychological tests. Fifty two drug addicts in treatment were tested using Dickman's Impulsivity Inventory and a battery of classical neuropsychological tests. FI shows moderate to high correlations with many classical neuropsychological test scores in relation to enhanced executive functioning, whereas DI reveals surprisingly weak and scarce correlations with indicators of impaired executive functioning. DI appears to be a trait related to some difficulties in classical neuropsychological tests, while FI emerges as a consistent and much stronger predictor of higher attention capacity, lower distractibility, better precision, fewer errors, and better maintenance of goal-oriented strategies. Thus, functional impulsivity is related to positive conditions and more efficient cognitive functioning.Implications for the treatment of drug addictions are suggested. La impulsividad es una de las variables más consistentemente vinculadas a las distintas fases del proceso adictivo. Sin embargo, casi siempre se ha estudiado como una condición negativa, vinculada a psicopatología. Dickman (1990) propuso dos tipos de impulsividad, una disfuncional (ID) y otra funcional (IF). A ésta última la definió como la tendencia a tomar decisiones rápidas, orientadas a metas, mediante un proceso de toma de decisiones con riesgo calculado. Pocos estudios han abordado la caracterización neuropsicológica de ambas variantes, relacionándolas con el rendimiento en pruebas clásicas. Una muestra de 52 sujetos adictos en tratamiento cumplimentó el Dickman Impulsivity Inventory y una batería de pruebas neuropsicológicas clásicas. Se observaron correlaciones de débiles a moderadas entre la IF e indicadores de éxito en las tareas neuropsicológicas, mientras que la ID mostró una relación difusa y débiles correlaciones con indicadores de mal rendimiento en todas las tareas. La ID se mostró como una disposición que dificulta la realización de las tareas de forma global, sin interferencia específica, en tanto que la IF se relacionó consistentemente con mayor precisión, menor número de errores y mejor mantenimiento de los planes, y ello a partir de una mejor gestión atencional y una mayor resistencia al ruido. Se sugieren las implicaciones de cara a los tratamientos de las adicciones.Palabras clave: Impulsividad funcional, impulsividad disfuncional, evaluación neuropsicológica, adicción, tratamiento, atención, funciones ejecutivas.

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