Frontal systems deficits in stimulant-dependent patients: Evidence of pre-illness dysfunction and relationship to treatment response

Abstract

BACKGROUND Frontal systems dysfunction is present in stimulant-dependent patients. However, it is unclear whether this dysfunction is a pre-morbid risk factor or stimulant-induced, is severe enough to be clinically relevant, and if it is relevant to treatment response. These questions were addressed using the Frontal Systems Behavior Scale (FrSBe), a reliable and valid self-report assessment of three neurobehavioral domains associated with frontal systems functioning (Apathy, Disinhibition, and Executive Dysfunction, summed for a Total), that assesses both pre- and post- morbid functioning, and has a specific cutoff for defining clinically significant abnormalities. METHOD Six sites evaluating 12-step facilitation for stimulant abusers obtained the FrSBe from 180 methamphetamine- and/or cocaine-dependent participants. Dichotomous treatment response measures included self-reported stimulant use, stimulant urine drug screens, and treatment completion. RESULTS A substantial percentage of participants retrospectively reported clinically significant neurobehavioral abnormalities prior to lifetime stimulant abuse initiation (e.g., 67.5% on FrSBe-Total) with a significant increase in the proportion reporting such abnormalities for current functioning (86% on FrSBe-Total; p<0.0001). Treatment response was significantly worse for participants with, relative to those without, clinically significant Disinhibition as measured by treatment non-completion (31.6% vs. 15.6%, OR=2.51) and self-reported stimulant use during treatment (40.5% vs. 16.7%, OR=3.40). CONCLUSION These findings suggest that frontal systems dysfunction is present prior to stimulant-abuse onset and worsens with stimulant use. Disinhibition may be a prime target for intervention in stimulant-dependent individuals.

Association of exposure to neighborhood drug activity, neurobehavioral traits, and marijuana use among at-risk African American females

“…Given a small base of research indicating that intact neurocognitive functioning might serve as a protective factor against adverse outcomes among high risk populations (Mitchell, Severtson, & Latimer, 2007), more research focused on the moderating effects of behavioral disinhibition on the association of exposure to neighborhood drug activity and marijuana use may prove beneficial. In addition, our findings support the utility of the FrSBe as a brief valid assessment for measuring frontally-mediated neurobehavioral traits relevant to substance use disorders (Lyvers et al, 2013;Winhusen et al, 2013). However, future studies aimed at examining the influence of neighborhood drug activity might benefit from more precise measures of neighborhood drug activity.…”

Sensation seeking and executive deficits in relation to alcohol, tobacco, and marijuana use frequency among university students: Value of ecologically based measures

“…Executive deficits have been observed in recreational users suggesting these deficits predate the development of addiction (Kollins, 2003;Soar, Mason, Potton & Dawkins, 2012). Frontal systems dysfunction has also been observed on selfreport measures of executive abilities prior to the development of stimulant abuse and to worsen with continued use (Winhusen, Somoza, Lewis, Kropp, Horigian, & Adinoff, 2013). Consistent with the suggestion that drugs of abuse can damage prefrontal cortical regions and produce deficits in executive function, several studies have reported links between the degree of drug exposure or dependence and neuropsychological and structural deficits (Ersche, Barnes, Jones,…”

“…Studies in substance dependent populations have shown substantial yet differential deficits across the three FrSBe subscales suggesting widespread frontal deficits accompany drug addiction (Cattie, Woods, Iudicello, Pasada, Grant & TMARC Group, 2013;Winhusen et al, 2013;Verdejo-Garcı´, Rivas-Pe´rez et al, 2006). In this study, as with others (Lyvers et al, 2009;Spinella;, the FrSBe Disinhibition scale appears to be most predictive of alcohol,…”

Risco de suicídio em dependentes de cocaína com episódio depressivo atual: sentimentos e vivências

“…Alcohol and crack/cocaine is related to suicide attempts, with an increase of depressive symptoms and impulsivity [20][21] . Impulsivity with the use of alcohol has shown evidenced in the relationship of use with depressive symptoms and suicidality.…”