Neuropsychological characterization of functional and dysfunctional impulsivity in drug addicts: clinical implications

Authors

  • Eduardo J. Pedrero-Pérez CAD 4 San Blas. Instituto de Adicciones. Ayuntamiento de Madrid. Enviar correspondencia a: Eduardo J. Pedrero Pérez. Centro de Atención a Drogodependientes (CAD 4 – San Blas). C/ Alcalá, 527. 28027 – Madrid. Teléfono: 91 743 47 71/ 72. Fax: 91 743 47 75.
  • José M. Ruiz Sánchez de León Servicio de Neurología del Hospital Sanitas La Moraleja.
  • Gloria Rojo Mota CAD 4 San Blas. Instituto de Adicciones. Ayuntamiento de Madrid.
  • Marcos Llanero Luque Servicio de Neurología del Hospital Sanitas La Moraleja.
  • Carmen Puerta García CAD 4 San Blas. Instituto de Adicciones. Ayuntamiento de Madrid.

DOI:

https://doi.org/10.20882/adicciones.117

Keywords:

Functional impulsivity, dysfunctional impulsivity, neuropsychological assessment, drug addiction, treatment, attention, executive functions

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.

Author Biography

Eduardo J. Pedrero-Pérez, CAD 4 San Blas. Instituto de Adicciones. Ayuntamiento de Madrid. Enviar correspondencia a: Eduardo J. Pedrero Pérez. Centro de Atención a Drogodependientes (CAD 4 – San Blas). C/ Alcalá, 527. 28027 – Madrid. Teléfono: 91 743 47 71/ 72. Fax: 91 743 47 75.

References

Army Individual Test Battery. (1944). Manual of directions and scoring.

Washington, DC: War Department, Adjutant General’s Office.

Bankston, S. M., Carroll, D. D., Cron, S. G., Granmayeh, L. K., Marcus, M.

T., Moeller, F. G., … Liehr P. R. (2009). Substance abuser impulsivity

decreases with a nine-month stay in a therapeutic community.

American Journal of Drug and Alcohol Abuse, 35, 417-420.

Bates, M. E., Voelbel, G. T., Buckman, J. F., Labouvie, E. W. y Barry D.

(2005). Short-term neuropsychological recovery in clients with substance use disorders. Alcoholism: Clinical and Experimental Research, 29, 367-377. doi: 10.1097/01.alc.0000156131.88125.2a

Brunas-Wagstaff, J., Bergquist, A., Morgan, K. y Wagstaff, G. F. (1996).

Impulsivity, interference on perceptual tasks and hypothesis testing. Personality and Individual Differences, 20, 471-482.

doi:10.1016/0191-8869(95)00200-6

Brunas-Wagstaff, J., Bergquist, A. y Wagstaff, G. F. (1994). Cognitive

correlates of functional and dysfunctional impulsivity. Personality and Individual Differences, 17, 289-292. doi:10.1016/0191-8869(94)90033-7

Chico, E., Tous, J. M., Lorenzo, U. y Vigil, A. (2003). Spanish adaptation

of Dickman’s impulsivity inventory: Its relationship to Eysenck’s personality questionnaire. Personality and Individual Differences, 35, 1883-1892. doi:10.1016/S0191-8869(03)00037-0

de Wit H. (2009). Impulsivity as a determinant and consequence of drug use: A review of underlying processes. Addiction Biology, 14, 22-31. doi: 10.1111/j.1369-1600.2008.00129.x

Dickman, S. J. (1985). Impulsivity and perception: Individual differences in the processing of the local and global dimensions of stimuli. Journal of Personality and Social Psychology, 48, 133-149. doi: 10.1037/0022-3514.48.1.133

Dickman, S. J. (1990). Functional and dysfunctional impulsivity: Personality and cognitive correlates. Journal of Personality and Social Psychology, 58, 95-102. doi: 10.1037/0022-3514.58.1.95

Dickman, S. J. y Meyer, D. E. (1988). Impulsivity and speed-accuracy

tradeoffs in information processing. Journal of Personality and Social Psychology, 54, 274-290. doi: 10.1037/0022-3514.54.2.274

Ernst, M., Pine, D. S. y Hardin, M. (2006). Triadic model of the neurobiology of motivated behavior in adolescence. Psychological Medicine, 36, 299-312. doi: 10.1017/s0033291705005891

Fals-Stewart, W. y Lam, W. K. K. (2010). Computer-assisted cognitive

rehabilitation for the treatment of patients with substance use disorders: A randomized clinical trial. Experimental and Clinical Psychopharmacology, 18, 87-98. doi: 10.1037/a0018058

Flory, J. D., Harvey, P. D., Mitropoulou, V., Newm A. S., Silvermanm J.

M., Sieverm L. J. y Manuck, S. B. (2006). Dispositional impulsivity in normal and abnormal samples. Journal of Psychiatric Research, 40, 438-447. doi:10.1016/j.jpsychires.2006.01.008

Forcada, R., Pardo, N. y Bondía, B. (2006). Impulsividad en dependientes

de cocaína que abandonan el consumo. Adicciones, 18, 111-118.

Franken, I. H. A. y Muris, P. (2005). Individual differences in decisionmaking. Personality and Individual Differences, 39, 991-998.

doi:10.1016/j.paid.2005.04.004

Gardner, D. M., Baldessarini, R. J. y Waraich, P. (2005). Modern antipsychotic drugs: a critical overview. Canadian Medical Association Journal, 172, 1703-1711. doi: 10.1503/cmaj.1041064

Golden, C. J. (2005). Test de colores y palabras (Stroop). Madrid: TEA

Ediciones.

Goldstein, R. Z, Leskovjan, A. C., Hoff, A. L., Hitzemann, R., Bashan, F., Khalsa, S. S., … Volkow, N. D. (2004). Severity of neuropsychological impairment in drug addiction: association with metabolism in the brain reward circuit. Neuropsychologia, 42, 1447-1458. doi:10.1016/j.neuropsychologia.2004.04.002

Harvey, P. D. y Keefe, S. E. (2001). Studies of cognitive change in patients with schizophrenia following novel antipsychotic treatment. American Journal of Psychiatry, 158, 176-184.

Kempen, G. I. J. M., Van Heuvelen, M. J. G., Van den Brink, R. H. S,

Kooijman, A. C., Klein, M., Houx, P. J. y Ormel, J. (1996). Factors affecting contrasting results between self-reported and performance based levels of physical limitations. Age and Ageing, 25, 458-464. doi: 10.1093/ageing/25.6.458

Kockelmann, E., Elger, C. E. y Helmstaedter, C. (2003). Significant

improvement in frontal lobe associated neuropsychological functions after withdrawal of topiramate in epilepsy patients. Epilepsy Research, 54, 171-178. doi:10.1016/S0920-1211(03)00078-0

Lansbergen, M. M., van Hell, E. y Kenemans, J. L. (2007). Impulsivity and conflict in the Stroop Task. An ERP study. Journal of Psychophysiology, 21, 33-50. doi: 10.1027/0269-8803.21.1.33

Lezak, M. D., Howieson, D. B. y Loring, D. W. (2004). Neuropsychological

Assessment (4th ed). New York: Oxford University Press.

Mobini, S., Grant, A., Kass, A. E. y Yeomans, M. R. (2007). Relationships

between functional and dysfunctional impulsivity, delay discounting and cognitive distortions. Personality and Individual Differences, 43, 1517-1528. doi:10.1016/j.paid.2007.04.009

Pedrero Pérez, E. J. (2009). Evaluación de la impulsividad funcional y

disfuncional en adictos a sustancias mediante el Inventario de Dickman. Psicothema, 21, 585-591.

Pedrero Pérez, E. J., López Durán, A. y Olivar Arroyo, A. (2011). Addiction: Frontal personality change but not personality disorder comorbidity. Implications for treatment of addictive disorders. In Jordan, M. E. (ed.), Personality Traits Theory, Testing and Influences (pp. 1-36). New York: Nova Publishers. ISBN: 978-1-61728-934-7

Pedrero Pérez, E. J., Puerta García, C., Rojo Mota, G., Ruiz Sánchez de

León, J. M., Llanero Luque, M. y Olivar Arroyo, Á. (2009). Déficit de

atención e hiperactividad en adultos con adicción a sustancias: ¿TDAH o síndrome secundario al abuso de sustancias? Revista Española de Drogodependencias, 34, 32-45.

Pedrero Pérez, E. J. y Rojo Mota, G. (2008). Diferencias de personalidad

entre adictos a sustancias y población general. Estudio con el TCI-R de casos clínicos con controles emparejados. Adicciones, 20, 251-262.

Pedrero Pérez, E. J., Ruiz Sánchez de León, J. M., Rojo Mota, G., Llanero

Luque, M., Olivar Arroyo, Á., Bouso Sainz, J. C. y Puerta García, C. (2009). Versión española del Cuestionario Disejecutivo (DEXSp): propiedades psicométricas en adictos y población no clínica. Adicciones, 21, 155-166.

Perry, J. L. y Carroll, M. E. (2008). The role of impulsive behavior in drug

abuse. Psychopharmacology, 200, 1-26. doi: 10.1007/s00213-008-1173-0

Rammsayer, T. H. y Rammstedt, B. (2000). Sex-related differences in

time estimation: The role of personality. Personality and Individual

Differences, 29, 301-312. doi:10.1016/S0191-8869(99)00194-4

Reeve, C. L. (2007). Functional impulsivity and speeded ability test

performance. International Journal of Selection and Assessment, 15, 56-62. doi: 10.1111/j.1468-2389.2007.00367.x

Reitan, R. y Wolfson, D. (1985). The Halstead-Reitan. Neuropsychological

Test Battery. Tucson: Neuropsychology Press.

Rey, A. (2009). Test de copia de una figura compleja. Madrid: TEA

Ediciones.

Rojo Mota, G., Pedrero Pérez, E. J., Ruiz Sánchez de León, J. M., Llanero

Luque, M., Olivar Arroyo, Á. y Puerta García, C. (2009). Terapia ocupacional en la rehabilitación de la disfunción ejecutiva en adictos a sustancias. Trastornos Adictivos, 11, 96-105. doi:10.1016/

S1575-0973(09)72057-4

Ruiz Sánchez de León, J. M., Llanero Luque, M., Montenegro, M. y Montejo, P. (2008). Tarea de inhibición frontal (Go - No Go) para la evaluación del envejecimiento normal, el deterioro cognitivo ligero y demencia de tipo Alzheimer leve. Neurología, 23, 839.

Seidenberg, M., Taylor, M. A. y Haitiner, A. (1994). Personality and self-report of cognitive functioning. Archives of Clinical Neuropsychology,

, 353-361. doi:10.1016/0887-6177(94)90023-X

Selby, M. J. y Azrin, R. L. (1998). Neuropsychological functioning in drug abusers. Drug and Alcohol Dependence, 1, 39-45. doi:10.1016/S0376-8716(98)00002-7

Shulman, L. M., Pretzer-Aboff, I., Anderson, K. E., Stevenson, R., Vaughan, C. G., Gruber-Baldini, A. L., … Weiner W. J. (2006). Subjective report versus objective measurement of activities of daily living in Parkinson’s disease. Movement Disorders, 21, 794-799. doi: 10.1002/mds.20803

Stroop, J. R. (1935). Studies of interference in serial verbal reactions.

Journal of Experimental Psychology, 18, 643-662. doi: 10.1037/0096-

121.1.15

Tanabe, J., Tregellas, J. R., Dalwani, M., Thompson, L., Owens, E., Crowley, T. y Banich, M. (2008). Medial orbitofrontal cortex gray matter is

reduced in abstinent substance-dependent individuals. Biological Psychiatry, 65, 160-164. doi:10.1016/j.biopsych.2008.07.030

Toulouse, E. Y. y Pieron, H. (1972). Toulouse-Piéron: prueba perceptiva

y de atención manual. Madrid: TEA Ediciones.

Verdejo, A., Orozco, C., Meersmans, M., Aguilar de Arcos, F. y Pérez-García, M. (2004). Impacto de la gravedad del consumo de drogas

sobre distintos componentes de la función ejecutiva. Revista de Neurología, 38, 1109-1116.

Verdejo, A., Lawrence, A. J. y Clark, L. (2008). Impulsivity as a vulnerability marker for substance use disorders: Review of findings from high-risk research, problem gamblers and genetic association studies. Neuroscience & Biobehavioral Reviews, 32, 777-810. doi:10.1016/j.neubiorev.2007.11.003

Vigil, A. y Codorniu, M. J. (2004). Aggression and inhibition deficits, the role of functional and dysfunctional impulsivity. Personality and Individual Differences, 37, 1431-1440. doi:10.1016/j.paid.2004.01.013

Vigil, A., Morales, F. y Tous, J. (2008). The relationships between functional and dysfunctional impulsivity and aggression across different samples. Spanish Journal of Psychology, 11, 480-487.

Vocci, F. J. (2008). Cognitive remediation in the treatment of stimulant

abuse disorders: A research agenda. Experimental and Clinical Psychopharmacology, 16, 484-497. doi: 10.1037/a0014101

Wechsler, D. (1999). Escala de Memoria Wechsler para Adultos (WMSIII)

(3ª Ed.). Madrid: TEA Ediciones.

Welsh, M. C. y Pennington, B. F. (1988). Assessing frontal lobe functioning

in children: Views from developmental psychology. Developmental

Neuropsychology, 4, 199-230. doi: 10.1080/87565648809540405.

Winstanley, C. A. (2007). The orbitofrontal cortex, impulsivity, and

addiction. Annals of the New York Academy of Sciences, 1121, 639-655. doi: 10.1196/annals.1401.024

Wittink, H., Rogers, W., Sukiennik, A. y Carr, D. B. (2003). Physical

functioning: self-report and performance measures are related but distinct. Spine, 28, 2407-2413.

Published

2012-03-01

Issue

Section

Originals