Papers by Javier Fernández-Montalvo
Frontiers in Psychiatry, 2019
Previous research has suggested the prevalence of certain personality traits, some of which are r... more Previous research has suggested the prevalence of certain personality traits, some of which are related to a disorganized attachment, in substance abuse disorders. Further, frustration tolerance (FT) has been proposed as an important factor in addiction, both at the inception-following the "self-medication" hypothesis-and regarding treatment compliance. In turn, an inadequate response to frustrating events has been also associated with a disrupted attachment. Our goal is to explore the mediational role of FT in the relationship between personality traits and two different treatments for substance addiction: therapeutic community (TC) and ambulatory treatment (AT). Eighty-four subjects with substance abuse disorder were recruited in total (22 female), including 46 volunteers (13 female) in TC and 38 (9 female) in AT. They were assessed with Rosenzweig's test for FT and the Millon Clinical Multiaxial Inventory-III (MCMI-III) test to evaluate personality factors. By comparing with a control sample (335 volunteers, 268 female), we found that FT was lower in patients. Between therapeutic groups, FT was significantly lower in TC. Depressive, antisocial, sadistic, negativistic, schizotypal, borderline, paranoid, anxiety, dysthymia, alcohol use, drug use, posttraumatic stress disorder (PTSD), thought disorder, and delusional disorder traits were suggestive of pathology in the clinical samples and were significantly different between control, AT, and TC groups. Further, anxiety and PTSD traits were higher in TC than in AT. A mediational analysis revealed that the effect of anxiety and PTSD scales on therapeutic group was partially mediated by FT. In conclusion, FT and its interplay with personality traits commonly related to disorganized attachment (anxiety and PTSD) might be important factors to consider within therapeutic programs for persons with substance addiction.
PLoS ONE, 2019
Background: The Alcohol Use Disorders Identification Test (AUDIT) is the gold standard in assessi... more Background: The Alcohol Use Disorders Identification Test (AUDIT) is the gold standard in assessing harmful alcohol intake, which is responsible for substantial morbidity and mortality. Objective: The goal of this study is to evaluate the psychometric properties and factor structure of an Ecuadorian adaptation of a Spanish translation of the AUDIT in a large sample of college students in Ecuador. Methods: A total of 7905 students, including 46.26% males, and 53.75% females, from 11 universities in Ecuador, were surveyed. The questionnaire was tested for two- and three-factor structures, reliability, and correlations with other health related measures. Results: The Kaiser-Meyer-Olkin test for sampling adequacy was satisfactory (.0885), and Bartlett´s test for sphericity was significant (p < .001). Although both models showed a good fit to the data, the two-factor model was preferred based on the high correlations between the factors 2 and 3 within the three-factor model (.86 for the total sample, .77 for females, and .91 for males). The reliability for the two-factor model was good, as indicated by Cronbach´s α = .806 (factor I) and .716 (factor II) for the total sample, .808 (factor I) and .667 (factor II) for females, and .787 (factor I) and .728 (factor II) for males. Additionally, the AUDIT scores positively correlated with several health-related measures: stress, psychological inflexibility, loneliness and depression/anxiety symptomatology. Conclusion: The Ecuadorian adaptation of the Spanish version of the AUDIT has good reliability, and internal consistency and correlates with other health related measures, proving to be a reliable tool that can be used by researchers and clinicians to screen hazardous alcohol intake in college students.
Archives of Suicide Research, 2019
Objectives: The main goals of this study were to determine the prevalence rate of suicidal ideati... more Objectives: The main goals of this study were to determine the prevalence rate of suicidal ideation among callers to a Spanish telephone helpline (Teléfono de la Esperanza) and to identify gender-based characteristics and risk factors related to suicidal ideation. Method: A sample of 10,765 (6,868 men and 3,897 women) callers to this telephone helpline was assessed. ATENSIS, an assessment tool designed to collect information related to suicidal ideation among callers to telephone helplines, was used. Comparisons between men and women with suicidal ideation were carried out in all variables studied: sociodemographics, telephone call timing, risk factors, and suicidality. Results: Of the total sample, 1.87% (n = 201) presented suicidal ideation, with a higher prevalence in women (2.80%) than in men (1.34%). Moreover, significant gender-based differences among callers with suicidal ideations were observed in some variables: women were older than men and showed a greater prevalence of chronic disease with pain; men showed a greater prevalence of depression, alcohol/drug abuse, helplessness, and lack of hope for the future. Conclusions: This study showed that telephone helplines can be used to identify suicidal ideation among callers. Moreover, gender-based differential characteristics among suicide ideators have been found. The implications for further research are discussed.
The American Journal of Drug and Alcohol Abuse, 2020
Background: Few studies have analyzed the specific characteristics related to uni/bidirectional i... more Background: Few studies have analyzed the specific characteristics related to uni/bidirectional intimate partner violence (IPV) in patients with addiction problems. Knowing the specific profiles of these patients would allow the development of effective tailored interventions. Objective: This study assessed gender differences in unidirectional and bidirectional IPV among patients undergoing drug addiction treatment. Method: We sampled 122 patients (91 male and 31 female) who sought treatment in an addiction treatment center, and collected cross-sectional self-reported data on violent behaviors (physical, sexual and psychological violence), sociodemographic factors, distorted thoughts about women and violence, impulsiveness, and anger. Results: Ninety-one percent of participants reported experience of IPV (any type and any direction). Sixty-three percent of participants reported bidirectional violence, which was more common among women (83.9%) than men (56.1%). Unidirectional (perpetration only) IPV was reported in 28.7% of participants, and it was more common among men (34.1%) than women (12.9%). No one reported unidirectional (victimization-only) IPV. When only physical and/or sexual violence was considered, bidirectional violence affected 32.0% of the sample; 23.8% were only victims, and 3.3% were only perpetrators (all of them men). Participants who reported bidirectional violence had higher scores for impulsiveness, anger, and distorted thoughts. Conclusions: Bidirectional IPV is commonly reported among patients seeking treatment for addiction, particularly among women, and should be considered in future research and clinical practice.
Advances in Dual Diagnosis, 2020
Purpose The purpose of this paper is to explore the prevalence and profile of mothers among women... more Purpose The purpose of this paper is to explore the prevalence and profile of mothers among women who sought treatment for drug addiction, as well as the therapeutic progression of these patients. Design/methodology/approach A sample of 180 Spanish women with addiction problems was assessed. Information was collected on the patients’ socio-demographic characteristics, consumption variables and psychological symptoms. Findings Of the total sample, 22.2 per cent ( n = 40) of the women seeking treatment for substance use disorder were mothers. Compared with women without children, mothers scored significantly higher on several EuropASI and psychological variables. Specifically, mothers presented with more medical problems, worse employment/financial situations, and more severity in alcohol use. Moreover, having a history of lifetime physical and/or sexual abuse was related to belonging to the group of mothers. Regarding therapeutic progression, no statistically significant differences in the retention rate were found between mothers and non-mothers. Originality/value The results of this study show that mothers generally have more severe problems than non-mothers. Therefore, comprehensive, continuum-based, and client-centred care for mothers is paramount for effective treatment in mothers. The implications of these results for further research and clinical practice are discussed.
Addictive Behaviors, 2019
Patients with addictions have a great risk of suicidal ideation and attempts. Suicidal behaviour ... more Patients with addictions have a great risk of suicidal ideation and attempts. Suicidal behaviour is a continuum that begins with ideation and may continue with planning, attempts and suicide completion. Investigating the specific risk characteristics for suicidal attempts in patients with addiction problems who present with suicidal ideation is crucial for developing prevention strategies. The main aims of this study were to determine the prevalence rate of suicide attempts among patients with lifetime suicidal ideation receiving treatment for addiction, and to explore the differential characteristics for suicide ideators with and without suicide attempts.
Methods
A sample of 149 patients with suicidal ideation (110 male and 39 female) who sought treatment for addiction in a Spanish clinical centre was assessed.
Measurements
Information concerning socio-demographic characteristics, addiction severity, and psychopathological symptoms was obtained.
Results
In total, 39.6% of the patients had attempted suicide (95% Confidence Interval: 32.1%–47.6%). Although all patients with suicidal behaviours presented a high severity in their addiction, patients with both suicidal ideation and suicide attempts showed a more severe addiction profile and more maladjustment to everyday life than patients with only suicidal ideation. Specifically, three psychopathological variables were related to suicide attempts: worse psychiatric state, previous hospitalization for psychological problems, and history of delirium.
Conclusions
According to the results, a systematic screening of suicidal risk in patients seeking treatment for addiction problems is recommended. Addiction treatment centres should develop treatment strategies to prevent suicidal ideators from attempting suicide, mainly in those cases with a worse lifetime psychiatric condition.
Psychiatry Research, 2018
Patients with substance dependence have a great risk of suicidal ideation and attempts. The study... more Patients with substance dependence have a great risk of suicidal ideation and attempts. The study of the specific risk characteristics of patients with substance use disorders who present with suicidal ideation and/or attempts becomes a crucial clinical issue in order to develop prevention strategies. The main goals of this study were to determine the prevalence rate of both suicidal ideation and attempts among patients receiving treatment for substance use disorder and to analyse the differential characteristics between these patients with and without suicidal behaviours. A sample of 334 patients (263 men-71 women) who sought treatment for substance use disorder in a Spanish clinical centre was assessed. In total, 43.7% of the patients presented with lifetime suicidal ideation (8.7% in the last month) and 17.7% with suicide attempts (1.5% in the last month). Patients with suicidal ideation or attempts showed a more severe addiction profile (assessed by the EuropASI), and more psychopathological symptoms (assessed by the SCL-90-R). Moreover the rate of suicidal ideation and attempts was significantly higher in inpatients than in outpatients. According to these results, systematic screening of suicidal risk in patients seeking treatment for substance use disorders is recommended, especially in those with a greater addiction severity.
Journal of Interpersonal Violence, 2017
This study explored the prevalence of victims of abuse and the therapeutic progression among wome... more This study explored the prevalence of victims of abuse and the therapeutic progression among women who sought treatment for drug addiction. A sample of 180 addicted Spanish women was assessed. Information was collected on the patients’ lifetime history of abuse (psychological, physical, and/or sexual), socio-demographic factors, consumption variables, and psychological symptoms. Of the total sample, 74.4% (n = 134) of the addicted women had been victims of abuse. Psychological abuse affected 66.1% (n = 119) of the patients, followed by physical abuse (51.7%; n = 93) and sexual abuse (31.7%; n = 57). Compared with patients who had not been abused, the addicted women with histories of victimization scored significantly higher on several European version of the Addiction Severity Index (EuropASI) and psychological variables. Specifically, physical abuse and sexual abuse were related to higher levels of severity of addiction. Regarding therapeutic progression, the highest rate of dropout was observed among victims of sexual abuse (63.5%; n = 33), followed by victims of physical abuse (48.9%; n = 23). Multivariate analysis showed that medical and family areas of the EuropASI, as well as violence problems and suicide ideation, were the main variables related to physical and/or sexual abuse. Moreover, women without abuse and with fewer family problems presented the higher probability of treatment completion. The implications of these results for further research and clinical practice are discussed.
Journal of Substance Abuse Treatment, 2017
The main aim of this study was to objectify the treatment assignment criteria used in a clinical ... more The main aim of this study was to objectify the treatment assignment criteria used in a clinical centre for addiction treatment in Spain. A sample of 162 patients (87 inpatients and 75 outpatients) who sought treatment between 2010 and 2012 was assessed. Clinical characteristics (addiction severity, psychopathological symptoms, impulsiveness and maladjustment) of the two treatment groups (inpatient and outpatient) into which patients were assigned according to the clinical criteria of therapists were analysed to identify which variables were more relevant for patient placement. Moreover, the therapeutic progression of patients who met and did not meet the assignment criteria received was studied. According to the results, a score above 4 in the family/social support area of the European Addiction Severity Index (EuropASI), or, in cases of a score between 2 and 4 in the family/social area of EuropASI, a score above 2 in the partner subscale of the Maladjustment Scale correctly classified 73.5% of cases (96.6% of inpatients and 46.7% of outpatients). Comparisons of therapeutic results depending on matching or mismatching these assignment criteria showed a larger effect size in mismatching patient assignment criteria for outpatient treatment. The results obtained in this study provide an objective criterion for addicted patient placement. Moreover, from a cost-effective perspective, they question the necessity of inpatient treatment in most cases, demonstrating that outpatient treatment is a sufficient level of care. This study addresses the approach to assigning patients to the treatment modality that best fits them, implementing the least expensive level of care needed to achieve treatment success
Comunicar, Jan 1, 2015
En los últimos años se ha producido un aumento espectacular del uso de las nuevas tecnologías de ... more En los últimos años se ha producido un aumento espectacular del uso de las nuevas tecnologías de la información y de la comunicación. En este estudio se analizaron las características y el patrón del uso de Internet en una muestra de preadolescentes de entre 10 y 13 años, que cursan 6º curso de Educación Primaria en Navarra (España). Asimismo, se analizó la existencia de un perfil diferencial en el uso de Internet en función del sexo y se detectó la existencia de conductas de riesgo. La muestra estaba compuesta por 364 estudiantes (206 chicos y 158 chicas), que fueron evaluados en sus centros educativos. Se recogió información sobre las características sociodemográficas, los hábitos de uso de Internet y los comportamientos desarrollados en la Red a través de un instrumento de recogida de datos diseñado específicamente para la investigación. Los resultados mostraron un uso elevado de Internet por parte de los adolescentes estudiados. Las chicas usaban más Internet para las relaciones sociales, mientras que los chicos tendían a darle otro tipo de usos, como el acceso a juegos online. Además, se encontraron algunas conductas de riesgo, como quedar con desconocidos, dar datos personales o enviar fotos y vídeos. Asimismo, se encontraron comportamientos relacionados con el «ciberbullying». Estos resultados indican la necesidad de establecer programas de prevención para el uso seguro y responsable de Internet.
Women & Health, 2017
The authors of this study explored the differences in treatment progress between men and women wh... more The authors of this study explored the differences in treatment progress between men and women who were addicted to drugs. The differential rate of completion of/dropout from treatment in men and women with substance dependence was established. Moreover, comparisons between completers and dropouts, accounting for gender, were carried out for several variables related to treatment progress and clinical profile. A sample of 183 addicted patients (96 male and 87 female) who sought outpatient treatment between 2002 and 2006 was assessed. Information on socio-demographic, consumption, and associated characteristics was collected. A detailed tracking of each patient’s progress was maintained for a minimum period of 8 years to assess treatment progression. The treatment dropout rate in the whole sample was 38.8%, with statistically significant differences between women (47.1%) andmen (31.3%). Women who dropped out of treatment presented a more severe profile in most of the psychopathologic variables than women who completed it. Moreover, women who dropped out from treatment presented a more severe profile than men who dropped out. According to these results, drug-addicted women showed worse therapeutic progress than men with similar histories. Thus, women must be provided with additional targeted intervention to promote better treatment outcomes.
This study carried out an assessment of the effectiveness of a digital literacy programme for pri... more This study carried out an assessment of the effectiveness of a digital literacy programme for primary education students. A quasi-experimental design with repeated measures of assessment was used. The sample consisted of 364 students (206 male and 158 female) from the sixth year of primary education. The students were assessed in their own schools and the sample was divided into two groups: experimental group (N = 190) and control group (N = 174). The assessment was carried out in three sessions: pre-intervention, post-intervention and six-month follow-up. The programme was composed of three sessions aimed at improving digital literacy, as a way of developing a safe and responsible use of the internet. The results obtained after the intervention showed statistically significant differences in the comparison between the two groups. Specifically, the experimental group reached a significantly higher degree of digital literacy (conceptual, procedural and attitudinal) than the control group after passing through the programme.
Drugs: Education, Prevention and Policy, 2017
Aims: The main goal of this study was to determine the characteristics of parents who sought hel... more Aims: The main goal of this study was to determine the characteristics of parents who sought help from two prevention programmes due to having an adolescent child who presents high-risk behaviours. Methods: The sample was composed of 374 parents (169 fathers and 205 mothers). Information on socio-demographic characteristics, psychopathological symptoms, emotional states, educational styles and maladjustment to everyday life was collected. Findings: The results show statistically differences by gender. Mothers obtained a higher degree of psychopathology symptoms, maladjustment and parental stress relative to fathers. Mothers also used more frequently authoritative and permissive parenting styles. In general, authoritarian and permissive parenting styles and stressful perceptions of the parental role are associated with more psychopathological symptoms and with maladjustment. Finally, the following variables predicted the severity of psychopathological symptoms: secondary education, maladjustment, stressful perceptions of the parental role and authoritarian and permissive parenting styles. Conclusions: This study highlights the need to assess the psychological problems of parents of adolescents with high-risk behaviours and to develop specific intervention programmes.
International Journal of Social Welfare, 2009
López-Goni JJ, Fernández-Montalvo J, Menéndez JC, Yudego F, García AR, Esarte S. Employment integ... more López-Goni JJ, Fernández-Montalvo J, Menéndez JC, Yudego F, García AR, Esarte S. Employment integration after therapeutic community treatment: a case study from SpainInt J Soc Welfare 2011: 20: 292–297 © 2009 The Author(s), International Journal of Social Welfare © 2009 Blackwell Publishing Ltd and the International Journal of Social Welfare.This article describes the employment evolution from pre- to post-treatment of 112 patients in two therapeutic communities of Proyecto Hombre (Spain). Moreover, an analysis was made using the composite scores of the EuropASI in order to evaluate the secondary outcomes in work status, beyond drug consumption. The results show that nearly half of the patients (46 per cent of the sample) changed their employment status after treatment. Specifically, 78.6 per cent of the men (N= 77) and 64.3 per cent of the women (N= 9) were working after treatment; there were no statistically significant differences between them. Although the unemployment figures after treatment remained high, the residents were satisfied with their work integration. No statistically significant differences were observed between those who completed the treatment and those who did not. Implications of these results for further research and clinical practice are discussed.
The American Journal on Addictions, 2015
The objectives of this study were, first, to explore the prevalence of aggressors with lifetime i... more The objectives of this study were, first, to explore the prevalence of aggressors with lifetime intimate partner violence (IPV) among patients in the Proyecto Hombre of Navarra (Spain) addiction treatment programme; and second, to know the specific and differential characteristics of patients presenting IPV as aggressors. A sample of 162 patients (119 men and 43 women) was assessed. Data on socio-demographic and substance consumption characteristics, IPV variables, psychopathological symptoms, and personality variables were obtained. The profiles of patients in addiction treatment with and without a history of violence towards their partners were compared. The results showed that 33.6% of people in treatment for addiction had committed violence against their partners. This prevalence was significantly higher (χ(2) = 15.6, p &amp;amp;lt; .001) in women (63.3%) than in men (24.2%). In the 98.4% of the cases the IPV was bidirectional. Patients with a history of IPV perpetration showed greater severity in substance consumption variables, psychopathological symptoms, and personality traits. Gender, the family scale on the European version of the Addiction Severity Index (EuropASI), and the aggressive-sadistic scale on the Millon Clinical Multiaxial Inventory (MCMI-III) were the main variables related to the presence of IPV as aggressors. There was a differential profile in patients with IPV perpetration, showing more psychopathological and personality symptoms. Moreover, in this study being a woman was one of the main predictors of committing IPV. (Am J Addict 2015;XX:1-9).
International Journal of Clinical and Health Psychology, 2006
ABSTRACT
The Spanish Journal of Psychology, 2015
This study explored the characteristics of a representative sample of patients who were addicted ... more This study explored the characteristics of a representative sample of patients who were addicted to either alcohol or cocaine, comparing the profiles of both types of drug users. A sample of 234 addicted patients (109 alcoholics and 125 cocaine addicts) who sought outpatient treatment in a Spanish clinical centre was assessed. Data on sociodemographic, consumption, psychopathological and maladjustment characteristics were collected using the European Addiction Severity Index (EuropASI), the Symptom Checklist-90-Revised (SCL-90-R) and the Millon Clinical Multiaxial Inventory (MCMI-II). Demographically, differences were observed with regard to age (alcoholics were older than cocaine addicts; t = 12.2, p = .001), employment (the alcoholic group had more labor problems; χ 2 = 6.2, p = .045) and family consequences (worse in alcoholics; t = 2.3, p = .025). The EuropASI results showed statistically significant differences in addiction severity, with alcoholics showing a greater severity than cocaine addicts. In terms of psychopathology, alcoholics presented more associated symptomatology than cocaine addicts. According to these results, patients with alcohol dependence have a different profile from patients with cocaine dependence, resulting in different repercussions for important areas of their lives. These differences should be taken into account when standard treatments for addiction are implemented.
Anales del Sistema Sanitario de Navarra, 2007
The aim of this paper was to review the current knowledge about the comorbidity between cocaine d... more The aim of this paper was to review the current knowledge about the comorbidity between cocaine dependence and personality disorders. Results concerning a specific profile of cocaine patients are not conclusive. The prevalence rate of personality disorders in cocaine dependents is very heterogeneous (with a mean of 66% of cases), and a great variability is observed between all the studies
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Papers by Javier Fernández-Montalvo
Methods
A sample of 149 patients with suicidal ideation (110 male and 39 female) who sought treatment for addiction in a Spanish clinical centre was assessed.
Measurements
Information concerning socio-demographic characteristics, addiction severity, and psychopathological symptoms was obtained.
Results
In total, 39.6% of the patients had attempted suicide (95% Confidence Interval: 32.1%–47.6%). Although all patients with suicidal behaviours presented a high severity in their addiction, patients with both suicidal ideation and suicide attempts showed a more severe addiction profile and more maladjustment to everyday life than patients with only suicidal ideation. Specifically, three psychopathological variables were related to suicide attempts: worse psychiatric state, previous hospitalization for psychological problems, and history of delirium.
Conclusions
According to the results, a systematic screening of suicidal risk in patients seeking treatment for addiction problems is recommended. Addiction treatment centres should develop treatment strategies to prevent suicidal ideators from attempting suicide, mainly in those cases with a worse lifetime psychiatric condition.
Methods
A sample of 149 patients with suicidal ideation (110 male and 39 female) who sought treatment for addiction in a Spanish clinical centre was assessed.
Measurements
Information concerning socio-demographic characteristics, addiction severity, and psychopathological symptoms was obtained.
Results
In total, 39.6% of the patients had attempted suicide (95% Confidence Interval: 32.1%–47.6%). Although all patients with suicidal behaviours presented a high severity in their addiction, patients with both suicidal ideation and suicide attempts showed a more severe addiction profile and more maladjustment to everyday life than patients with only suicidal ideation. Specifically, three psychopathological variables were related to suicide attempts: worse psychiatric state, previous hospitalization for psychological problems, and history of delirium.
Conclusions
According to the results, a systematic screening of suicidal risk in patients seeking treatment for addiction problems is recommended. Addiction treatment centres should develop treatment strategies to prevent suicidal ideators from attempting suicide, mainly in those cases with a worse lifetime psychiatric condition.