Iranian Journal of Psychiatry and Clinical Psychology
Year:2008 | Volume:14 | Issue:3 (54)|Papers Count:18

Impulsive behaviors are activities in daily life which are sometimes referred to as risky activities and encompass a diverse group of reward-oriented, immature and high risk behaviors. It can be argued that impulsivity is the main core of different social pathologies such as disinhibited sexual behavior, pathological gambling, drug abuse, personality disorders and criminal activities. Considering the young population of our country and the high rate of crime and substance abuse, conducting research and providing cultural validated assessment instruments on impulsivity and impulsive behaviors is necessary.Despite the importance of this subject in psychology and psychiatry, there is not much agreement with regard to the definitions. In this review article, the authors have aimed to gather different definitions of impulsivity which has been given up to the present as well as different approaches to its evaluation in a homogeneous collection. Also, different methods and examples of their application in the evaluation of these behaviors and current experiences in Iran will be presented. In the end, different methods and horizon of intervention and treatment will be discussed.

Objectives: This study is carried out with the aim of assessing the relationship between craving and impulsivity factors in three main groups of opiate addicts [heroin, crack-heroin (locally known, purified crystaline heroin), and opium]. Method: 77 opiate users in 3 groups [37 heroin intravenous (IV) abusers, 17 crack smokers and 23 opium smokers] were selected using a semi-structured interview and based on dependency criteria of Diagnositic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), from treatment waiting list of Iranian National Center for Clinics Addiction Studies. At first, demographic information was collected from each subject. Computerized version of Barratt and Zuckerman Scales, and Eysenck and Dickman questionnaires were used to assess different aspects of impulsivity. Craving was assessed through a computerized visual cue task for opiate addicts (heroin, heroin-crack, and opium).Results: Results show higher scores in motor and dysfunctional impulsivity among heroin IV abusers than opium smokers and higher experience seeking and boredom susceptibility in heroincrack smokers. Higher craving was correlated with higher scores in non-planning, motor and cognitive impulsivity, and total Barratt score. Craving scores were negatively correlated with age and functional impulsivity and positively correlated with the total score on Barratt Impulsiveness Scale. Conclusion: Personality features can be important predictive factors for craving severity in addicts. This can help to choose an appropriate treatment and the control of craving which is the most important factor leading to relapse in substance abuse.

Objectives: Regarding the importance of craving in the persistence of addiction, this study has been carried out with the aim of determining the differences between the two distinguishable groups of heroin addicts: responders and non-responders to craving cues. Method: In a case control study, 26 male intravenous heroin addicts were selected from among non-treatment seeker abusing addicts in Tehran, and entered the study after a semistructured interview and based on DSM-IV criteria. A demographic questionnaire and Addiction Severity Index were administered to all subjects before imaging. Each of the subjects underwent functional imaging with visual cue-induced craving, using functional magnetic resonance imaging (fMRI). Subjective reports of craving were evaluated after the imaging, using Visual Analog Scale (VAS). Also, 15 normal individuals with no history of drug abuse underwent fMRI as the control group. Blood oxygen-level-dependent (BOLD) signal obtained during fMRI was analyzed using FSL. Results: There was a significant difference in brain activation between responder and non-responder groups (p<0.01). Responder subjects (craving higher than 70 in VAS) demonstrated cortical activation in the following areas: left anterior cingulated gyrus, left anterior rectus gyrus, left anterior mid-orbital frontal gyrus (Broadman areas 24, 11 and 25), left nucleus accumbens (Broadman area 34), and left anterior frontal superior gyrus, right anterior superior medial frontal gyrus, and right anterior middle frontal gyrus (Broadman areas 8, 10 and 9). Non-responder subjects (craving less than 30 in VAS) showed no significant difference in brain activation with normal people. According to FEAT analysis the score of substance abuse in Addiction Severity Index (ASI) has a significant correlation with brain activation in the responder group (P<0.01). Conclusion: Subjects who do not respond to drug cues with craving, like the normal group, do not show activation in related areas in fMRI. In the process of inducing heroin craving through related cues in substance abusers, the same areas involved in reward/punishment process get activated. The limbic/ paralimbic and pleasure/avoidance systems participate in inducing heroin craving.

Objectives: The purpose of this study was to investigate the effectiveness of cognitive-behavioral group therapy on improving coping skills and relapse prevention in addicts. Method: In a semi-experimental study, 30 individuals who had been successfully detoxified at the Self Introducing Health Center in the city of Shiraz, Iran, were divided into an experimental (15 subjects) and a control (15 subjects) group. The experimental group underwent twelve 90 minutes sessions of cognitive-behavioral group therapy and the control group did not receive any particular treatment. All participants completed the Carver Coping Inventory at the beginning of the study and two months following the completion of treatment and underwent urine tests for morphine. Data were analyzed using descriptive statistics, c2 and multiple analysis of variance.Results:  c2 test results showed significant difference in relapse rates of two groups (p<0.01). MANOVA showed a significant difference between the two groups regarding benefiting from problem oriented coping strategies and the interactive effect of problem oriented coping strategy in the post test stage (p<0.001). Conclusion: Cognitivebehavioral group therapy is effective in the improvement of coping skills and relapse prevention in addicts.

Objectives: This study was carried out to compare the personality traits, personality disorders, and problemsolving strategies in self-introduced addicts and the normal population. Method: 50 self-introduced addicts, who had presented for the first time to the addicts’ health center in the city of Rasht, Iran, were compared to 50 normal subjects who were matched on some demographic characteristics in a descriptive cross-sectional study. Data were gathered using the NEO Five-Factor Inventory- Revised (NEO-FFI-R), the Millon Clinical Multiaxial Inventory-II (MCMI-II), and Problem-Solving Strategies Questionnaire. Data were analyzed using correlation coefficient and multi-factor analysis of variance. Results: Addicts scored higher than normal people on the measure of neuroticism (N), and lower on measures of agreeableness (A), openness (O), and conscientiousness (C) (p<0.05). No significant difference was showed on the measure of extraversion (E) between the two groups. There was a significant difference in most measures of personality disorder between the self-introduced addict group and the normal group; with the addict group scoring higher in these measures (p<0.05). Moreover, addicts, in comparison with normal individuals used non-constructive problem-solving strategies such as avoidance and helplessness (p<0.05). Conclusion: An assessment of the three over-lapping areas of personality traits, problems, and disorders in addicts contributes important information for a better differentiation and definition of addicts and has implications for their treatment.

Objectives: Considering the importance of demographic factors such as age, sex, education, type of abused substance, method of abuse, the effect of previous treatments and the severity of addiction on craving and subsequent successful treatment, this research was carried out with the aim of examining the relationship between these factors and the severity of craving in intravenous heroin addicts. Method: In this study 26 male heroin addicts were selected using snowball sampling from among abusing addicts not seeking treatment, in the city of Tehran, Iran. The subjects entered the study after a primary interview and completed a demographic and Addiction Severity Index (ASI). Thereafter, the severity of cravings were assessed and the subjects were divided into two groups of responders and nonresponders to craving symptoms. Results: The responders were subjects with lower age, lower addiction durations, higher drug expenditure, higher withdrawal symptoms, and more severe addiction symptoms in many components of ASI. Also, age and education had a negative significant correlation; and duration of abuse, daily cost of abuse and sub-components of substances, and legal and psychiatric problems had a significant correlation with individual reports of craving. Conclusion: Some demographic factors can be important predictors of craving in addicts, which is itself a considerable aspect of deviation from treatment. The independent positive significant effects of factors of craving and addiction severity in the linear regression model indicates a reciprocal relationship between substance abuse and craving. The independent negative significant effect of substance abuse duration in the linear regression model in this study can indicate the process of the development of an compulsive behavior from an impulsive behavior in the process of addiction development.

Objectives: The aim of this research was to investigate the predictive role of emotional intelligence and religious coping in relapse or recovery from substance abuse. Method: 62 male subjects who had presented to two addiction detoxification centers in the city of Nafajabad, Iran, and who were selected using convenience sampling, were divided into an abstinent (31 individuals with a history of at least one year abstinence) and relapsed (31 individuals with an abstinence history less than one year) groups. Data were gathered using Religious Coping Scale and Trait Emotional Intelligence Questionnaire and were analyzed using discriminate analysis test and independent t-test. Results: The relapsed and non-relapsed individuals were significantly different in Internal/Private Religious Coping (p<0.001), External/Social Religious Coping (p<0.05), and Emotional Intelligence (0.001). Also, discriminate analysis test showed that 79% of relapsed and non-relapsed individuals can be distinguished based on internal/private coping and emotional intelligence. Conclusion: Internal private religious coping is the most important factor in distinguishing and categorizing the individuals presenting to addiction abstinence centers into abstinent and relapsed groups.

Objectives: This study examined the psychometric properties of the Brief Fear of Negative Evaluation Scale (FNES-B) in a nonclinical, student sample. Method: 325 students (143 male and 182 female) who were selected using randomized multi-stage sampling method responded to FNES-B Scale and Academic Expectations Stress Inventory (AESI). In this research, the confirmatory factor analysis was used to determine the validity of FNES-B, and Cronbach’s alpha was used to determine its internal consistency. Results: Confirmatory factor analysis revealed that while the unidimensional model of Brief Fear of Negative Evaluation Scale had an acceptable fit to the data, the two-factor model of Brief Fear of Negative Evaluation Scale (including positive and reverse scored items) demonstrated a superior fit to the data. The data also supported the reliability of FNES-B scores. In other words internal consistency was good for the positive scored factor (a=0.87) and for the full FNES-B scale (a=0.84) and acceptable for the reverse scored factor (a=0.47). FNES-B scores were significantly correlated with the AESI (p<0.001). Female students scored higher in FNES-B scores in comparison with male students.Conclusion: FNES-B is a valid and reliable measurement instrument for measuring fear of negative evaluation in students.

Objectives: This study aims to assess the validity and reliability of Persian versions of Barratt Impulsivity Scale (BIS-II), Dickman Impulsivity Inventory (DII-2), Eysenck Impulsivity Questionnaire (EIQ-7) and Zuckerman Sensation Seeking Scale (SSS-5) by administering them to normal subjects and opiate abusers. Method: The Persian versions of BIS, DII, EIQ and SSS, were completed by a group of normal individuals (39 subjects) and opiate abusers (30 subjects). Reliability was assessed using internal consistency. Validity was checked using two methods: inter-scale correlation and known-groups comparison. Results: Cronbach's alpha coefficients in all questionnaires and in both groups ranged from 0.40 to 0.83. Except for “Boredom susceptibility” factor of SSS (0.22), the subgroups of questionnaires in BIS showed significant correlation (r=0.4). There was a significant correlation between impulsivity factors in other questionnaires and BIS results. BIS scores and impulsivity factors of other questionnaires in the substance abuser group was significantly (p<0.001) higher in comparison with normal subjects, but there were no differences regarding high risk and venturesome behavior indices. Also, substance abuse was an important factor in determining BIS scores as well as impulsivity factors in other questionnaires. Age, gender, and education have roles in determining this score as well. Conclusion: The Persian version of Barratt’s four questionnaires is a valid and reliable measure of impulsivity. It seems that among Iranian drug abusers, impulsivity rather than risk taking tendencies is the main psychological feature of addiction.

Objectives: The aim of this study was to provide a visual task for the evaluation of craving in opiate abusers, by implementing visual cues inducing craving. Method: 175 opiate abusers who had presented to the National Center for Addiction Studies in Iran in eleven months of the years 1385 and 1386 participated in the study. The subjects were divided into five groups (heroin injecting, heroin sniffing, heroin smoking, crystalline heroin (locally known as crack) smoking, and opium ingestion/smoking). The test was developed in the following order: identifying visual cues which could induce craving in interactive meetings between professionals and opiate abusers, categorization and providing the effective pictures from the list of cues, rating the severity of craving induced through the pictures by addicts, final categorization and setting, providing the computerized visual cue-induced tasks in different groups, determining the scores of opiate induction and evaluating the reliability of the tasks in craving induction. All subjects completed demographic questionnaires, Addiction Severity Index (ASI), Beck Depression Inventory, Agonist Effect Symptoms Checklist, Opiate Withdrawal Symptoms Checklist, and Raven IQ Test. Data were analyzed using descriptive statistic methods and Pearson’s correlation coefficient. Results: The mean score of inducedcraving was significantly higher in crack smokers and heroin injectors in comparison with opium abuser groups (F=12.21, p<0.001). Tukey test showed significant difference between drug craving scores in heroin and opium abusers (I-J=27.89, p<0.001) and also between crack smokers and opium abusers (I-J=27.89, p<0.001). The evaluation of the reliability of results in craving induction tasks by Cronbach’s alpha and split-half reliability, showed a good reliability in most tasks (except for some cues in opium tasks). Craving was negatively correlated with age (r= -0.26, p<0.001), abusing duration (r= -0.23, p<0.001) and positively with family problems in ASI (r=0.18, p<0.05). Conclusion: Providing a task for the evaluation of craving induction in different groups of opiate abusers, with an appropriate validity and reliability, can help to a better understanding about the dimensions of drug craving through neuroimaging studies, pre-and post-treatment evaluations, and assessing different treatment protocol effects on the craving control. Also, this method can be used to assess the relationship of craving to other features of addiction.