title: 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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors: Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3210 Jefferson Avenue, Cincinnati, OH 45220, USA. winhusen@carc.uc.edu
authors: Theresa M
authors: TM
authors: Winhusen
authors: Eugene C
authors: EC
authors: Somoza
authors: Daniel F
authors: DF
authors: Lewis
authors: Frankie B
authors: FB
authors: Kropp
authors: Viviana Elizabeth
authors: VE
authors: Horigian
authors: Bryon
authors: B
authors: Adinoff
mesh_terms: D000328:Adult; D019969:Amphetamine-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D019970:Cocaine-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D005260:Female; D005625:Frontal Lobe / Q000473:pathology*; D006801:Humans; D008297:Male; D008694:Methamphetamine; D009483:Neuropsychological Tests; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D008694:Methamphetamine