Decision-making impairment predicts 3-month hair-indexed cocaine relapse

Antonio Javier Verdejo-Garcia, Natalia Albein-Urios, Jose Miguel Martinez-Gonzalez, Ester Civit, Rafael de la Torre, Oscar M Lozano Rojas

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47 Citations (Scopus)


Rationale One of the key outstanding challenges in cocaine dependence research is determining who is at risk of relapsing during treatment. Objectives We examined whether cognitive decision-making profiles predict objectively (hair) indexed cocaine relapse at 3-month follow-up. Methods Thirty-three cocaine-dependent patients commencing outpatient treatment in a public clinic performed baseline decision-making assessments with the original and variant versions of the Iowa Gambling Task, and provided a 3-cm hair sample 3 months afterwards. Based on Iowa Gambling Tasks performance cut-offs, 5 patients had intact decision-making skills, 17 patients showed impaired sensitivity to reward or punishment (impairment in one of the tasks), and 9 patients showed insensitivity to future consequences (impairment in both tasks). Based on a 0.3 ng/mg cocaine cut-off, 23 patients were classified as relapsers and 10 as non-relapsers at the 3-month follow-up. Results Eighty percent of patients with intact decision-making were abstinent at follow-up, whereas 90 of patients with insensitivity to future consequences had relapsed. The two subgroups (relapsers and non-relapsers) showed no significant differences on drug use, comorbidities, or psychosocial function, and significantly differed on verbal but not performance IQ. A regression model including decision-making scores and verbal IQ predicted abstinence status with high sensitivity (95 ) and moderately high specificity (81 ). Conclusion These preliminary findings demonstrate that decision-making profiles are associated with cocaine relapse. Moreover, combined decision-making and IQ assessments provide optimal predictive values over stimulant relapse, yielding significant opportunities for clinical translation
Original languageEnglish
Pages (from-to)4179 - 4187
Number of pages9
Issue number21
Publication statusPublished - 2014

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