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

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Abstract

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.

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Funding and disclosure

This study has been funded by the grants from the Spanish Ministry of Health: project grant COPERNICO, Drug Abuse Plan (Plan Nacional sobre Drogas Convocatoria 2009) and program grant RETICS, Carlos III Health Institute (Instituto de Salud Carlos III, Red de Trastornos Adictivos).

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Authors and Affiliations

  1. Red de Trastornos Adictivos, Universidad de Granada, Granada, Spain

    Antonio Verdejo-Garcia, Jose Miguel Martinez-Gonzalez & Oscar Lozano

  2. Department of Clinical Psychology & Institute of Neuroscience F. Oloriz, Universidad de Granada, Granada, Spain

    Antonio Verdejo-Garcia & Natalia Albein-Urios

  3. School of Psychology and Psychiatry, Monash University, 3800 Wellington Rd. Clayton Campus, Melbourne, Australia

    Antonio Verdejo-Garcia

  4. Centro Provincial de Drogodependencias, Diputación de Granada, Granada, Spain

    Jose Miguel Martinez-Gonzalez

  5. Human Pharmacology and Clinical Neurosciences Research Group, IMIM-Institut de Recerca Hospital del Mar, Barcelona, Spain

    Ester Civit & Rafael de la Torre

  6. CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Santiago de Compostela, Spain

    Rafael de la Torre

  7. Universitat Pompeu Fabra (CEXS-UPF), Barcelona, Spain

    Rafael de la Torre

  8. Department of Psychology, Universidad de Huelva, Granada, Spain

    Oscar Lozano

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  1. Antonio Verdejo-Garcia
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  2. Natalia Albein-Urios
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Correspondence to Antonio Verdejo-Garcia.

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Verdejo-Garcia, A., Albein-Urios, N., Martinez-Gonzalez, J.M. et al. Decision-making impairment predicts 3-month hair-indexed cocaine relapse. Psychopharmacology 231, 4179–4187 (2014). https://doi.org/10.1007/s00213-014-3563-9

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  • DOI: https://doi.org/10.1007/s00213-014-3563-9

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