title: Risky decision-making predicts short-term outcome of community but not residential treatment for opiate addiction. Implications for case management.
abstract: BACKGROUND
  Opiate addiction is associated with decision-making deficits and we previously showed that the extent of these impairments predicts aspects of treatment outcome. Here we aimed to establish whether measures of decision-making performance might be used to inform placement matching.
  
  
  METHODS
  Two groups of opiate dependent individuals, one receiving treatment in a community setting (n=48) and one in a residential setting (n=32) were administered computerised tests of decision-making, impulsivity and planning shortly after the beginning of treatment, to be followed up three months into each programme.
  
  
  RESULTS
  In the community sample, performance on the decision-making tasks at initial assessment predicted abstinence from illicit drugs at follow-up. In contrast, in the residential sample there was no relationship between decision-making and clinical outcome.
  
  
  CONCLUSIONS
  Intact decision-making processes appear to be necessary for upholding a resolve to avoid taking drugs in a community setting, but the importance of these mechanisms may be attenuated in a residential treatment setting. The results support the placement matching hypothesis, suggesting that individuals with more prominent decision-making deficits may particularly benefit from treatment in a residential setting and from the inclusion of aspects of cognitive rehabilitation in their treatment programme.
authors.affiliation: Division of Mental Health, St. George's University of London, Cranmer Terrace, London SW17 0RE, UK. fpassett@sgul.ac.uk
authors.forename: F
authors.initials: F
authors.lastname: Passetti
authors.forename: L
authors.initials: L
authors.lastname: Clark
authors.forename: P
authors.initials: P
authors.lastname: Davis
authors.forename: M A
authors.initials: MA
authors.lastname: Mehta
authors.forename: S
authors.initials: S
authors.lastname: White
authors.forename: K
authors.initials: K
authors.lastname: Checinski
authors.forename: M
authors.initials: M
authors.lastname: King
authors.forename: M
authors.initials: M
authors.lastname: Abou-Saleh
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D019090:Case Management; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D005715:Gambling / Q000523:psychology; D006801:Humans; D007175:Impulsive Behavior / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000534:rehabilitation / Q000628:therapy; D011569:Psychiatric Status Rating Scales; D012114:Residential Treatment; D012201:Reward; D012309:Risk-Taking; D012984:Software; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult