title: Decision-making impairment predicts 3-month hair-indexed cocaine relapse.
abstract: BACKGROUND
  One of the key outstanding challenges in cocaine dependence research is determining who is at risk of relapsing during treatment.
  
  
  OBJECTIVE
  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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Red de Trastornos Adictivos, Universidad de Granada, Granada, Spain, antonio.verdejo@monash.edu.
authors.forename: Antonio
authors.initials: A
authors.lastname: Verdejo-Garcia
authors.forename: Natalia
authors.initials: N
authors.lastname: Albein-Urios
authors.forename: Jose Miguel
authors.initials: JM
authors.lastname: Martinez-Gonzalez
authors.forename: Ester
authors.initials: E
authors.lastname: Civit
authors.forename: Rafael
authors.initials: R
authors.lastname: de la Torre
authors.forename: Oscar
authors.initials: O
authors.lastname: Lozano
mesh_terms: D000328:Adult; D003042:Cocaine / Q000032:analysis*; D019970:Cocaine-Related Disorders / Q000523:psychology*; D003071:Cognition; D003657:Decision Making; D005260:Female; D005715:Gambling / Q000523:psychology*; D006197:Hair / Q000737:chemistry; D006801:Humans; D007361:Intelligence Tests; D008297:Male; D009483:Neuropsychological Tests; D011678:Punishment; D012008:Recurrence; D012201:Reward; D012680:Sensitivity and Specificity
chemical_list: D003042:Cocaine
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