title: Decision-making processes as predictors of relapse and subsequent use in stimulant-dependent patients.
abstract: BACKGROUND
  Decision-making processes have been posited to affect treatment outcome in addicted patients.
  
  
  OBJECTIVE
  The present multi-site study assessed whether two measures of decision-making predicted relapse and subsequent use in stimulant-dependent patients.
  
  
  METHODS
  A total of 160 methamphetamine- or cocaine-dependent patients participating in a multi-site clinical trial evaluating a modified 12-step facilitation intervention for stimulant-dependent patients (STAGE-12) were assessed. Decision-making processes of risk and delay (Iowa Gambling Task [IGT]) and response reversal (Wisconsin Card Sorting Task [WCST]) were obtained shortly after treatment admission followed by assessment of stimulant use over the next six months. The relationships of the IGT and WCST (Perseverative Errors) with relapse (yes/no) and days of stimulant use during the 6-month period following post-randomization were evaluated.
  
  
  RESULTS
  Performance on the IGT and WCST did not significantly predict relapse status or time to relapse. Unexpectedly, worse performance on the IGT was associated with a fewer number of stimulant use days (p = 0.001). In contrast, worse performance on the WCST (more perseverative errors) was associated with a greater number of stimulant use days (p = 0.0003). The predictive effects of perseverative errors on subsequent use were confined to methamphetamine-dependent and Minority participants.
  
  
  CONCLUSIONS
  Decision-making processes, as measured in the current study, do not uniformly predict relapse or subsequent use. A decrease in the salience attribution of non-drug reinforcers may explain the positive relationship between IGT performance and post-relapse use. More comprehensive and global measures of impulsiveness may better assess relapse risk and use.
authors.affiliation: a VA North Texas Health Care System, Dallas VAMC , Dallas , TX , USA.|b Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , TX , USA.
authors.forename: Bryon
authors.initials: B
authors.lastname: Adinoff
authors.affiliation: b Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , TX , USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Carmody
authors.affiliation: b Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , TX , USA.
authors.forename: Robrina
authors.initials: R
authors.lastname: Walker
authors.affiliation: c Alcohol & Drug Abuse Institute, University of Washington , Seattle , WA , USA.|d Department of Psychiatry & Behavioral Sciences , University of Washington , Seattle , WA , USA.
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Donovan
authors.affiliation: e Addiction Sciences Division, Department of Psychiatry and Behavioral Neuroscience , University of Cincinnati College of Medicine , Cincinnati , OH , USA.|f Maryhaven , Columbus , OH , USA.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Brigham
authors.affiliation: e Addiction Sciences Division, Department of Psychiatry and Behavioral Neuroscience , University of Cincinnati College of Medicine , Cincinnati , OH , USA.
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Winhusen
mesh_terms: D000328:Adult; D019969:Amphetamine-Related Disorders / Q000523:psychology*; D019970:Cocaine-Related Disorders / Q000523:psychology*; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D012008:Recurrence; D013997:Time Factors; D055815:Young Adult
keywords: Impulsivity; cocaine use disorder; decision-making; gambling task; methamphetamine use disorder; relapse