title: Anhedonia Is Associated with Poorer Outcomes in Contingency Management for Cocaine Use Disorder.
abstract: This study explored anhedonia (lack of interest or pleasure in non-drug rewards) as a potentially modifiable individual difference associated with the effectiveness of Contingency Management (CM). It also tested the hypothesis that a dopaminergic drug, levodopa (L-DOPA), would improve the effectiveness of CM, particularly in individuals high in anhedonia. The study was a single-site, randomized, double-blind, parallel group, 12-week trial comparing L-DOPA with placebo, with both medication groups receiving voucher-based CM targeting cocaine-negative urines. Participants were N=85 treatment-seeking adults with CUD. Anhedonia was measured at baseline using a validated self-report measure and a progressive ratio behavioral measure. Treatment Effectiveness Score (TES) was defined as the total number of cocaine-negative urines submitted. Analyses based on Frequentist general linear models were not significant, but Bayesian analyses indicated a high probability (92.6%) that self-reported anhedonia was associated with poor treatment outcomes (lower TES). L-DOPA did not significantly improve outcomes, nor was the effect of L-DOPA moderated by anhedonia. While the study failed to replicate positive findings from previous studies of L-DOPA in combination with CM, it does provide preliminary evidence that anhedonia may be a modifiable individual difference associated with poorer CM outcomes.
authors.affiliation: Center for Neurobehavioral Research on Addiction, University of Texas Medical Center at Houston, 1941 East Rd., Houston, TX, 77054, USA. Electronic address: Margaret.C.Wardle@uth.tmc.edu.
authors.forename: Margaret C
authors.initials: MC
authors.lastname: Wardle
authors.affiliation: Center for Neurobehavioral Research on Addiction, University of Texas Medical Center at Houston, 1941 East Rd., Houston, TX, 77054, USA.
authors.forename: Jessica N
authors.initials: JN
authors.lastname: Vincent
authors.affiliation: Center for Neurobehavioral Research on Addiction, University of Texas Medical Center at Houston, 1941 East Rd., Houston, TX, 77054, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Suchting
authors.affiliation: Center for Neurobehavioral Research on Addiction, University of Texas Medical Center at Houston, 1941 East Rd., Houston, TX, 77054, USA.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Green
authors.affiliation: Center for Neurobehavioral Research on Addiction, University of Texas Medical Center at Houston, 1941 East Rd., Houston, TX, 77054, USA; Graduate School of Biomedical Sciences, University of Texas Medical Center at Houston, 1941 East Rd., Houston, TX, 77054, USA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Lane
authors.affiliation: Center for Neurobehavioral Research on Addiction, University of Texas Medical Center at Houston, 1941 East Rd., Houston, TX, 77054, USA; Graduate School of Biomedical Sciences, University of Texas Medical Center at Houston, 1941 East Rd., Houston, TX, 77054, USA.
authors.forename: Joy M
authors.initials: JM
authors.lastname: Schmitz
mesh_terms: D000328:Adult; D059445:Anhedonia / Q000502:physiology*; D001521:Behavior Therapy / Q000379:methods*; D019970:Cocaine-Related Disorders / Q000188:drug therapy / Q000503:physiopathology* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003131:Combined Modality Therapy; D015259:Dopamine Agents / Q000008:administration & dosage / Q000494:pharmacology*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007206:Individuality; D007980:Levodopa / Q000008:administration & dosage / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012201:Reward
chemical_list: D015259:Dopamine Agents; D007980:Levodopa
keywords: Anhedonia; Bayesian statistics; Cocaine use disorder; Contingency management; Incentives; Levodopa