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Decision-making processes have been posited to affect treatment outcome in addiction patients. This multi-site study assessed whether two measures of decision-making predicted relapse and subsequent use in stimulant-dependent patients. 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 (NIDA Clinical Trials Network protocol CTN-0031, 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 period following post-randomization were evaluated.
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 fewer number of stimulant use days (p=0.001). In contrast, worse performance on the WCST (fewer 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.
Related protocols: CTN-0031Individuals with addictive disorders often make rash decisions and behave impulsively, which can impact their treatment. This 1 hour, 45 minute webinar critically examines different ways to measure impulsivity and how performance on these measures can predict changes in addictive behaviors. The discussion highlights the important ways clinical research and basic science research can inform each other, including research from the Clinical Trials Network. It also examines various factors that impact impulsivity, including genetics, environmental history of adversity and stress, emotional state including distress due to substance withdrawal symptoms, and other psychosocial factors. The final part of this webinar outlines studies that show how these factors alter the neural functions that govern impulsivity.
Greater impulsivity, assessed by the Barratt Impulsiveness Scale-11 (BIS-11) and Stroop interference scores, has been associated with treatment completion in cocaine-dependent patients. This study, an ancillary investigation of data from the National Drug Abuse Treatment Clinical Trials Network study CTN-0031, evaluated the relationships among impulsivity, stimulant-dependence diagnosis, and treatment completion. Six sites evaluating 12-step facilitation for stimulant abusers obtained the BIS-11 and Stroop Color Word test results from 182 methamphetamine- and/or cocaine-dependent participants. Methamphetamine-dependent, relative to cocaine-dependent, participants evidenced significantly greater BIS-11 non-planning and total scores. There was a trend for poorer response inhibition, measured by the Stroop, in cocaine-dependent, relative to methamphetamine-dependent, participants. Accounting for other factors related to treatment completion, BIS-11 motor score, and assessing the tendency to act without thinking predicted treatment completion for both cocaine-dependent and methamphetamine-dependent patients.
Conclusions: These results suggest that methamphetamine-dependent and cocaine-dependent patients may have different impulsivity profiles but that the BIS-11 may be useful in identifying both methamphetamine-dependent and cocaine-dependent patients who are at risk for treatment non-completion.
Related protocols: CTN-0031-A-1