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.

KEYWORDS:

• Impulsivity
• decision-making
• methamphetamine use disorder
• cocaine use disorder
• gambling task
• relapse

Declaration of interest

The authors report no conflicts of interest. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Additional information

Funding

This study was supported by the following grants from the National Institute on Drug Abuse (NIDA) Clinical Trials Network: U10-DA020024 to the University of Texas Southwestern Medical Center (Dr. Trivedi); U10-DA013714 to the University of Washington (Dr. Donovan); U10-DA013732 to the University of Cincinnati (Dr. Winhusen).