Abstract
Background: The treatment of cocaine-dependent individuals (CDI) is substantially challenged by high drop-out rates, raising questions regarding contributing factors. Recently, a number of studies have highlighted the potential of greater focus on the clinical significance of neurocognitive impairments in treatment-seeking cocaine users. In the present study, we hypothesized that disadvantageous decision-making would be one such factor placing CDI at greater risk for treatment drop-out.Methods: In order to explore this hypothesis, the present study contrasted baseline performance (at treatment onset) on two validated tasks of decision-making, the Iowa Gambling Task (IGT) and the Cambridge Gamble Task (CGT) in CDI who completed treatment in a residential Therapeutic Community (TC) (N = 66) and those who dropped out of TC prematurely (N = 84).Results: Compared to treatment completers, CDI who dropped out of TC prematurely did not establish a consistent and advantageous response pattern as the IGT progressed and exhibited a poorer ability to choose the most likely outcome on the CGT. There were no group differences in betting behavior.Conclusion: Our findings suggest that neurocognitive rehabilitation of disadvantageous decision-making may have clinical benefits in CDI admitted to long-term residential treatment programs.
Highlights
The treatment of cocaine-dependent individuals (CDI) is substantially challenged by high drop-out rates
Our findings suggest that neurocognitive rehabilitation of disadvantageous decision-making may have clinical benefits in CDI admitted to long-term residential treatment programs
Whereas treatment attrition is high across the majority of substance abuse treatment studies, drop-out rates ranging from 60 to 80% have been reported among CDI [1,2,3]
Summary
The treatment of cocaine-dependent individuals (CDI) is substantially challenged by high drop-out rates. CDI who drop-out of treatment prematurely fare worse than those who stay in treatment for the entire period: high drop-out rates limit overall treatment effectiveness, increase the propensity to relapse and seriously exacerbate health, financial, and legal consequences [6, 7]. This relationship between treatment drop-out/completion and post-treatment outcomes has been found across all the major addiction treatment modalities [8,9,10], including drug-free inpatient therapeutic communities (TCs), which remain a core modality of the drug treatment system in Europe and the United States [11, 12]. We hypothesized that disadvantageous decision-making would be one such factor placing CDI at greater risk for treatment drop-out
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