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Front Psychiatry. 2013 Nov 15;4:149. doi: 10.3389/fpsyt.2013.00149. eCollection 2013.

Disadvantageous Decision-Making as a Predictor of Drop-Out among Cocaine-Dependent Individuals in Long-Term Residential Treatment.

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Department of Orthopedagogics, Ghent University , Ghent , Belgium.



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.


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).


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.


Our findings suggest that neurocognitive rehabilitation of disadvantageous decision-making may have clinical benefits in CDI admitted to long-term residential treatment programs.


addiction treatment outcomes; cocaine dependence; decision-making; drop-out; treatment retention

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