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J Psychopharmacol. 2016 Jul;30(7):616-26. doi: 10.1177/0269881116645268. Epub 2016 May 4.

Impulsivity and attentional bias as predictors of modafinil treatment outcome for retention and drug use in crack-cocaine dependent patients: Results of a randomised controlled trial.

Author information

1
Parnassia Addiction Research Centre (PARC), Brijder Addiction Treatment, The Hague, the Netherlands mascha.nuijten@brijder.nl.
2
Parnassia Addiction Research Centre (PARC), Brijder Addiction Treatment, The Hague, the Netherlands.
3
Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
4
Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands Arkin Mental Health Care, Amsterdam, the Netherlands.
5
Parnassia Addiction Research Centre (PARC), Brijder Addiction Treatment, The Hague, the Netherlands Department of Child and Adolescent Psychiatry, Leiden University Medical Centre, Leiden University, Leiden, the Netherlands.

Abstract

BACKGROUND:

High impulsivity and attentional bias are common in cocaine-dependent patients and predict poor treatment outcomes. The pharmacological agent modafinil is studied for its cognitive-enhancing capacities and may therefore improve clinical outcomes in crack-cocaine dependent patients. In this study, we investigated first whether pre-treatment impulsivity and attentional bias predict treatment outcome; next whether the drug modafinil given as an add-on treatment to cognitive behavioural therapy (CBT) improves impulsivity and attentional bias; and last, whether changes in impulsivity and attentional bias are related to improvements in treatment outcome.

METHODS:

Crack-cocaine dependent outpatients (n = 65) were randomised to 12 weeks CBT plus modafinil (400 mg/day) or only CBT. Self-reported impulsivity was assessed at baseline using the Barratt Impulsiveness Scale. At baseline and Week 12, we assessed inhibitory control as a behavioural measure of impulsivity, in terms of cognitive interference (Stroop task) and response inhibition ('stop-signal task'), and attentional bias with the addiction Stroop task. Clinical outcomes were CBT-retention and crack-cocaine use.

RESULTS:

At baseline, self-reported impulsivity predicted better CBT-retention; low self-reported and behavioural impulsivity and attentional bias predicted less crack-cocaine use. Changes in cognitive performance were not modafinil-related, but most likely due to low adherence. Improvements in impulsivity or attentional bias were not associated with CBT-retention nor changes in crack-cocaine use.

CONCLUSIONS:

Baseline impulsivity and attentional bias predicted clinical outcomes in crack-cocaine dependent patients. There were no firm indications that modafinil reduced impulsivity nor attentional bias in this population. Future studies involving cognitive-enhancing medications should include strategies to optimise adherence, to be better able to evaluate their potential.

KEYWORDS:

Adherence; attentional bias; cocaine dependence; cognition; cognitive behavioural therapy; crack cocaine; drug use; impulsivity; modafinil; randomised controlled trial

PMID:
27147591
DOI:
10.1177/0269881116645268
[Indexed for MEDLINE]

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