Decision-making processes as predictors of relapse and subsequent use in stimulant-dependent patients

Bryon Adinoff, Thomas J. Carmody, Robrina Walker, Dennis M. Donovan, Gregory S. Brigham, Theresa M. Winhusen

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)88-97
Number of pages10
JournalAmerican Journal of Drug and Alcohol Abuse
Issue number1
StatePublished - Jan 2 2016


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

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Clinical Psychology
  • Psychiatry and Mental health


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