Risky decision-making predicts short-term outcome of community but not residential treatment for opiate addiction. Implications for case management

TY - JOUR

T1 - Risky decision-making predicts short-term outcome of community but not residential treatment for opiate addiction. Implications for case management

AU - Passetti, F.

AU - Clark, L.

AU - Davis, P.

AU - Mehta, M. A.

AU - White, S.

AU - Checinski, K.

AU - King, M.

AU - Abou-Saleh, M.

PY - 2011/10/1

Y1 - 2011/10/1

N2 - Background: Opiate addiction is associated with decision-making deficits and we previously showed that the extent of these impairments predicts aspects of treatment outcome. Here we aimed to establish whether measures of decision-making performance might be used to inform placement matching. Methods: Two groups of opiate dependent individuals, one receiving treatment in a community setting (n = 48) and one in a residential setting (n = 32) were administered computerised tests of decision-making, impulsivity and planning shortly after the beginning of treatment, to be followed up three months into each programme. Results: In the community sample, performance on the decision-making tasks at initial assessment predicted abstinence from illicit drugs at follow-up. In contrast, in the residential sample there was no relationship between decision-making and clinical outcome. Conclusions: Intact decision-making processes appear to be necessary for upholding a resolve to avoid taking drugs in a community setting, but the importance of these mechanisms may be attenuated in a residential treatment setting. The results support the placement matching hypothesis, suggesting that individuals with more prominent decision-making deficits may particularly benefit from treatment in a residential setting and from the inclusion of aspects of cognitive rehabilitation in their treatment programme. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

AB - Background: Opiate addiction is associated with decision-making deficits and we previously showed that the extent of these impairments predicts aspects of treatment outcome. Here we aimed to establish whether measures of decision-making performance might be used to inform placement matching. Methods: Two groups of opiate dependent individuals, one receiving treatment in a community setting (n = 48) and one in a residential setting (n = 32) were administered computerised tests of decision-making, impulsivity and planning shortly after the beginning of treatment, to be followed up three months into each programme. Results: In the community sample, performance on the decision-making tasks at initial assessment predicted abstinence from illicit drugs at follow-up. In contrast, in the residential sample there was no relationship between decision-making and clinical outcome. Conclusions: Intact decision-making processes appear to be necessary for upholding a resolve to avoid taking drugs in a community setting, but the importance of these mechanisms may be attenuated in a residential treatment setting. The results support the placement matching hypothesis, suggesting that individuals with more prominent decision-making deficits may particularly benefit from treatment in a residential setting and from the inclusion of aspects of cognitive rehabilitation in their treatment programme. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

U2 - 10.1016/j.drugalcdep.2011.02.015

DO - 10.1016/j.drugalcdep.2011.02.015

M3 - Article

SN - 1879-0046

VL - 118

SP - 12

EP - 18

JO - Drug and alcohol dependence

JF - Drug and alcohol dependence

IS - 1

ER -