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

Background: This study aimed to explore the association between psychiatric comorbidity and treatment outcomes in therapeutic communities (TCs). Methods: A prospective longitudinal descriptive design was used. A baseline psychopathological assessment was performed within the first 15 to 20 days of treatment in the TCs. The length of treatment stay was computed for each individual. The study was conducted in the region of Andalusia (Spain). The participants were 218 cocaine-dependent individuals. Psychopathological assessment was performed using the Psychiatric Research Interview for Substance and Mental Disorders (PRISM). The outcome measures were retention, defined as the time in TC treatment (number of days), and the patient's assessment upon leaving the TC. Results: The number of psychopathological comorbidities present in the last year among the patients was high (57.8%) and was associated with a worse response to treatment ( P =.004). The patients with co-occurring psychiatric disorders had a decreased probability of remaining in the TCs compared with patients who only presented with substance use disorders (hazards ratio = 1.61). Conclusions: Psychiatric comorbidity predicts cocaine-dependent individuals’ likelihood of remaining in residential treatment.