Drug and Alcohol Dependence 122 (2012) 142–148 Contents lists available at SciVerse ScienceDirect Drug and Alcohol Dependence j ourna l ho me pag e: www.elsevier.com/locate/drugalcdep Self-regulation and treatment retention in cocaine dependent individuals: A longitudinal study A. Verdejo-García a,b,∗ , P. Betanzos-Espinosa a , O.M. Lozano c , E. Vergara-Moragues d , F. González-Saiz d,e , F. Fernández-Calderón c,d , I. Bilbao-Acedos d , M. Pérez-García a,b a Department of Clinical Psychology, Universidad de Granada, Spain b Institute of Neuroscience F. Olóriz, Universidad de Granada, Spain c Department of Psychology, Universidad de Huelva, Spain d Fundación Andaluza para la Atención a las Drogodependencias e Incorporación Social (FADAIS), Sevilla, Spain e Unidad de Salud Mental Comunitaria Villamartín, Unidad de Gestión Clínica Hospital de Jerez, Cádiz, Spain a r t i c l e i n f o Article history: Received 12 May 2011 Received in revised form 27 September 2011 Accepted 27 September 2011 Available online 21 October 2011 Keywords: Cocaine Executive functions Orbitofrontal cortex Self-regulation Retention Therapeutic community a b s t r a c t Background: We aimed to explore the association between baseline executive functioning and treatment outcome in Therapeutic Communities (TCs). Methods: We used a longitudinal descriptive design: a baseline neuropsychological assessment was per- formed within the first 30 days of treatment in TCs. Once participants finished or abandoned treatment, the information about time of stay in treatment was computed for each individual. The study was con- ducted across six TCs located in the region of Andalusia (Spain): Cartaya, Almonte, Mijas, Los Palacios, La Línea, and Tarifa. Participants were 131 patients with cocaine dependence who initiated and fin- ished treatment in TCs between January 2009 and December 2010 (2 years). Cognitive assessment was composed of general measures of executive functioning: Letter Number Sequencing (working memory) and Similarities (reasoning), and executive tasks sensitive to ventromedial prefrontal cortex dysfunction, including the Delis–Kaplan Stroop test (inhibition/cognitive switching), the Revised-Strategy Application Test (strategy application/multitasking), and the Iowa Gambling Task (decision-making). The outcome measure was retention, defined as time in TC treatment (number of days). Results: Poor executive functioning significantly predicted shorter treatment retention in cocaine depen- dent individuals on TC residential treatment (14% of explained variance). Reduced performance on the R-SAT, a multitasking test taxing the ability to develop and apply the best strategy to organize multiple sub-routine tasks in order to achieve a long-term goal, was the most powerful predictor of treatment retention. Conclusions: Self-regulation deficits predict the capacity to remain in residential treatment among cocaine dependents. © 2011 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Addiction is currently conceptualized as a chronic, often relaps- ing brain disorder that causes compulsive drug use despite harmful consequences to the addicted individual (National Institute of Drug Abuse, 2011). Cocaine and heroin dependence are considered brain disorders in light of evidence of drug-related neuroadaptations in brain systems that are critical for executive control of behavior, with particular relevance of the ventromedial prefrontal cortex, including the medial orbitofrontal cortex, frontal pole, and adja- cent anterior cingulate regions (Alia-Klein et al., 2011; Franklin ∗ Corresponding author at: Facultad de Psicología, Universidad de Granada, Cam- pus de Cartuja S/N, 18071 Granada, Spain. Tel.: +34 958242948; fax: +34 958243749. E-mail address: averdejo@ugr.es (A. Verdejo-García). et al., 2002; Langleben et al., 2008; Tanabe et al., 2009). The orbitofrontal cortex is primarily involved in reward-based updat- ing of representations of the affective value of reinforcers (Buckley et al., 2009; Kringelbach, 2005), and therefore it plays a key role in driving behavior according to long-term goals or delayed rein- forcers (Bechara, 2005; Sellitto et al., 2010). Adjacent anterior frontal regions, such as the anterior cingulate cortex and medial aspects of the frontopolar cortex (Bechara, 2004), are also rele- vant to set and follow plans and rules (and inhibiting competitive responses) in order to achieve long-term goals and intentions (Burgess, 2010; Dreher et al., 2008). Although often elusive, the cognitive deficits associated with ventromedial prefrontal cortex dysfunction include strategy application, cognitive switching, and decision-making (Levine et al., 1998; Tranel et al., 2007; Zald and Andreotti, 2010), which are thought to hinder substance use behav- ior change (Blume and Marlatt, 2009). The persistence of these 0376-8716/$ – see front matter © 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.drugalcdep.2011.09.025