ORIGINAL INVESTIGATION Decision-making impairment predicts 3-month hair-indexed cocaine relapse Antonio Verdejo-Garcia & Natalia Albein-Urios & Jose Miguel Martinez-Gonzalez & Ester Civit & Rafael de la Torre & Oscar Lozano Received: 16 January 2014 /Accepted: 24 March 2014 /Published online: 13 April 2014 # Springer-Verlag Berlin Heidelberg 2014 Abstract Rationale One of the key outstanding challenges in cocaine dependence research is determining who is at risk of relapsing during treatment. Objectives We examined whether cognitive decision-making profiles predict objectively (hair) indexed cocaine relapse at 3- month follow-up. Methods Thirty-three cocaine-dependent patients commenc- ing outpatient treatment in a public clinic performed baseline decision-making assessments with the original and variant versions of the Iowa Gambling Task, and provided a 3-cm hair sample 3 months afterwards. Based on Iowa Gambling Tasks’ performance cut-offs, 5 patients had intact decision- making skills, 17 patients showed impaired sensitivity to reward or punishment (impairment in one of the tasks), and 9 patients showed insensitivity to future consequences (im- pairment in both tasks). Based on a 0.3 ng/mg cocaine cut-off, 23 patients were classified as relapsers and 10 as non-relapsers at the 3-month follow-up. Results Eighty percent of patients with intact decision-making were abstinent at follow-up, whereas 90 % of patients with insensitivity to future consequences had relapsed. The two subgroups (relapsers and non-relapsers) showed no significant differences on drug use, comorbidities, or psychosocial func- tion, and significantly differed on verbal but not performance IQ. A regression model including decision-making scores and verbal IQ predicted abstinence status with high sensitivity (95 %) and moderately high specificity (81 %). Conclusion These preliminary findings demonstrate that decision-making profiles are associated with cocaine relapse. Moreover, combined decision-making and IQ assessments provide optimal predictive values over stimulant relapse, yielding significant opportunities for clinical translation. Keywords Cocaine . Decision-making . Insensitivity to future consequences . Hair analysis . Iowa Gambling Task Introduction Relapse is the main challenge faced by stimulant-dependent patients undergoing treatment. Even effective psychosocial treatments are associated with relapse rates of 60 to 70 % in post-treatment follow-ups (Bisaga et al. 2010; Dutra et al. 2008; Knapp et al. 2007). Therefore, an outstanding issue for cocaine addiction treatment research is predicting who is at risk of drug relapse and which strategies can be used to A. Verdejo-Garcia : J. M. Martinez-Gonzalez : O. Lozano Red de Trastornos Adictivos, Universidad de Granada, Granada, Spain A. Verdejo-Garcia : N. Albein-Urios Department of Clinical Psychology & Institute of Neuroscience F. Oloriz, Universidad de Granada, Granada, Spain A. Verdejo-Garcia (*) School of Psychology and Psychiatry, Monash University, 3800 Wellington Rd. Clayton Campus, Melbourne, Australia e-mail: antonio.verdejo@monash.edu J. M. Martinez-Gonzalez Centro Provincial de Drogodependencias, Diputación de Granada, Granada, Spain E. Civit : R. de la Torre Human Pharmacology and Clinical Neurosciences Research Group, IMIM-Institut de Recerca Hospital del Mar, Barcelona, Spain R. de la Torre CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Santiago de Compostela, Spain R. de la Torre Universitat Pompeu Fabra (CEXS-UPF), Barcelona, Spain O. Lozano Department of Psychology, Universidad de Huelva, Granada, Spain Psychopharmacology (2014) 231:4179–4187 DOI 10.1007/s00213-014-3563-9