Cognitive Control Related to Cocaine Abstinence and Treatment Retention

People with a history of cocaine dependence (CD) have been shown to have impaired cognitive control. This diminished capacity results in high rates of relapse and poor treatment retention. Understanding the mechanisms that cause these impairments could help in the development of more focused treatments for individuals with CD. Deficits in specific regions of the brain are thought to influence executive control and, in particular, impulsive and motivational behaviors related to drug dependency. To this end, Patrick D. Worhunsky of the Department of Psychiatry at Yale University School of Medicine recently led a study that examined the motivational and reward sensitivity of cognitive functioning known to be related to addictive behavior patterns.

For his study, Worhunsky used magnetic resonance imaging to evaluate specific regions of the brain as 20 CD participants and 20 non-CD control participants completed a commonly used cognitive skills test. Worhunsky assessed how certain neural activity influenced treatment adherence and drug use in the participants. He found that certain top-down and bottom-up neural mechanisms predicted poorer treatment outcome and higher rates of relapse in the CD participants. The control group exhibited higher rates of motivational mechanism than the CD group, suggesting that the bottom-up mechanisms of executive control are critical for abstinence.

The cognitive skills test used in this study revealed that CD participants had impaired top-down control mechanisms that resulted in lower rates of treatment adherence than the controls. Additionally, the CD participants had deficits in motivational processes known as bottom-up mechanisms that led to more relapses and fewer cases of abstinence. Worhunsky believes that the findings of this study have significant clinical implications. Exploring the neural structures that impact executive control in those with CD could provide further insight into the challenges they face in overcoming their addictions. He added, “The identification of subcortical networks linked to cocaine abstinence and cortical networks to treatment retention suggests that specific circuits may represent important, complementary targets in treatment development for cocaine dependence.”

Worhunsky, P. D., Stevens, M. C., Carroll, K. M., Rounsaville, B. J., Calhoun, V. D., Pearlson, G. D., et al. (2012). Functional brain networks associated with cognitive control, cocaine dependence, and treatment outcome. Psychology of Addictive Behaviors. Advance online publication. doi: 10.1037/a0029092

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  • Kerry


    July 18th, 2012 at 4:04 AM

    Wouldn’t it be nice if potential drug abusers could somehow know this before turning to drug use and then decide to not use drugs at all? I know, I know, just a pipe dream, but at least I wish that more people would give a little more thought to the damage that they can cause to their bodies with drug usage before they use and have to then go down that inevitable road of abuse and addiction.

  • moore


    July 18th, 2012 at 3:15 PM

    having the ability to see where these deficits are in cocaine addicts could do wonders for the way that they are treated, and ultimately to helping them overcome their addictions

  • Kat


    July 19th, 2012 at 8:02 PM

    @Kerry:It is not too distant a dream if you ask me.We can already find out the disorders a person is vulnerable to at a very early age now. So this could be the future. it will be great though!

  • Eliza


    July 20th, 2012 at 4:31 AM

    Do we have any real sort of understanding as to whether other drugs tend to affect individuals in the same way that dependence upon and use of cocaine has? If it is comparable, then this is not only a huge step for treatment for addicts of cocaine, but for others who have abuse issues as well. Hope that lots of treatment counselors are keeping up with this one.

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