The purpose of this project is to examine the use of responding to drug- related cues (DRCs) as a risk factor for later drug use. The study has two general aims. First, levels of DRC responding at the outset of drug treatment will be used to predict later levels of drug use. Second, responding to DRCs will be assessed both before and after drug treatment as a means of assessing whether different treatments have differential effects on this risk factor. If DRC responding serves as an accurate predictor of treatment outcome, then such assessments could routinely be used to identify high-risk patients as well as to assist in patient- treatment matching. Differential DRC responding after different treatments would help us identify treatment modalities that may minimize the risk of later relapse to drug taking. DRC responding will be assess in three treatment populations: male cocaine addicts enrolled in studies of anti-craving medications, female cocaine addicts who are enrolled in a study of different psychosocial interventions, and nicotine addicts (smokers) enrolled in a smoking cessation program including use of the nicotine patch. For each population, subjects will have a cue assessment laboratory session both before and after treatment. In each session, subjects will listen to an audiotape, watch a videotape and perform a manual task while both physiological and self-report assessments are made. In these sessions, subjects will be exposed to events related to their drug of abuse (cocaine or nicotine). During each session, measurements of heart rate, skin temperature, skin resistance, and facial electromyography (EMC) will be taken. Subjects will also be asked to rate their general mood and their perceived states of high, craving, and withdrawal both before and after the session. Data from the initial DRC session will be entered into a discriminant equation previously found to accurately predict levels of drug use following treatment (22). For each individual treatment modality, prospective predications of outcome will be made using the already developed discriminant function. In addition, a new function will be developed for each treatment modality. In this way, the potential exists to develop multiple predictive equations tailored to specific treatments. By applying each equation to data from a particular subject, one could determine the treatment modality most likely to produce a successful outcome (patient-treatment matching). Data from the second DRC session (post-treatment) will be used to assess the efficacy of different treatment strategies. Treatments which more effectively reduce craving and arousal produced by DRCs should be associated with a lower risk of later relapse.
