Preliminary evidence for normalization of risk taking by modafinil in chronic cocaine users

Abstract

Modafinil, a wake-promoting agent used to treat sleep disorders, is thought to enhance cognition. Although modafinil has shown promise as a pharmacotherapy for the treatment of cocaine dependence, it is unknown to what extent cognitive effects may play a role in such treatment. We examined the effect of modafinil on the Balloon Analogue Risk Task (BART), a behavioral measure in which higher scores are purported to reflect a greater propensity for risk-taking. Thirty cocaine dependent individuals, enrolled in a randomized clinical trial of modafinil 400mg (n=12) versus placebo (n=18), were administered the BART during the second week of inpatient treatment for cocaine dependence. A comparison cohort of healthy participants (n=19) performed the BART under similar conditions. Modafinil treatment was associated with significantly higher BART scores (p=0.01), which were comparable to scores in healthy persons. BART scores in placebo treated participants were much lower than previously reported in healthy participants, and lower than those observed in the comparison cohort. As propensity toward risk taking is typically associated with higher BART scores as well as increased risk for substance use, our findings may reflect a novel aspect of cognitive impairment related to chronic cocaine use. Notably, the low BART scores reflect highly suboptimal performance on the task, and the observed effect of modafinil may indicate a normalization of this impairment and have implications for treatment outcome.

Relationship between trait impulsivity and cortical volume, thickness and surface area in male cocaine users and non-drug using controls

“…While these morphological abnormalities might recover with abstinence, improving the functional imbalance between these brain regions may be a an important treatment strategy. This could be achieved for instance by the use of cognitive enhancers such as modafinil (Canavan et al, 2014), cognitive behavioural therapy (Dutra et al, 2008) or cognitive remediation (Vocci, 2008).…”

Impulsivity and attentional bias as predictors of modafinil treatment outcome for retention and drug use in crack-cocaine dependent patients: Results of a randomised controlled trial

“…In two randomised, placebo-controlled studies in patients with cocaine dependence, short 4-5-day modafinil treatment significantly improved performance on two measures of working memory span and normalised risk taking (Canavan et al, 2014;Kalechstein et al, 2013). In addition, in a randomised placebo-controlled cross-over study, a single dose of modafinil attenuated neural reactivity to cocaine-related cues and selfreported craving, in treatment-seeking cocaine-dependent patients (Goudriaan et al, 2013).…”

Modulation of Risky Choices in Recently Abstinent Dependent Cocaine Users: A Transcranial Direct-Current Stimulation Study

“…In particular, several studies have shown significant behavioral impairments of risky decision-making tasks, such as the Iowa gambling task (IGT) and the balloon analog risk task (BART), in substance-dependent individuals [e.g., Wang et al (2013); Balconi et al (2014); Canavan et al (2014); Hulka et al (2014); Yan et al (2014)].…”