The Role of Iowa Gambling Task Performance in Response to Citalopram Treatment for Cocaine Use Disorder

Authors

Constanza de Dios
Robert Suchting
Charles E Green
Heather E Webber
F Gerard Moeller
Scott D Lane
Joy Schmitz

Language

English

Publication Date

1-2-2025

Journal

The American Journal of Drug and Alcohol Abuse

DOI

10.1080/00952990.2024.2420773

PMID

39853194

PMCID

PMC11899305

PubMedCentral® Posted Date

1-24-2026

PubMedCentral® Full Text Version

Author MSS

Abstract

Background:

Cocaine use disorder (CUD) is associated with executive functioning impairments linked to serotonergic function. Previous studies reported efficacy with the selective serotonin reuptake inhibitor citalopram in reducing cocaine use.

Objectives:

The current study explored moderation and mediation of citalopram effects on cocaine use by performance across executive function domains.

Methods:

We conducted a secondary analysis of a double-blind, placebo-controlled, randomized Bayesian adaptive trial investigating citalopram efficacy in CUD treatment-seeking adults. At baseline and mid-treatment, participants completed assessments of decision-making (Iowa Gambling Task; IGT), attention, response inhibition, and cognitive flexibility. Outcomes were longest duration of abstinence (LDA; count of consecutive cocaine-negative urine tests) and Treatment Effectiveness Score (TES; count of cocaine-negative urine tests from study midpoint to endpoint). Bayesian models estimated independent moderation and mediation effects of cognitive ability on the association between treatment (citalopram 40mg vs. placebo) and LDA/TES.

Results:

Of the four assessments, only the IGT demonstrated concurrent moderation and mediation in the sample (N=80; 82% males). Treatment effects on LDA (IRR=1.02) and TES (IRR=1.03) were strongest in participants with higher baseline IGT scores which indicate less risky decision-making (posterior probabilities >93%). Models supported a positive indirect effect of treatment on TES (IRR=1.12, posterior probability=81.6%), with 52.3% of the total effect mediated by changes in IGT scores from baseline to mid-treatment.

Conclusion:

We found evidence for IGT as a moderator and mediator of citalopram’s effects on cocaine use. Decision-making ability may play a role in predicting who responds to citalopram and how.

Keywords

Adult, Female, Humans, Male, Middle Aged, Bayes Theorem, Citalopram, Cocaine-Related Disorders, Decision Making, Double-Blind Method, Executive Function, Gambling, Selective Serotonin Reuptake Inhibitors, Treatment Outcome, Secondary Data Analysis, Cocaine use disorder, decision-making, citalopram, Iowa Gambling Task, randomized clinical trial, Bayesian mediation

Published Open-Access

yes

Recommended Citation

de Dios, Constanza; Suchting, Robert; Green, Charles E; et al., "The Role of Iowa Gambling Task Performance in Response to Citalopram Treatment for Cocaine Use Disorder" (2025). Faculty, Staff and Student Publications. 6049.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/6049