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      Impaired decision-making in opiate-dependent subjects: effect of pharmacological therapies.

      Drug and Alcohol Dependence
      Adult, Buprenorphine, therapeutic use, Cognition Disorders, diagnosis, epidemiology, Decision Making, Female, Gambling, psychology, Humans, Male, Methadone, Middle Aged, Narcotic Antagonists, Neuropsychological Tests, Opioid-Related Disorders, rehabilitation, Severity of Illness Index

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          Abstract

          Cognitive dysfunction is a major feature of drug addiction. In the present paper, we compared the decision-making ability using the Iowa gambling task of methadone- and buprenorphine-maintained individuals to non opiate-dependent drug-free controls. Buprenorphine-maintained individuals performed better than methadone-maintained individuals, and not differently than non opiate-dependent controls. In addition, methadone-maintained individuals had more perseverative errors on the Wisconsin card sorting task (WCST) as compared with non opiate-dependent drug-free controls whereas buprenorphine-maintained individuals had intermediate scores. Scores on Weschler adult intelligence scale (WAIS-R) were similar for methadone- and buprenorphine-maintained individuals whereas drug-free controls had significantly higher scores. In addition, both opiate-dependent groups performed more poorly than drug-free controls on the Benton visual retention test (BVRT). The results suggest that buprenorphine in contrast to methadone improves decision-making, and thus may be more effective in rehabilitation programs of opiate-dependent subjects and this improvement may be related to its distinct pharmacological action as a k antagonist.

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