Negative urgency and negative affect paradigms in patients during cocaine detoxification treatment: Relationship to craving behaviour

Drug addiction is one of the most concerning problems globally. Significant advances have been made in understanding the physiological brain mechanisms underlying addiction to numerous substances, such as alcohol and opioids. Although experimental evidence suggests that addiction to these substances involves common neural structures and pathways, the pathophysiological mechanism underlying addiction to other substances, such as cocaine, remains uncertain. In our study, craving, as a traditional behavioral driving force of drug consumption, was revised and contrasted with alternative behavioral expressions, such as negative and positive affect, which have been shown to complement the complex expression of addictive behavior toward alcohol and other substances, for instance nicotine and opiods. In cocaine addiction, the interaction between craving behavior and the behavioral processes of positive and negative affect is unclear. Thus, we aimed to evaluate these interactions in cocaine consumers in the city of Mendoza, Argentina.

Twenty-seven men and five women were selected after providing informed consent to participate in the detoxifying program of the Psychiatric Clinic Del Prado of the city of Mendoza. Blood samples for cortisol measurement were acquired, and psychometric tests for evaluating positive and negative affect, craving, depression, and impulsivity were performed at the beginning of treatment (t₀) and at discharge on day 14 (t_F).

Results showed that negative affect and craving behavior decreased at t_F. Positive affect showed an inverse relationship with craving at t_F. Impulsivity scores improved at the end of treatment; moreover, depression and global clinical impression scores significantly improved. Cortisol blood levels significantly decreased, which suggested that patients were less stressed at t_F.

Our results suggest that during cocaine withdrawal, positive and negative affect interact with craving to reduce craving behavior, which lowers the impact of stress on consumption.