Attentional Bias to Drug- and Stress-Related Pictorial Cues in Cocaine Addiction Comorbid with Posttraumatic Stress Disorder


  • Estate Sokhadze
  • Shraddha Singh
  • Christopher Stewart
  • Michael Hollifield
  • Ayman El-Baz
  • Allan Tasman



Introduction. Cocaine addiction places a specific burden on mental health
services through its comorbidity with other psychiatric disorders. Treatment of patients with cocaine abuse is more complicated when addiction is co-occurring with posttraumatic stress disorder (PTSD). This study used dense-array event-related potential (ERP) technique to investigate whether the patients with this form of dual diagnosis display excessive reactivity to both trauma and drug cues as compared to neutral cues. Cue reactivity refers to a phenomenon in which individuals with a history of drug dependence exhibit verbal, physiological, and behavioral responses to cues associated with their preferred substance of abuse. This study explores ERP differences associated with cue-related responses to both drug and trauma cues in a three-category oddball task using neutral, drug-related, and trauma-related pictorial stimuli. Methods. The study was conducted on 14 cocaine dependent participants, 11 participants with cocaine-dependence comorbid with PTSD, and 9 age- and gender-matched control subjects. A 128-channel Electrical Geodesics EEG system was used to record ERP during the visual three-category oddball task with three categories (neutral, drug, stress) of affective pictures. Results. Patients with cocaine dependence and PTSD, as compared to patients with only cocaine addiction and control participants, showed excessive cue reactivity to both drug- and trauma-related visual stimuli. Most profound differences were found in the amplitude and latency of frontal P3a, and centro-parietal P3b ERP components. Group differences were found as well between patients with cocaine abuse (both addiction-only and dual diagnosis groups) versus controls on most ERP measures for drug-related cues. Conclusion. We propose that the employed ERP cue reactivity variables could be used as valuable functional outcome measures in dually diagnosed drug addicts undergoing behavioral treatment.