Drug and Alcohol Dependence 89 (2007) 97–101
Short communication
Drug fluency: A potential marker for cocaine use disorders
R.Z. Goldstein
a,∗
, P.A. Woicik
a
, T. Lukasik
a
, T. Maloney
a
, N.D. Volkow
b
a
Brookhaven National Laboratory, Medical Department, Upton, NY 11973, United States
b
National Institute on Drug Abuse, Bethesda, MD 20892, United States
Received 25 October 2006; received in revised form 14 December 2006; accepted 18 December 2006
Abstract
The goal of the current study was to tailor semantic fluency to increase its sensitivity and ecological validity in the study of drug use disor-
ders. On a newly modified “drug” fluency task, individuals with cocaine use disorders who tested positive for cocaine at study day named more
drug-related words than control subjects. The number of words provided on the classical semantic fluency task (animals and fruits/vegetables)
did not differ between the groups. While the individuals with cocaine use disorders who tested negative for cocaine at study day did not differ
from the control subjects in total words named on this task, a qualitative analysis indicated that both cocaine subgroups provided significantly
more words pertaining to the experience of using drugs (paraphernalia, administration) than the matched control subjects. These results demon-
strate that compared to classical neurocognitive assessment tools, newly tailored measures may be more sensitive to cocaine use disorders,
psychopathologies that are often characterized by mild neuropsychological deficits but a well-circumscribed attentional bias to drug-related
cues. Future studies are needed to probe the exact cognitive processes and neural circuitry underlying performance on this cue-sensitive 1-min
measure.
© 2006 Elsevier Ireland Ltd. All rights reserved.
Keywords: Semantic memory; Cocaine; Drug addiction; Salience; Cue-reactivity; Craving; Prefrontal cortex
1. Introduction
Neuropsychological (NP) tests have emerged from the neces-
sity to non-invasively identify a putative brain dysfunction
mostly in individuals suffering from brain trauma or pronounced
learning disabilities (Lezak, 1995). However, the developmentof
sensitive neuroimaging techniques has been replacing this diag-
nostic need with a more descriptive role for NP tasks, such as
the association of behavioral, cognitive and emotional function
with a documented brain lesion. In recent years, this combined
neurobehavioral functional mapping has extended to disorders
where deficits at both the neural and cognitive levels may be
relatively subtle (Franklin et al., 2002; Goldstein et al., 2004),
yet predictive of clinical treatment outcomes (Aharonovich et
al., 2006), such as in cocaine use disorders. However, a gap
remains between the NP tools that continue to use a neutral
∗
Corresponding author at: Brookhaven National Laboratory, P.O. Box 5000,
Upton, NY 11973-5000, United States. Tel.: +1 631 344 2657;
fax: +1 631 344 5260.
E-mail address: rgoldstein@bnl.gov (R.Z. Goldstein).
context when assessing cognition, and evidence that points
to a core impact of emotion, or context-specificity, on cog-
nition in this psychopathology. For example, cocaine-related
cues reliably elicit self-reported craving and more objectively
measured physiological reactions in individuals with cocaine
use disorders (Carter and Tiffany, 1999) as induced by vari-
ous cognitive-behavioral methods (e.g., imagery, Sinha et al.,
2000).
The goal of the current study was therefore to adapt a neutral
NP tool to incorporate a symptom-specific context with the goal
of probing the effect of salient context/emotion on cognition in
cocaine use disorders. A similar approach was previously used
with a single NP task, the color-word Stroop (Hester et al., 2006),
where subjects have to ignore the meaning of drug-related words
or pictures to perform the task at hand (pressing for stimulus
color); compared to non-drug using populations, active cocaine
users display an attentional bias to cocaine-related cues on this
drug Stroop task (Hester et al., 2006). We hypothesized that sim-
ilarly to results on this drug Stroop task, a semantic fluency task
tailored specifically to elicit drug-related responses would dif-
ferentiate between individuals with cocaine use disorders from
healthy control subjects.
0376-8716/$ – see front matter © 2006 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.drugalcdep.2006.12.001