Positive and negative affect in cocaine use disorder treatment: Change across time and relevance to treatment outcome.

Background: Cognitive-behavior therapy (CBT) for substance use disorder is empirically supported, and may be associated with change in affect over time.

Objectives: Understanding the role of affect in cocaine use disorder could help to improve CBT outcomes.

Methods: This secondary analysis included 140 adults with cocaine use disorder, 57.9% female, drawn from two randomized controlled studies of web-based cognitive-behavior therapy who completed the Positive and Negative Affect Scale (PANAS) before and during treatment.

Results: In mixed-effects regression models, baseline negative affect (NA) scores were not associated with self-reported cocaine use during treatment, but baseline PA scores were associated with less frequent cocaine use (β = -0.04, p = .02). During treatment, NA scores reduced over time in CBT and treatment as usual (β = -0.27, p < .01), although PA scores did not change. Higher weekly NA scores were associated with weekly cocaine use (β = .02, SE = .01, t(746.15) = 2.37, p = .02), although weekly PANAS PA scores were not associated with weekly cocaine use.

Discussion And Conclusions: Results indicated that individuals with higher baseline PA were more likely to abstain from cocaine use during treatment, even when controlling for baseline cocaine use frequency. Although baseline NA was not associated with cocaine use, NA during treatment was associated with greater cocaine use.

Scientific Significance: PA at baseline and NA during treatment were associated with cocaine use. If findings are replicated, treatment developers may wish to include treatment interventions to boost early PA and reduce NA throughout treatment. (Am J Addict 2018;XX:1-8).