Cocaine-related attentional bias following trauma cue exposure among cocaine dependent in-patients with and without post-traumatic stress disorder


Matthew T. Tull, Department of Psychiatry and Human Behavior, 2500 North State Street, Jackson, MS 39216, USA. E-mail:


Aims  Although the co-occurrence of post-traumatic stress disorder (PTSD) and cocaine dependence is associated with a wide range of negative clinical outcomes, little is known about the mechanisms that underlie this association. This study investigated one potential mechanism—attentional bias to cocaine imagery following trauma cue exposure.

Design  Male and female cocaine-dependent in-patients with and without PTSD were exposed to both a neutral and personalized trauma script on separate days, followed by a visual dot-probe task. A 2 (PTSD versus non-PTSD) × 2 (neutral versus trauma script) × 2 (male versus female) design was used to examine hypotheses.

Setting  Participants were recruited from a residential substance use disorder (SUD) treatment center.

Participants  Participants were 60 trauma-exposed cocaine dependent in-patients, 30 with current PTSD and 30 without a history of PTSD.

Measurements  Attentional bias was assessed using a visual dot-probe task depicting cocaine-related imagery following both a neutral script and personalized trauma script.

Findings  Following neutral script exposure, PTSD (versus non-PTSD) participants exhibited an attentional bias away from cocaine imagery. This effect was reversed following trauma script exposure, with PTSD participants exhibiting a greater attentional bias towards the location of cocaine imagery than non-PTSD participants. Severity of subjective distress following trauma script exposure predicted level of attentional bias among PTSD participants.

Conclusions  Cocaine appears to serve an emotion-regulating function among post-traumatic stress disorder patients and may be a potential target for brief post-traumatic stress disorder–substance use disorder interventions that can facilitate residential substance use disorder treatment retention.