Baseline electrophysiological markers of reward and error processing are associated with improved outcomes in...

Veterans are disproportionately affected by cocaine use disorder (CUD), a condition without approved pharmacotherapies, marked by high return to use rates. Prize-Based Contingency Management (PBCM) is an effective behavioral intervention, but treatment response varies. Electrophysiological and cognitive measures may help identify who is likely to benefit from specific PBCM variants. This study evaluates whether neurocognitive profiles predict differential response to monetary versus tangible reward-based PBCM, with the goal of informing measurement-based, personalized treatment.

Forty-five Veterans with CUD completed EEG and cognitive assessments before randomization to a 12-week treatment trial evaluating PBCM with either tangible or voucher rewards. Manipulation checks validated the measurement approach for candidate neurocognitive predictors. Treatment outcomes were analyzed using longitudinal logistic regression across 24 possible PBCM sessions. A forward selection approach guided model building, and generalizability was assessed using leave-one-out cross-validation.

Manipulation checks confirmed expected neurocognitive effects across tasks. Modeling identified greater anticipatory alpha suppression to tangible reward, larger ERN amplitudes, and lower craving as significant predictors of abstinence. Voucher PBCM, younger age, and earlier timepoints were also associated with better outcomes. Model 1 demonstrated good discrimination (AUC = 0.773), with no added benefit from predictor-by-treatment interactions.

This study highlights the potential of neurocognitive markers associated with PBCM outcomes in Veterans with CUD to inform treatment development and personalization. Baseline features did not predict differential outcomes by reward type; instead, tangible rewards were generally linked to poorer outcomes. Findings therefore also support the broad utility of abstract, voucher-based rewards in PBCM treatment.