Psychopharmacology (2010) 210:377–392

DOI 10.1007/s00213-010-1833-8

ORIGINAL INVESTIGATION

Impulsivity and executive functions

in polysubstance-using rave attenders
Antonio Verdejo-García & María del Mar Sánchez-Fernández &
Luisa María Alonso-Maroto & Fermín Fernández-Calderón & Jose C. Perales &
Óscar Lozano & Miguel Pérez-García

Received: 1 December 2009 / Accepted: 10 March 2010 / Published online: 13 April 2010
# Springer-Verlag 2010

Abstract Impulsive Behavior Scale, the delay-discounting question-

Objectives Rave parties are characterized by high levels of
drug use and polysubstance-using patterns that may be
especially harmful for psychological and neuropsychological
functioning. The aim of this study was to conduct a
comprehensive assessment of different aspects of impulsivity
and executive functions in a sample of polysubstance-using
rave attenders.
Methods We collected data from two groups: rave attenders
(RvA, n=25) and drug-free healthy comparison individuals
(HCI, n=27). RvA were regular users of cannabis, cocaine,
methampethamine, hallucinogens, and alcohol. The assess-
ment protocol included a drug-taking interview, the UPPS-P
naire and a set of neuropsychological tests taxing different
aspects of executive functions: response speed, working
memory, reasoning, response inhibition and switching,
self-regulation, decision making, and emotion perception.
Results For impulsivity measures, RvA had significantly
elevated scores on lack of perseverance and positive and
negative urgency, but did not differ from controls on lack of
premeditation or sensation seeking. For neuropsychological
functioning, RvA had significantly poorer performance on
indices of analogical reasoning, processing speed, working
memory, inhibition/switching errors, and decision making,
but performed similar to controls on indices of self-

María del Mar Sánchez-Fernández and Luisa María Alonso-Maroto

contributed equally to the development of this manuscript.
Electronic supplementary material The online version of this article
(doi:10.1007/s00213-010-1833-8) contains supplementary material,
which is available to authorized users.
A. Verdejo-García : M. Pérez-García F. Fernández-Calderón : Ó. Lozano
Department of Personalidad, Department of Psychology, Universidad de Huelva,
Evaluación y Tratamiento Psicológico, Huelva, Spain
Universidad de Granada,
Granada, Spain

A. Verdejo-García : M. Pérez-García J. C. Perales

Institute of Neuroscience F. Olóriz, Universidad de Granada, Department of Experimental Psychology,
Granada, Spain Universidad de Granada,
Granada, Spain
M. del Mar Sánchez-Fernández : L. M. Alonso-Maroto
Department of Psychology, Universidad de Jaén,
Jaén, Spain
A. Verdejo-García (*)
F. Fernández-Calderón Facultad de Psicología, Universidad de Granada,
Fundación Andaluza de Ayuda a las Drogodependencias Campus de Cartuja S/N,
e Inserción Social (FADAIS), 18071 Granada, Spain
Andalusia, Spain e-mail: averdejo@ugr.es
378
regulation, reversal learning, and emotion processing. Peak
and binge alcohol and drug use were positively correlated
with positive urgency, and negatively correlated with
performance on executive indices.
Conclusion Rave attenders have selective alterations of
impulsive personality and executive functions. These
findings can contribute to delineate the neuropsychological
profiles that distinguish recreational polysubstance use from
substance dependence.
Keywords Raves . Impulsivity . Executive function .
Neuropsychology . Addiction . Prefrontal cortex .
Inhibition . Drug abuse
Introduction
There is currently no consensus on the best definition for
“rave” (Boeri et al. 2004). However, there are a number of
common characteristics which are typical of these types of
parties: they are held in venues of difficult access (deserted
buildings, beaches, mountains, or forests) (Anderson and
Kavanaugh 2007), they are long-lasting and alternative to
the typical recreational circuits (Boeri et al. 2004), they are
self-organized and without commercial purposes, and they
revolve around music (Sanders 2006) and dance (Romaní
and Sepulveda 2005). Rave attenders have been character-
ized as a fragmented “subculture” (Goulding et al. 2002),
meaning they are made up by socially integrated people
who maintain normalized activities and lifestyles according
to their societies' standards, but who spend part of their
leisure time attending raves. Therefore, all classes or social,
economic, and cultural levels can be equally represented in
these parties (Abanades et al. 2004; Kavanaugh and
Anderson 2008).
On the other hand, raves are also characterized by high
levels of drug use and frequently by polysubstance-using
patterns (Forsyth 1996; Riley and Hayward 2004), which
may be especially harmful for general and brain health. The
preferred drugs among rave attenders are known as “club
drugs” or “dance drugs” (including 3,4-methylenedioxyme-
thamphetamine (MDMA), methamphetamine, or gamma
hydroxybutyrate among others), but considerable rates of
alcohol, cannabis, cocaine, and hallucinogens use are also
detected (Barrett et al. 2005; Boys et al. 1997; Lenton et al.
1997; Yacoubian et al. 2003). The use of several of these
drugs have been associated with significantly elevated levels
of impulsivity, which are regarded as having dysfunctional
and detrimental effects on neuropsychological perfor-
mance measures (see Verdejo-García et al. 2004, 2008
for reviews). MDMA use has been associated with
significant declines on measures of processing speed,
verbal fluency, working memory, reflection impulsivity
Psychopharmacology (2010) 210:377–392
and decision making in recreational users (De Sola et al.
2008; Fisk and Montgomery 2009; Hanson et al. 2008;
Quednow et al. 2007). Nevertheless, some of these effects
have been attributed to the frequent co-abuse of cannabis
among MDMA recreational users (Clark et al. 2009; Croft
et al. 2001; see Gouzoulis-Mayfrank and Daumann 2006
for a review). Methamphetamine use has been related to
impaired performance on processing speed, response
inhibition, delay-discounting and decision-making tests
(Monterosso et al. 2005; Paulus et al. 2002; Salo et al.
2005; see Scott et al. 2007 for a review). Furthermore,
recent studies indicate that recreational use of drugs like
alcohol and cocaine can produce significant impairments
in particular components of executive functions, such as
response inhibition, switching (Colzato et al. 2007, 2009),
and decision making (Goudriaan et al. 2007; Johnson et al.
2008).
The fact that these drugs are frequently co-abused in a
single rave session raises additional questions about their
additive deleterious (or protective) effects on brain function
and neuropsychological performance (Bolla et al. 2000;
Gonzalez et al. 2004; Jatlow 1993). Similarly, the fact that
these drugs are frequently used in “binge” patterns also raise
concerns on increasingly detrimental neuropsychological
effects (Field et al. 2008; Stephens and Duka 2008). On
the other hand, many “rave attenders” seem to be somewhat
resistant to addiction, since they are able to parcel out
consumption periods from adaptive standard activities,
making up an interesting model of drug exposure without
drug dependence. Although this characteristic may be partly
shared with other polysubstance abusers who maintain a job
or courses of studies, the “rave attenders” constitute a
uniquely homogeneous subculture characterized by coupling
high levels of drug use with low rates of treatment demand,
being neatly fragmented (drug use is typically restricted to
the rave environment), and lacking some of the socio-
demographic (low education or IQ) and psychopathological
(e.g., anxiety or depression) confounders usually found in
more heterogeneous samples of polysubstance abusers
(Goulding et al. 2002; Kavanaugh and Anderson 2008).
Furthermore, the rave movement has similar common
characteristics in different countries across Europe, and
therefore our results could be more readily generalized
(than in the case of a more heterogeneous group of
polysubstance abusers) and their clinical implications
could be useful to prevention or clinical approaches in
different countries.
Both impulsivity and executive functions are key con-
structs to explain processes of vulnerability to drug use, drug
self-administration patterns, transition to drug dependence,
and different drugs use-related consequences (Belin et al.
2008; Dalley et al. 2007; Verdejo-García et al. 2008).
Furthermore, both of them are complex multidimensional
Psychopharmacology (2010) 210:377–392
constructs that need to be addressed by comprehensive
assessments (Verdejo-García and Pérez-García 2007;
Verdejo-García et al. 2008); no studies to date have
performed such a comprehensive assessment in groups of
rave attenders. The main aims of the study were: (1) To
assess multidimensional aspects of impulsivity. (2) To
characterize neuropsychological performance on executive
function measures in polysubstance-using rave attenders, as
compared to drug-free comparison individuals.
Methods
Participants
Twenty-five regular rave attenders and 27 healthy compar-
ison individuals participated in this study. Rave attenders
were recruited through a non-governmental organization
(Energy Control) specialized in providing harm reduction
guidelines among drug users. Specifically, we used mailing
lists and web-based adverts to recruit rave attenders among
members and users of this organization. Inclusion criteria
were: (1) having attended at least one rave in the last year
(descriptives for self-reported rave attendance in the last
year are reported in Table 1), (2) being polysubstance users
of at least two of the following drugs: cocaine, metham-
phetamine (speed), MDMA, hallucinogens, ketamine, or
opiates, which are typically used at rave settings, and (3)
being otherwise healthy, i.e., never sought or received
treatment for neurological, psychiatric, or systemic diseases
affecting the central nervous system. Healthy comparison
individuals were recruited through word of mouth among
friends and acquaintances of the research team who fulfilled
criterion (3) and did not meet criteria (1) and (2). Both
groups had similar (non-significantly different) distributions
for sex, age, education, depression symptoms, and anxiety
symptoms (the two latter measured with the Hamilton
scales) (Table 1). As intended, both groups sharply differed
on patterns of drug taking: healthy comparison individuals
had only used tobacco and alcohol (regularly) and
marijuana (incidentally, none of them had regular cannabis
use) throughout their lifetime.
Table 1 Descriptive scores
and between-group comparisons
for socio-demographic and
psychological measures of rave Number of raves attended (last year)
attenders (RvA) and healthy Gender (% male)
control individuals (HCI) Age (Mean, SD)
Years of education (mean, SD)
Anxiety (mean, SD)
Depression (mean, SD)
379
Measures
Information on patterns of drug use
Interview for Research on Addictive Behavior—revised
(IRAB; Verdejo-García et al. 2005) This interview provides
an estimation of several patterns of drug taking referring to the
multiple substances used by this sample of rave attenders.
These drug use parameters included: (1) average regular and
peak monthly use of each substance (regular quantity per
month and peak quantity per month), (2) total duration of use
of each substance (duration in years), and (3) age at onset of
use of each substance. We also collected information on
patterns of binge use of each of the substances by querying
about the maximum amount of units of a certain drug taken in
the time frame of 1 h. Descriptive scores for all these variables
in the present sample are displayed in Table 2. Inter-
correlations between the patterns of use of the different
drugs taken by the rave attenders group in the last month are
displayed in Table 3. Since we performed 45 different
correlations, we adjusted the alpha level following the
Bonferroni correction (0.05/45=0.001) to avoid inflated type
I error. Therefore, in Table 3, we only report as significant
those correlations yielding a p value below 0.001.
Questionnaire measures of impulsivity
UPPS-P impulsive behavior scale (Whiteside and Lynam
2001) This scale is a 59-item inventory designed to measure
five distinct personality pathways to impulsive behavior:
negative urgency, lack of perseverance, lack of premeditation,
sensation seeking, and positive urgency. The total scores of
each of these five dimensions were obtained for analyses.
Delay-discounting questionnaire, now or later (Kirby et al.
1999) This is a monetary-choice questionnaire asking for
individual preferences between smaller, immediate rewards
and larger, delayed rewards varying on their value and time
to be delivered. The questionnaire is composed of a fixed
set of 27 choices; the amounts of money and delays used in
all 27 trials are reported in Kirby et al. (1999). The
RvA (n=25) HCI (n=27) Chi-square or t test p
9.75 (5.89)
60% 44.4% 1.258 0.262
24.92 (3.07) 25.22 (4.04) −0.3 0.76
14.1 (2.85) 14.2 (2.55) −0.087 0.931
6.72 (7.42) 5.96 (5.88) 0.409 0.684
3.88 (4.53) 3.74 (4.26) 0.114 0.909
380 Psychopharmacology (2010) 210:377–392

Table 2 Descriptive scores of consumption patterns for the different drugs used in the polysubstance-using rave attenders group

Drugs Any time (%) Last Quantity LM Quantity RU Quantity MxU Binge use Abstinence
month (%) mean (SD) [Mdn] mean (SD) [Mdn] mean (SD) [Mdn] mean (SD) (week) mean
[Mdn] (SD) [Mdn]

Marihuana 96 80 10 (20.3) [3] 16.5 (23.1) [6] 36.7 (35.2) [26] 1 (1) [0.6] 56.8 (113.7) [9]
Hashis 96 84 24.4 (30.2) [12] 27.3 (29.3) [16] 39.2 (32.2) [31] 1.4 (1.4) [1] 3.8 (4.7) [2]
Cocaine 80 48 11 (13.7) [4.5] 8.1 (14.7) [0.55] 23.9 (38.7) [6] 0.5 (0.3) [0.4] 48.7 (80.2) [12]
Amphetamine 28 12 – 2.7 (2.3) [1.5] 40.6 (88.8) [1.5] 1 (0.5) [1] –
Speed (meth-) 92 52 5.4 (6) [2] 4.5 (4.4) [3] 9.6 (13.4) [6] 0.6 (0.5) [0.5] 18.8 (21.3) [4]
Hallucinogens 76 44 1.2 (1) [1] 0.9 (0.6) [1] 3 (4.6) [1] 0.7 (0.5) [0.5] 26 (31.7) [10]
MDMA 88 28 2.7 (3.5) [2] 2.1 (2.1) [1] 4.8 (4.2) [4.2] 0.4 (0.4) [0.2] 30.8 (22.1) [24]
Benzodiazepine 8 8 – – – – –
Ketamine 12 8 – – – – –
Tobacco 96 92 333.5 (226.9) [270] 368.7 (223.2) [300] 515.8 (327.1) [580] 4.7 (4) [5] –
Wine & Beer 96 96 40.7 (26.7) [30] 53 (46.6) [45] 68 (48.8) [60] 2.8 (1.9) [2] –
Liquors, Cocktails, 92 80 34.9 (26.4) [30] 41.6 (35.2) [42] 68.3 (47.8) [60] 2.9 (1.5) [3] –
Mixers

For those drugs with less than 20% of responses (n<5) we did not display mean, SD, or median values
Mdn Median, quantity LM quantity of use in the last month, quantity RU quantity of use during regular use, quantity MxU quantity of use during
maximum use

dependent measure was based on the area under the curve
(AUC) methodology (Myerson et al. 2001), as employed in
recent studies investigating delay discounting in substance
abusers (Field et al. 2006; Field et al. 2007). The AUC was
calculated for each of the three reward magnitudes included
in the questionnaire (small, medium, and large), according
to the formula (x2−x1)[(y1−y2)/2], where x1 and x2 are
successive delays, and y1 and y2 are the subjective values
associated with these delays. This formula defines different
trapezoids, and the area under the empirical discounting
function is equal to the sum of the areas of these trapezoids.
Neuropsychological assessment
Processing speed—digit symbol (coding, incidental learning,
and copy) (Wechsler 1997) Digit symbol coding requires
participants to replace numbers with specified symbols as
fast and accurately as possible. This is followed by the
incidental memory probe which tests participants learning
of the association between numbers and codes. In the
copy subtest symbols (rather than numbers) are printed in
the upper half of each box; participants are instructed
simply to copy each symbol into the lower half. The
main dependent measures were the raw scores from the
three subtests.
Working memory—letter number sequencing (LNS) (Wechsler
1997) Participants are asked to listen a sequence in which
letters and numbers are combined, and are asked to
reproduce the sequence, first placing the numbers in
ascending order and then the letters in alphabetical order.
The dependent variable from this test was the total number
of hits.

Table 3 Intercorrelations
between the use of the different Marih Hashis Cocaine Amph Speed Halluc. MDMA Keta. Tob.
substances during lifetime
Marih. 1
Hashis 1a 1
Correlation analyses were Cocaine 0.102 0.102 1
conducted using the phi Amph. 0.327 0.327 0.134 1
coefficient for dichotomic
Speed 0.060 0.060 0.147 0.183 1
variables
Halluc. 0.115 0.115 0.047 0.067 0.166 1
Marih. marihuana, Amph.
amphetamine, Halluc. MDMA 0.075 0.075 0.123 0.318 0.109 0.081 1
hallucinogens Ketamine 0.075 0.075 0.123 0.044 0.345 0.081 0.621a 1
a
Significant correlations after Tobacco 0.042 0.042 0.102 0.127 0.692a 0.115 0.075 0.075 1
Bonferroni corrections: 0.05/45, Alcohol 1a 1a 0.102 0.327 0.060 0.115 0.075 0.075 0.042
p<0.001
Psychopharmacology (2010) 210:377–392
Analogical reasoning—similarities (Wechsler 1997) Pairs
of words are read that represent common objects or
concepts, and participants have to indicate how these
objects/concepts are similar or what they have in common.
The dependent variable from this test was the number of
correct answers.
Attentional interference/response inhibition and switching—
Stroop test (Delis–Kaplan Executive Functions System; Delis
et al. 2001) This test consists of four different conditions,
each containing 50 items. The first condition presents
patches of colors and participants have to name them as
quickly and accurately as they can. The second condition
presents the words “red”, “blue”, and “green” printed in
black ink and participants are asked to read aloud the words
written. The third condition introduces the condition of
interference: the words “red”, “blue”, and “green” are
printed in incongruent colors ink and participants have to
name the color and ignore the word. In the fourth condition,
the items are similar to condition three but participants have
to switch their response between naming the color of the
ink and ignoring the word or reading the word (when the
item is inside a little box). The main dependent variables
used in this test were the composite time measures:
inhibition vs. color naming (time part 3–time part 1) and
switching vs. inhibition (time part 4–time part 3), and the
number of unadverted and self-corrected errors committed
in conditions 3 (inhibition errors) and 4 (switching errors).
Motor response inhibition—no/no go A computer-based
implementation of the go/no-go task was used (Verdejo-
García et al. 2007b). The task consisted of 60 trials. In the
first 30 trials (pre-switch), participants were asked to press
a key as quickly as they could whenever the go stimulus (a
letter) was presented, and to withhold the response when
the no-go stimulus (a different letter) was presented. The
assignation of stimuli to the go and no-go conditions were
counterbalanced across subjects. In the second 30 trials of
the task (post-switch), participants were asked to switch the
assignation of the response from the go to the no-go
stimulus (which obviously became the post-switch go trial);
in other words, they were asked to respond to the
previously no-go stimulus and not to respond to the
previously go stimulus. The proportion of go vs. no-go
trials on both phases (pre- and post-switch) was 70/30. The
inter-stimulus interval (ISI) was set at 100 ms, and each
stimulus was presented during 1,000 ms. Auditory feedback
(one of two distinctive sounds) was provided after each
response to indicate whether that response had been right or
wrong. If participants did not respond in the 1,000 ms
response window, the two same sounds were used as
positive and negative feedback for not responding. That is,
if no response was given, the same sounds indicated
381
whether the absence of response had been right (no-go
trials) or wrong (go trials). The main dependent variables
from this test were hit and false alarm rates. These variables
were analysed across six blocks of 10 trials to explore
effects of learning and switching during the task.
Reversal learning—probabilistic reversal The task was
based on the Probabilistic Reversal Learning (PROB)
described in Swainson et al. (2000). Briefly, each trial of
the task involves the simultaneous presentation of two
stimuli (two squares, drawn in thick colored lines) that
differ only in line color. In each phase of the task, one
stimulus is considered the “correct” one, as choosing it
provides reward in most cases, and the other is the “wrong”
one, as choosing it was penalized most of the times. The
stimuli shifted positions randomly to avoid the motor
perseveration.
In phases 1 and 2 of the task (trials 1–80), the correct
selection was probabilistically rewarded in 7 out of 10
cases, and penalized 3 out of 10; and the incorrect selection
was penalized in 7 out of 10 trials, and rewarded in the
remaining 3 out of 10. This means that on 30% of the trials,
the computer provided false feedback, i.e., selecting the
correct stimulus was followed by false negative feedback
and selecting the incorrect one was followed by false
positive feedback (still, for the sake of simplicity, we keep
on labelling the two colors as “correct” and “incorrect”, as,
a priori, the former is the one most likely to be rewarded,
and the latter the least likely to be rewarded). Negative and
positive feedback were presented acoustically (by two
different tones), and involved winning or losing five points.
The total amount of points accrued so far was continuously
present on one corner of the screen.
Phases 3 and 4 (trials 81–160) were identical to phases 1
and 2, respectively, but the probability of rewarding for the
correct response was lowered to 60% and the proportion of
rewarding for the incorrect one was raised to 40%.
Most importantly, the color corresponding to the right
choice and the one corresponding to the wrong choice
shifted after every 40 trials (after every phase), that is, the
stimulus that was previously correct became incorrect, and
vice versa (see Table 4).
The main dependent measure for this task was the
proportion of correct choices for each 5-trial block in each
task phase (1–4). Extra analyses were carried out on the
probability of holding the prior trial choice after being
rewarded, and after being penalized. This second dependent
measure is aimed at detecting differential choice dependen-
cies on reinforcement and punishment for the two groups.
Self-regulation—Revised Strategy Application Test (R-SAT)
(Levine et al. 2000) This is a multitasking test that consists
of three types of activities: figure tracing, sentence copying,
382 Psychopharmacology (2010) 210:377–392

Table 4 Top panel depiction of events' sequence in each single trial during the probabilistic reversal task; bottom panel reward/penalization
contingencies for each of the two options in each phase of the task
a) Event sequence during the probabilistic reversal learning task.

1. Warning cue 2. Choice options 3. Choice 4. Feedback

b) Reward/penalization contingencies during the probabilistic reversal learning task.

1st Phase: Acquisition (trials 1-40).
-Black square: “Correct”, 70% of choices of this stimulus rewarded,
30% penalized.
-Grey square: “Incorrect”, 30% of choices of this stimulus
rewarded, 70% penalized.

2nd Phase: Reversal 1 (trials 41-80).

-Black square: “Incorrect”, 30% of choices of this stimulus
rewarded, 70% penalized.
-Grey square: “Correct”, 70% of choices of this stimulus rewarded,
30% penalized.

(No reversal warning provided)

3rd Phase: Reversal 2 (trials 81-120).

-Black square: “Correct”, 60% of choices of this stimulus rewarded,
40% penalized.
-Grey square: “Incorrect”, 40% of choices of this stimulus
rewarded, 60% penalized.

(No reversal warning provided)

4th Phase: Reversal 3 (trials 121-160).
-Black square: “Incorrect”, 40% of choices of this stimulus
rewarded, 60% penalized.
-Grey square: “Correct”, 60% of choices of this stimulus rewarded,
40% penalized.

(No reversal warning provided)

In the actual task the stimuli were of two different colors randomly chosen from the green, yellow, red, and blue set; and the positions (right/left)
of the colors were randomly set. Messages on screen have been translated from Spanish. The “hand” icon for the illustration in each phase (bottom
panel) signals the correct (most probably reinforced) option

and object numbering. The activities are presented on two
different stacks (A and B), each containing 120 items. The
main goal of the task is to win as many points as possible,
considering that large items score 0 points, and small items
score 100 points each. However, both small and large items
can be of different difficulty: some of them are easy and
quick to complete (i.e., they take a couple of seconds and
are defined as “brief items”) whereas others are very
laborious and time-consuming (i.e., they can take longer
than 1 min and are defined as “lengthy items”). Given the
limitation of time (10 min), the most efficient strategy
(to-be-discovered) is to complete only the brief items to the
exclusion of lengthy items, which the subjects must learn to
skip as they are introduced in later pages of the test; this
way subjects can optimize long-term profit by completing
more items during the time limit. We also asked participants
to tick a box every time they thought 1 min had passed (we
previously asked them to remove their watches if they had
any). The main dependent variable from the R-SAT is the
proportion of brief items completed in relation to the total
number of items attempted. Additional dependent measures
are: the number of action slips (number of obvious motor
Psychopharmacology (2010) 210:377–392
inhibition mistakes; e.g., completing large items) and the
proportion of time marks with respect to the total number of
minutes employed (i.e., this is a measure of appropriate
time estimation during task performance).
Affective decision making—Iowa gambling task (IGT)
(Bechara et al. 2001) This is a computer task that factors
several aspects of decision making, including uncertainty,
risk, and evaluation of reward and punishing events. The
IGT involves four decks or cards, decks A′, B′, C′, and D′.
Each time a participant selects a card, a specified amount of
play money is awarded. However, interspersed among these
rewards, there are probabilistic punishments (monetary
losses with different amounts). Two of the decks of cards
(A′ and B′) produce high immediate gains; however, in the
long run, these two decks will take more money than they
give, and are therefore considered to be the disadvanta-
geous decks. The other two decks (C′ and D′) are
considered advantageous, as they result in small, immediate
gains, but will yield more money than they take in the long
run. The main dependent variable from this task was the net
score for each block of the task (5 blocks of 20 trials). We
calculated net scores by subtracting the number of
disadvantageous choices (decks A and B) from the number
of advantageous choices (decks C and D) for each block.
We also calculated the global IGT net score applying the
same formula to the 100 trials of the task.
Test of emotion recognition: Ekman Faces Test (EFT) (Young
et al. 2002) The Ekman Faces Test (EFT) is a computer task
that assesses recognition of facial emotional expressions.
The task uses stimuli from the Facial Expressions of
Emotion: Stimuli and Tests (FEEST; Young et al. 2002).
A series of 60 stimuli featuring faces portraying basic
emotions were presented. Faces depicted expressions of
anger, disgust, fear, happiness, sadness, and surprise
(6 emotions, 10 faces each). Photographs were posed by each
of 10 models (six female, four male). Each face was presented
on a computer monitor for a maximum of 5 s and individuals
were asked to select one of the six expression labels (listed
above) that best described the emotion expressed. The labels
were visible throughout testing, thus minimizing working
memory demands, and individuals were given as much time
as they required to respond. No feedback was given regarding
the appropriateness of their responses. We obtained the sum
score of total correct identifications (total recognition, ranging
0–60) as the dependent variable.
Procedure
All participants were asked to abstain from any drug taking
(with the exception of tobacco) for at least 48 h before the
383
scheduled testing session. All testings were conducted on
human research testing rooms at the Biomedical Research
Building of the Institute of Neuroscience (University of
Granada). Prior to study onset, all participants signed an
informed consent form. Abstinence status was self-reported
by participants before testing session onset; no other
objective abstinence checks were conducted because
participants were not treatment-enrolled or treatment
seekers and there was no objective reason to provide
inaccurate information to researchers. Questionnaires and
neuropsychological tests were administered by Ph.D.
students with a master's degree in clinical psychology.
The IRAB was administered first and then questionnaire
measures were counterbalanced across subjects. Neuropsy-
chological tests administration was arranged to alternate
between verbal and non-verbal tasks and between more and
less demanding tasks; these tests were administered in a
fixed order to all participants. The total duration of the
session was approximately 2 h. Participants were paid 15
euros for their collaboration. We made clear before the
initial interviews that in case of reporting having taken any
drug, the testing session would be simply rescheduled but
they would not miss the opportunity to participate in the
study.
Data analysis
Statistical analyses were implemented on SPSS v.17. We first
explored dependent variables to examine missing data points
and normality of distributions (tested by Kolgomorov–
Smirnov tests) and presence of outliers (defined by the
Explore command of SPSS v.17). Data from some neuropsy-
chological measures were missing due to technical problems
during data collection (the sample size of the rave attenders
group is n=23 for the Stroop and digit symbol measures, and
n=24 for similarities). On those variables that followed a
normal distribution (UPPS-P subscales, delay discounting
AUC, LNS, similarities, symbol digit, Stroop composite time
scores, go/no go, probabilistic reversal, Ekman faces test,
and Iowa gambling task) we conducted independent samples
t tests to examine differences between rave attenders and
healthy comparison individuals. On those variables that
failed to meet normality assumptions (Stroop number of
errors and self-corrections and R-SAT) we used non-
parametric Mann–Whitney U tests to examine differences
between rave attenders and healthy comparison individuals.
We also conducted mixed-design repeated measures
ANOVAs to track task performance dynamics on the go/
no-go, the probabilistic reversal, and the IGT. In addition, to
further explore the association between patterns of drug use
and trait impulsivity and neuropsychological performance,
we performed four series of bivariate correlation analyses
between (1) peak quantity of use of each drug, (2) duration
384
of use of each drug, and (3) binge use of each drug and the
dependent variables. We restricted these correlation analyses
to those drugs that had been used by at least by 70% of rave
participants (cannabis, cocaine, methamphetamine, MDMA,
hallucinogens, and alcohol) and to the dependent variables
that differed significantly between groups. Furthermore, due
to the considerable number of correlation analyses, we
applied Bonferroni correction and set the alpha level for
statistical significance at p≤0.001 (0.05/48 contrasts) to
protect against inflated type 1 error.
Results
Questionnaire measures
Rave attenders scored significantly higher than healthy
comparison individuals on the UPPS-P subscales of
negative urgency, t=2.61, df=1, 50, p<0.05, positive
urgency, t=2.04, df=1, 50, p<0.05, and (lack of) persever-
ance, t=2.94, df=1, 50, p<0.05 (see Fig. 1). Following
Cohen´s interpretation of effect sizes (Zakzanis 2001), the
effect size of group differences was large for (lack of)
perseverance, and medium for positive urgency and
negative urgency. We did not find significant differences
for (lack of) premeditation, t=2.94, df=1, 50, p>0.1, and
sensation seeking, t=0.60, df=1, 04, p>0.1. We also failed
to find significant differences for the different reward
magnitudes of the delay-discounting AUC: small, t=0.57,
df=1, 50, p>0.1, medium, t=0.52, df=1, 50, p>0.1, and
large, t=−0.04, df=1, 50, p>0.1.
Neuropsychological measures
Rave attenders performed significantly more poorly than
healthy comparison individuals on LNS, t=−2.21, df=1, 50,
p<0.05, similarities, t=−5.02, df=1, 49, p<0.001, digit
50.00
45.00 Rave attenders
Healthy Comparison Indiv.
40.00
UPPS Scores
35.00 * *
30.00
*
25.00
20.00
15.00
10.00
5.00
0.00
Neg. Ur. Pos. Ur. (lo) Prem (lo) Pers
UPPS Dimensions
Fig. 1 Descriptive scores and significant differences between groups
on the UPPS-P dimensions. Effect sizes for variables showing
significant differences were d=0.72 for negative urgency, d=0.56 for
positive urgency, and d=0.81 for lack of perseverance
Psychopharmacology (2010) 210:377–392
symbol (coding and incidental learning), t=−2.28, df=1,
48, p<0.05 and t=−2.21, df=1, 48, p<0.05, respectively,
R-SAT number of time marks, U=213, df=1, 50, p<0.05,
and IGT net score, t=−1.99, df=1, 50, p=0.05 (see Table 5).
Rave attenders also committed significantly more errors on
the third condition of the Stroop (inhibition), U=219.5, df=1,
48, p<0.05, and significantly more self-corrections on the
fourth condition of this test (switching), U=214.5, df=1, 48,
p<0.05 (see Table 5). Following Cohen´s interpretation of
effect sizes (Zakzanis 2001), the effect size of group
differences was large for similarities, medium-large for
incidental learning, medium for coding, LNS, Stroop
inhibition and switching errors, and IGT, and small for
R-SAT number of time marks. We found no significant
differences between groups on the remaining dependent
variables.
IGT learning curve
For the IGT, the learning curve was explored using a 2
(group) × 5 (block) mixed-design ANOVA. Results showed
no significant effects of group or the group × block
interaction. Visual inspection of the plot indicated that the
lack of effects was probably due to the fact that healthy
comparison individuals did not develop steady learning
across blocks (see Supplementary material).
In-depth analysis of go/no-go and probabilistic reversal
Rave attenders and controls also differed in their dynamic
response patterns in the go/no-go and reversal learning
tasks.
Hit rate in the go/no-go task was computed as the ratio
between hits and the sum of hits and misses. Figure 2 (top
panel) shows mean hit rates for each block and each group.
Only the effect of block was significant, F(5, 230)=6.717,
MSE=0.017, p<0.001. As can be seen in the figure, hit
rates gradually grew across blocks and locally decreased
when the letter assignation to the go and no-go stimuli was
shifted (after block 3). Rates returned to asymptotical
values right after the post-shift block. This pattern was
qualitatively and quantitatively similar for the two groups,
although the main effect of group was not far from
significance [F<1 for the block×group interaction, and
F(1, 46)=2.659, MSE=−0.035, p=0.109 for the main
group effect].
False alarm rates in the go/no-go task (computed as the
Sseek ratio between the number of false alarms and the sum of
false alarms and correct rejections) yielded significant
differences between groups (see Fig. 2, bottom panel).
Neither the main effect of block [F(5, 230)=1.443, MSE=
0.069, p=0.209] nor the main effect of group (F<1) reached
significance. However, the interaction [F(5, 230)=2.250,
Psychopharmacology (2010) 210:377–392 385

Table 5 Descriptive scores and

between group comparisons for Test Dependent variables RvA HCI t/U p ES
neuropsychological performance
of rave attenders (RvA) and Digit symbol Coding 70.47 (19.46) 80.56 (11.17) −2.28 0.03 0.65
healthy control individuals Inc. learn. 7.35 (1.40) 8.26 (0.76) −2.91 0.005 0.75
(HCI) Copy 115.91 (28.91) 120.81 (15.01) −0.73 0.45
LNS Hits 10.36 (2.94) 12.11 (2.76) −2.21 0.03 0.59
Similarities Hits 13.12 (4.00) 19.67 (5.14) −5.02 0.000 1.41
Stroop Inhibition vs. Col. N 20.61 (11.01) 19.70 (16.10) 0.23 0.82
Switching vs. inhibition 7.61 (13.47) 1.03 (16.13) 1.55 0.13
Errors inhibition 1.09 (1.50) 0.44 (0.84) 219.5 0.04 0.56
Errors switching 0.87 (1.14) 0.56 (0.97) 257.5 0.24
Self-corrections inhibition 1.18 (1.26) 1.07 (1.24) 279.5 0.71
Inc. learn incidental learning, Self-corrections Switching 1.17 (1.43) 0.44 (0.69) 214.5 0.04 0.67
LNS letter number sequencing, R-SAT Proportion brief items 0.84 (0.10) 0.87 (0.11) 274.5 0.25
Stroop Col. N. Stroop colour Action slips 1.76 (2.39) 1.59 (3.04) 292.5 0.38
naming, R-SAT revised-strategy
application test, IGT Iowa gam- Time marks/real time 0.70 (0.18) 1.01 (1.01) 213 0.02 0.42
bling task, EFT Ekman faces IGT Net score −4.36 (16.19) 5.11 (17.90) −1.99 0.05 0.55
test, ES effect size calculated as EFT Total recognition hits 48.16 (7.06) 50.04 (4.47) −1.15 0.25
Cohen's d

MSE=0.069, p=0.050] between the two factors unveiled
differential block effects across groups. Specifically, controls
showed a fairly constant false alarm rate across the whole
task (between 0.20 and 0.30, approximately), whereas rave
attenders showed a normal false alarm rate in the pre-shift
blocks (1–3), and an anomalously high rate after shift
(blocks 4–6). In other words, shift seemed to provoke an
abrupt rise in false alarms (the probability of responding to
the no-go trials) that remained approximately constant during
the rest of the task. This impression was confirmed by the
detailed analysis of the interaction. Restricted ANOVAs
showed that the effect of block was not significant for
controls, F<1, but was significant for rave attenders, F(5,
110)=2.58, MSE=0.078, p=0.03. More specifically, LSD
tests showed this effect to be exclusively due to the
difference between blocks 3 and 4 (p=0.03). On the other
hand, the difference between rave attenders and controls was
not significant in any of the blocks (min p=0.13).
Performance in the reversal learning task was firstly
analyzed in a standard fashion, computing the proportion of
correct choices for each five trial block in each 40 trial
phase, for the two groups. As expected (see Fig. 3), the
proportion of correct choices gradually grew across blocks
in each phase, F(7, 350)=37.145, MSE=0.064, p<0.001.
Globally, the proportion of correct choices was also higher
in phases 1 and 2, than in phases 3 and 4, F(3, 150)=6.887,
MSE=0.142, p<0.001 (note that in phases 1 and 2 the
proportion of reinforced “correct” choices was 0.70,
whereas it was 0.60 in phases 2 and 3; so this effect reflect
sensitivity of choices to reinforcement levels). Most
interestingly, however, block marginally interacted with
group, F(7, 150)=1.867, MSE =0.064, p=0.074. This
marginally significant interaction clearly reached signifi-
cance when the analysis was restricted to phases 1 and 2
[Fs for the block×group interaction were F(7, 350)=2.039
and F(7, 350)=2.039, p=0.049 and p=0.013, for phases 1
and 2, respectively], but not in phases 3 and 4 [F<1 in both
cases]. As can be seen in the figure, in both phases, the
proportion of correct choices reached higher levels in the
group of rave attenders than in the group of controls.
This pattern can be explained by three possible sub-
patterns: (1) rave attenders are less prone to change their
choice when they were penalized for choosing that option
in the previous trial (low relative sensitivity to punishment);
(2) they are more prone to hold their choice when they are
rewarded (high relative sensitivity to reward); or (3) they
are both oversensitive to reward and undersensitive to
penalization. In accordance with this, we calculated the
probability of holding the choice after being penalized and
after being rewarded in each 20-trial block and each phase
for each group. Figures 4 and 5 display these probabilities
across block and phase conditions. Groups did not differ in
their sensitivity to punishment (Fig. 4), as their tendency to
hold the same choice after being penalized did not differ
across blocks (F<1) for all interactions involving the group
factor. Only the effect of block was significant, as the
probability of holding the choice was consistently higher
for the second half of each phase than for the first half,
F(1, 50)=30.780, MSE=0.038, p<0.001.
Results regarding sensitivity to reward seem to be clearer
(Fig. 5). The probability of holding the choice after being
rewarded varied across phases, F(3, 150)=5.23, MSE=
0.030, p=0.002. More interestingly, although the effect of
group was not globally significant, F(1, 50)=2.870, MSE=
209, p=0.096, it was significant when restricted to phase 2,
F(1, 50)=4.485, MSE=0.083, p=0.039. We are aware that it
386 Psychopharmacology (2010) 210:377–392

Hit rate (h) rates across blocks

performance on similarities, r=−0.53, p=0.000. In addition,
peak amount of use of cocaine, r=0.66, p=0.001 was
1.0 significantly correlated with Positive Urgency.

Total duration of use Duration of hallucinogens use was

significantly correlated with LNS performance, r=−0.75, p=
h (hit rate)

0.8 0.000. Duration of alcohol use was significantly correlated

with similarities performance, r=−0.48, p=0.001.

Binge use (number of units used in a row during a 1-h period)

0.6 Binge use of methamphetamine (speed) was significantly
correlated with R-SAT number of time marks, r=0.61, p=
1 2 3 4 5 6
0.001. In addition, binge use of alcohol was significantly
Block correlated with Positive Urgency, r=0.46, p=0.001.
False alarm rates (f) across blocks
0.6

Discussion
f (false alarm rate)

0.4
0.2
0.0
1 2 3 4
Block
Fig. 2 Mean hit rate across blocks in the go/no-go task for the control
and rave attending participants (top panel). Mean false alarm rates rate
across blocks in the go/no-go task for the control and rave attending
participants (bottom panel)
could be argued that this analysis of simple effects is
unjustified, given the non-significance of either the main
effect of group or the interaction. However, it still seems to
show that, with regard to the effects seen analysis of
proportions of correct responses, differences in sensitivity
to reinforcement seem to carry more weight than differences
in sensitivity to punishment. In other words, if we accept this
argument, rave attenders were more prone to hold to
response after being rewarded, but showed choice strategies
similar to those of controls when penalized. We will
reconsider this pattern and its possible implications in the
discussion section.
Correlation analyses
Peak quantity of use Peak amount of cocaine use was
significantly correlated with poorer performance on digit
symbol coding, r=−0.67, p=0.001 and peak amount of
alcohol use was significantly correlated with poorer
The results from the study showed that polysubstance-using
rave attenders had significantly elevated scores on impul-
sivity indices of lack of perseverance and positive and
negative urgency, and a significantly poorer performance
on indices of processing speed, working memory, analog-
ical reasoning, inhibition/switching errors, time estimation,
and decision making. The effect size of group differences
were large for the personality trait of lack of perseverance
5 6
and cognitive indices of incidental learning (in the context
of fast/accurate processing speed demands) and analogical
reasoning and medium for all other indices (with the
exception of a small effect size for an index of time
estimation). On the other hand, rave attenders did not differ
from drug-free controls on indices of inhibition/switching
time cost, self-regulation or emotional perception, and
decoding. Correlations between the patterns of use of the
different drugs co-abused and the dependent variables
showed that, for personality variables, cocaine peak
quantity of use, and alcohol binge use were significantly
associated with Positive Urgency. For neuropsychological
indices, peak quantity of cocaine use was significantly
correlated with slower processing speed, quantity and
duration of alcohol use were significantly correlated with
poorer analogical reasoning, and quantity of use of
hallucinogens was significantly correlated with poorer
working memory skills.
These results are broadly consistent with previous
findings obtained in groups of recreational alcohol and
drug users, and there is also some degree of overlap with
findings on treatment-enrolled alcohol and drug abusers.
For personality variables, lack of perseverance was the
more prominent impulsivity pathway among rave attenders.
Lack of perseverance (i.e., an inability to remain focused on
a task that may be boring or difficult) was theoretically
Psychopharmacology (2010) 210:377–392
Proportion of correct choices across Phases (1-4) and Blocks (1-8)
1.00
0.75
Proportion of correct choices
0.50
0.25
0.00
1 2 3 4 5 6 7 8
Phase 1
Fig. 3 Proportion of correct choices for each block (1–8) and each phase (1–4) in the reversal learning task. Reward contingency reversals
occurred after each 40-trial phase. Blocks are composed of five trials
proposed to be linked with attention deficit/hyperactivity
disorder symptoms (Whiteside and Lynam 2001) and it is
also significantly elevated in polysubstance-dependent indi-
viduals with principal use of alcohol and psychostimulants
(Verdejo-García et al. 2007a). Furthermore, rave attenders
had significantly elevated scores on both negative and
positive urgency, the latter being significantly correlated
with peak estimates of cocaine use and with the maximum
number of drinks taken in the interval of 1 h (alcohol binge
use). These results are consistent with the prominent role of
emotion-driven impulsivity (i.e., urgency traits) in alcohol
and drug use (Whiteside and Lynam 2003; Verdejo-García et
al. 2007a) and with recent data indicating that positive
urgency significantly predicts the quantity of alcohol that
students consume at any given drinking episode and the
negative outcomes experienced from drinking (Cyders et al.
2009). On the other hand, both groups did not differ on
levels of lack of premeditation, an impulsivity dimension
that was elevated in a sample of substance dependents
(Verdejo-García et al. 2007a) and that correlated with
disadvantageous decision-making skills in healthy volunteers
(Zermatten et al. 2005). Groups did not differ on sensation
seeking either. Previous evidence indicates that higher
387
Control
1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 Rave
Phase 2 Phase 3 Phase 4
sensation seeking may be relevant to predict the frequency
of early drug exposure (Cyders et al. 2009), but not so
sensitive to discriminate between regular or pathological
drug users and drug-free controls.
For cognitive measures, effect sizes results showed that
analogical reasoning (i.e., the ability to infer the association
between two words or concepts) was the most robustly
impaired process in rave attenders. Although analogical
reasoning is highly correlated with educational level, we
should note that our groups were well matched on years of
education; therefore, it is unlikely that performance differ-
ences can be explained in terms of premorbid educational
background. On the other hand, poor performance on
analogical reasoning was significantly associated with
heavier use of alcohol. The association between alcohol
abuse and abstraction skills had been previously observed
in social drinkers (Tracy and Bates 1994) and clinical
samples of alcoholics (Beatty et al. 2000; Ratti et al. 2002).
Furthermore, analogical reasoning skills are also robustly
impaired in clinical samples of polysubstance abusers
(Fernández-Serrano et al. 2010a). Rave attenders also
performed moderately worse than controls on a well-
validated measure of working memory (Letter Number
388 Psychopharmacology (2010) 210:377–392

Fig. 4 Probability of holding Probability of holding choice after punishment

the same choice after being 1.00
penalized in the previous trial
across blocks (25 trials) and
phases (40 trials), for the control
and rave attending participants

0.75

Holding choice probability

0.50

0.25

0.00 Control
1 2 1 2 1 2 1 2
Rave
Phase 1 Phase 2 Phase 3 Phase 4

Sequencing). Several previous studies have shown an deficits on working memory are dose-dependent (Fernández-
association between recreational use of MDMA (De Sola Serrano et al. 2010b; Verdejo-García et al. 2005); whereas
et al. 2008) and alcohol binge drinking (Crego et al. 2009) cocaine recreational use effects seem to spare working
and poorer working memory performance. Cannabis-related memory skills (Colzato et al. 2009). In our correlation

Fig. 5 Probability of holding Probability of holding choice after reward

the same choice after being 1.00
rewarded in the previous trial
across blocks (25 trials) and
phases (40 trials), for the control
and rave attending participants

0.75
Holding choice probability

0.50

0.25

0.00 Control
1 2 1 2 1 2 1 2
Rave
Phase 1 Phase 2 Phase 3 Phase 4
Psychopharmacology (2010) 210:377–392
analyses, working memory performance was significantly
correlated with quantity of hallucinogens use (e.g., psyloci-
bin, LSD, or ayahuasca, but not ketamine or MDMA which
were coded separately in the drug-taking interview). Acute
administration of these hallucinogenic drugs has been
associated with increased activation of both frontomedial
and frontolateral sections of the prefrontal cortex (Riba et al.
2006; Vollenweider et al. 1997) and with declines of
attentional tracking skills (Carter et al. 2005) in humans—
both congruent with detrimental effects on working memory.
In spite of the associations with specific substances, both
deficits on working memory and reasoning should be
interpreted in the context of polysubstance use. Therefore,
they might be associated with detrimental effects of
polysubstance use on executive control, or with certain pre-
morbid personality traits or neuropsychological dysfunctions
that convey vulnerability for drug use (Verdejo-García et al.
2008). Additional methodological efforts are warranted to
address this important question. Irrespective of their etiology,
the cognitive decline of these executive skills, which are
involved in the ongoing updating and manipulation of
relevant information for on-line tasks, can importantly
compromise everyday cognitive activities even in the
absence of an obvious functional impairment.
Other medium-size additional deficits were observed in
performance measures of psychomotor response speed and
inhibition and monitoring errors (during Stroop and go/no-go
performance). Peak cocaine use was significantly correlated
with slowed psychomotor speed, consistent with previous
evidence of dose-related detrimental effects of this drug on
processing speed (Bolla et al. 2000). MDMA and cannabis
use have also been associated with slower speed of
processing (Medina et al. 2007; Wareing et al. 2007). These
deficits may have important implications for several other
performance domains, since neuropsychological studies
indicate that processing speed is a key variable to energize
and optimize the resources of frontal systems and executive
functions (Stuss et al. 2005). A related issue in this sample of
rave attenders is that of mild alterations in time perception,
specifically characterized by underestimation of the passage
of time across a 10 min lapse. The opposite pattern
(overestimation of time intervals) had been previously
observed in psychostimulant users measured with specific
time estimation tasks and interpreted in terms of increased
impulsivity (Wittmann et al. 2007). However, our time
estimation index was obtained in the context of a multitask-
ing self-regulation test, in which participants had to tick a
box anytime they thought 1 min had passed; therefore,
underestimation may be viewed as an index of difficulties to
set the pace of their performance in absence of external cues.
Additionally, rave attenders showed an increased number of
errors during the inhibition phase of the Stroop and increased
number of self-corrections during the switching phase of the
389
Stroop. These elevated error scores did not produce parallel
declines on the main composite time performance indices;
they are therefore mild indicators of inhibitory/switching
deficits, which can be overall compensated in terms of final
behavioral output. The performance pattern in the go/no-go
task is also accountable in terms of poorer inhibition and
switching skills. Once the response to the go trial has been
firmly learnt, to stop responding to that stimulus seems more
difficult for rave attenders than for controls. In this task,
these inhibition difficulties seem to be quite long lasting, as
rave attenders take several blocks to recover their pre-shift
alarm rate level.
The results observed in the probabilistic reversal learning
task are somewhat counterintuitive. In previous studies, drug-
abusing and drug-dependent individuals have been observed
to present reversal difficulties—perseverance at choosing the
same option after the reinforcement contingencies have
changed (Ersche et al. 2008). Rave attenders do not show
reversal problems, as they are as fast as controls to detect
contingency changes. However, they do show significant
differences with controls: a higher proportion of correct
choices seemingly based on a stronger tendency to maintain
their choice after reward. Therefore, unlike controls, rave
attenders failed to show probability matching. Some authors
(Unturbe and Corominas 2007; although see Shanks et al.
2002; Perales et al. 2005) have accounted probability
matching in terms of intentional hypothesis testing and
sequence discovery. In contrast to non-human animals,
humans do not always consider forced-choice tasks as
essentially probabilistic, but try to unveil the existence of
sequences that could explain why a given choice is rewarded
or not in each particular occasion. These conscious attempts
are strongly dependent on planning and executive functions,
but make performance become sub-optimal. If this is the case
here, reward dependence—as observed in rave attenders—
can result from diminished planning or executive capacities.
The fact that, in our study, rave attenders also showed low
performance levels in other executive function indexes (LNS,
similarities, Stroop) thus supports the idea that probability
matching and planning/executive capacities may depend on
common brain circuits (Wolford et al. 2000).
It is worth commenting on the fact that rave attenders
showed unimpaired performance patterns in a number of
neuropsychological indices previously shown to discriminate
between substance-abusing/dependent individuals and
healthy comparison individuals, including reversal learning
(i.e., perseveration errors), self-regulation, and emotional
perception. The discrepancy between neuropsychological
findings on chronic users vs. rave recreational users (who
maintain functional activities and abstain from drug use
during most of the time) may have implications for a better
understanding of the neuropsychological mechanisms that
differentiate “functional” vs. “dysfunctional” drug users.
390
Assuming this is the case, we may suggest that perseveration
errors in reversal learning and impaired self-regulation and
altered emotional perception are hallmark characteristics of
chronic but not recreational users. Interestingly, all of these
processes have been associated with orbitofrontal functioning
(Clark et al. 2004; Heberlein et al. 2008; Levine et al. 2000),
which is consistent with the hypothesis that this brain system
may be more robustly involved in the individual vulnerabil-
ity to become addicted (Bechara 2005). Nonetheless, rave
attenders did perform more poorly than controls on decision
making taxed by the Iowa gambling task, which is also
linked to orbitofrontal cortex functioning. However, this
finding does not necessarily contradicts the former notion,
since previous research indicates that other cognitive
processes (e.g., working memory) and brain systems (e.g.,
dorsolateral prefrontal cortex) can also contribute to Iowa
gambling task performance (see Dunn et al. 2006 for
review). Furthermore, we should also note that, for those
domains that showed significant differences between rave
attenders and controls, the degree of decline in recreational
users as compared to drug free controls is substantially
smaller (according to effect sizes) than the one found in
polysubstance-dependent individuals—with the exception of
analogical reasoning skills (Fernandez-Serrano et al. 2010a).
Therefore, future studies should address the functional and
clinical significance of the mild to medium size neuropsy-
chological deficits of polysubstance-using rave attenders.
This study has noteworthy limitations, including the
relatively small sample size and the pattern of polysubstance
use of the rave attenders group. However, both limitations are
inherent to the type of population that we aimed to investigate.
Raves are not a massive phenomenon and rave attenders do
not tend to seek counseling or treatment in addiction centers;
therefore, they are relatively rare and difficult to track.
Furthermore, polysubstance abuse is a hallmark characteristic
of raves, and therefore it is virtually impossible to study this
population without taking this variable into account. None-
theless, we have attempted to be cautious in interpreting our
findings mainly as a function of the mixed pattern of drug use
and not in terms of specific effects of certain substances. Even
in those cases where strong correlations between certain drugs
and patterns of performance emerged, the polysubstance use
context was discussed. Another relevant limitation is the
absence of objective checks of drug abstinence; however, as
we mentioned before, participants had no objective major
reasons for providing inaccurate information.
Acknowledgements The research described here has been supported
by grants SEJ2006-08278/PSIC, Spanish Ministry of Science, and P07-
HUM-03089 from the Council of Innovation, Science and Enterprise,
Junta de Andalucía (PI: Mguel Pérez-García) and PSI2009-13133 (PI:
José C Perales) from the Spanish Ministry of Science. The authors would
like to thank Mr. Claudio Vidal Giné and Energy Control for their
important support in the recruitment of rave attenders.
Psychopharmacology (2010) 210:377–392
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