Targeting cognitive impairment in substance use disorders: the need, efficacy, and implications of cognitive remediation
Background: Cognitive impairments are common among individuals with substance use disorder (SUD) and have been proposed to make it more difficult to engage in psychosocial treatments and to implement the behavioural changes necessary in order to achieve recovery in the long term. Addressing these impairments through cognitive remediation has thus been hypothesised as an effective method for improving outcomes for those in SUD treatment. Existing research examining the role of cognitive remediation in SUD treatment outcomes has been limited, with an overall dearth of high-quality research and few studies implemented in ecologically valid samples.
Aims: This body of research aimed to 1) examine the association of cognitive impairments and related disorders with SUD treatment retention; 2) synthesise the theoretical and empirical evidence for cognitive remediation as an efficacious adjunct treatment for SUD; and 3) evaluate the efficacy and effectiveness of a novel, evidence-informed cognitive remediation intervention for improving cognitive functioning and treatment retention among individuals in residential SUD treatment.
Methods: The first aim of the research was achieved through examining the association of neurocognitive disorders, neurodevelopmental disorders, and cognitive impairment with SUD treatment dropout using binary logistic regression analysis. The second aim was achieved through systematic review of existing literature to evaluate the evidence for cognitive remediation as an adjunct treatment for improving cognitive functioning and SUD treatment outcomes. The final aim was achieved using a stepped-wedge cluster randomised controlled trial to evaluate the efficacy and effectiveness of a six-week cognitive remediation intervention for improving inventory-based executive functioning and treatment retention in a large sample of residential SUD treatment consumers.
Results & Conclusions: The findings of this research provided further evidence for the role of cognitive impairment and neurodevelopmental disorders, including ADHD, as predictors of dropout from residential SUD treatment, supporting the hypothesis that cognitive impairment may be an effective target for improving treatment outcomes. Review of the literature indicated that cognitive remediation for SUD has promising preliminary evidence, however, heterogeneous research practices and a predominance of low-powered studies indicate that more research is required. Finally, the results of the trial indicated that participating in cognitive remediation while in SUD treatment was associated with improved self-reported executive functioning and treatment retention compared to treatment-as-usual. More research is needed in order to fully understand the mechanism of these improvements, and the impact of introducing cognitive remediation as a part of standard evidence-based treatment.
