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Cognitive training and remediation interventions for substance use disorders: a Delphi consensus study
journal contributionposted on 2023-02-16, 03:15 authored by A Verdejo-Garcia, T Rezapour, E Giddens, A Khojasteh Zonoozi, P Rafei, J Berry, A Caracuel, ML Copersino, M Field, EL Garland, V Lorenzetti, L Malloy-Diniz, V Manning, EM Marceau, DL Pennington, JC Strickland, R Wiers, R Fairhead, A Anderson, M Bell, WJ Boendermaker, S Brooks, R Bruno, S Campanella, J Cousijn, WM Cox, AC Dean, KD Ersche, I Franken, B Froeliger, P Gamito, TE Gladwin, PD Goncalves, K Houben, J Jacobus, A Jones, AM Kaag, J Lindenmeyer, E McGrath, T Nardo, J Oliveira, CR Pennington, K Perrykkad, H Piercy, CI Rupp, MHJ Schulte, LM Squeglia, Petra StaigerPetra Staiger, DJ Stein, J Stein, M Stein, WW Stoops, M Sweeney, K Witkiewitz, SP Woods, R Yi, M Zhao, H Ekhtiari
Aims: Substance use disorders (SUD) are associated with cognitive deficits that are not always addressed in current treatments, and this hampers recovery. Cognitive training and remediation interventions are well suited to fill the gap for managing cognitive deficits in SUD. We aimed to reach consensus on recommendations for developing and applying these interventions. Design, Setting and Participants: We used a Delphi approach with two sequential phases: survey development and iterative surveying of experts. This was an on-line study. During survey development, we engaged a group of 15 experts from a working group of the International Society of Addiction Medicine (Steering Committee). During the surveying process, we engaged a larger pool of experts (n = 54) identified via recommendations from the Steering Committee and a systematic review. Measurements: Survey with 67 items covering four key areas of intervention development: targets, intervention approaches, active ingredients and modes of delivery. Findings: Across two iterative rounds (98% retention rate), the experts reached a consensus on 50 items including: (i) implicit biases, positive affect, arousal, executive functions and social processing as key targets of interventions; (ii) cognitive bias modification, contingency management, emotion regulation training and cognitive remediation as preferred approaches; (iii) practice, feedback, difficulty-titration, bias modification, goal-setting, strategy learning and meta-awareness as active ingredients; and (iv) both addiction treatment work-force and specialized neuropsychologists facilitating delivery, together with novel digital-based delivery modalities. Conclusions: Expert recommendations on cognitive training and remediation for substance use disorders highlight the relevance of targeting implicit biases, reward, emotion regulation and higher-order cognitive skills via well-validated intervention approaches qualified with mechanistic techniques and flexible delivery options.
Publication classificationC1 Refereed article in a scholarly journal
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Science & TechnologyLife Sciences & BiomedicineSubstance AbusePsychiatryCognitive remediationcognitive trainingDelphi methodinterventionsneurosciencetreatmentADDICTION TREATMENT OUTCOMESNEUROCLINICAL ASSESSMENTCONTINGENCY MANAGEMENTPARENTING STRATEGIESANXIETY DISORDERSIMPULSIVITYRISKREHABILITATIONNEUROSCIENCEIMPROVEMENTBehavioral and Social ScienceBrain DisordersMind and BodyClinical ResearchMental Health6.6 Psychological and behavioural6 Evaluation of treatments and therapeutic interventionsMental health3 Good Health and Well BeingMedical and Health SciencesPsychology and Cognitive Sciences