Cognitive training and remediation interventions for substance use disorders: A Delphi consensus study
Author:
Verdejo-Garcia AntonioORCID, Rezapour TaraORCID, Giddens Emily, Zonoozi Arash KhojastehORCID, Rafei ParnianORCID, Berry JamieORCID, Caracuel AlfonsoORCID, Copersino Marc L.ORCID, Field MattORCID, Garland Eric L., Lorenzetti ValentinaORCID, Malloy-Diniz LeandroORCID, Manning VictoriaORCID, Marceau Ely M.ORCID, Pennington David L.ORCID, Strickland JustinORCID, Wiers ReinoutORCID, Fairhead Rahia, Anderson AlexandraORCID, Bell MorrisORCID, Boendermaker Wouter J.ORCID, Brooks SamanthaORCID, Bruno RaimondoORCID, Campanella SalvatoreORCID, Cousijn JannaORCID, Cox MilesORCID, Dean Andrew C., Ersche Karen DORCID, Franken IngmarORCID, Froeliger Brett, Gamito PedroORCID, Gladwin Thomas E.ORCID, Goncalves Priscila D., Houben Katrijn, Jacobus JoannaORCID, Jones Andrew, Kaag Anne M.ORCID, Lindenmeyer JohannesORCID, McGrath Elly, Nardo TaliaORCID, Oliveira Jorge, Pennington Charlotte R.ORCID, Perrykkad KelseyORCID, Piercy HughORCID, Rupp Claudia IORCID, Schulte Mieke H. J.ORCID, Squeglia Lindsay M.ORCID, Staiger PetraORCID, Stein Dan JORCID, Stein Jeff, Stein Maria, Stoops William W.ORCID, Sweeney MaryORCID, Vo Hoa, Witkiewitz KatieORCID, Woods Steven P, Yi RichardORCID, Zhao Min, Ekhtiari HamedORCID
Abstract
AbstractBackground and AimsSubstance 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.DesignDelphi approach with two sequential phases: survey development and iterative surveying of experts.SettingOnline study.ParticipantsDuring 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=53) identified via recommendations from the Steering Committee and a systematic review.MeasurementsSurvey with 67 items covering four key areas of intervention development, i.e., targets, intervention approaches, active ingredients, and modes of delivery.FindingsAcross 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 workforce and specialized neuropsychologists facilitating delivery, together with novel digital-based delivery modalities.ConclusionsExpert recommendations on cognitive training and remediation for SUD 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.
Publisher
Cold Spring Harbor Laboratory
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