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Sweeney MM, Rass O, DiClemente C, Schacht RL, Vo HT, Fishman MJ, Leoutsakos JMS, Mintzer MZ, Johnson MW. Working Memory Training for Adolescents With Cannabis Use Disorders: A Randomized Controlled Trial. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2018; 27:211-226. [PMID: 30524179 DOI: 10.1080/1067828x.2018.1451793] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Adolescent cannabis use is associated with working memory impairment. The present randomized controlled trial assigned adolescents ages 14 to 21 enrolled in cannabis use treatment to receive either working memory training (experimental group) or a control training (control group) as an adjunctive treatment. Cognitive function, drug use, and other outcomes were assessed before and after training. We observed few differences in cognitive, functional, or self-reported drug use outcomes as a function of training group, although tetrahydrocannabinol (THC) urinalysis results favored the experimental group. These findings are similar to previous studies in substance users, which have shown limited transfer effects for working memory training.
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Affiliation(s)
- Mary M Sweeney
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Olga Rass
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Cara DiClemente
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Rebecca L Schacht
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Hoa T Vo
- Mountain Manor Treatment Center, Baltimore, MD, USA
| | - Marc J Fishman
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.,Mountain Manor Treatment Center, Baltimore, MD, USA
| | - Jeannie-Marie S Leoutsakos
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Miriam Z Mintzer
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Matthew W Johnson
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Schulte MHJ, Wiers RW, Boendermaker WJ, Goudriaan AE, van den Brink W, van Deursen DS, Friese M, Brede E, Waters AJ. The effect of N-acetylcysteine and working memory training on cocaine use, craving and inhibition in regular cocaine users: correspondence of lab assessments and Ecological Momentary Assessment. Addict Behav 2018; 79:24-31. [PMID: 29241082 DOI: 10.1016/j.addbeh.2017.11.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 11/21/2017] [Accepted: 11/29/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Effective treatment for cocaine use disorder should dampen hypersensitive cue-induced motivational processes and/or strengthen executive control. Using a randomized, double-blind, placebo-controlled intervention, the primary aim of this study was to investigate the effect of N-Acetylcysteine (NAC) and working memory (WM)-training to reduce cocaine use and craving and to improve inhibition assessed in the laboratory and during Ecological Momentary Assessment (EMA). The second aim was to examine correspondence between laboratory and EMA data. METHODS Twenty-four of 38 cocaine-using men completed a 25-day intervention with 2400mg/day NAC or placebo and WM-training as well as two lab-visits assessing cocaine use, craving and inhibition (Stop Signal task). Additionally, cocaine use, craving and cognition (Stroop task) were assessed using EMA during treatment, with 26 participants completing 819 assessments. RESULTS Cocaine problems according to the Drug Use Disorder Identification Test (DUDIT) decreased more after NAC than after placebo, and the proportion of cocaine-positive urines at lab-visit 2 was lower in the NAC group. No NAC effects were found on craving. For cocaine use and craving, results from the lab data were generally similar to EMA results. NAC also showed some effects on cognitive control: improved inhibition assessed with the Stop Signal task in the lab, and decreased classic Stroop performance during EMA. There were no significant effects of number of completed WM-training sessions. CONCLUSIONS Overall this study revealed mixed findings regarding the treatment of cocaine use disorders with NAC and WM-training. The effect of NAC on inhibition should be further investigated.
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Affiliation(s)
- Mieke H J Schulte
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands; Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Reinout W Wiers
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Wouter J Boendermaker
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands; Department of Experimental Psychology, Utrecht University, The Netherlands
| | - Anna E Goudriaan
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Arkin Mental Health, Amsterdam, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Denise S van Deursen
- Addiction, Development, and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands; Faculty of Psychology and Educational Sciences, Open University of The Netherlands, Heerlen, The Netherlands
| | - Malte Friese
- Department of Psychology, Saarland University, Saarbruecken, Germany
| | - Emily Brede
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Andrew J Waters
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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Kaag AM, Goudriaan AE, De Vries TJ, Pattij T, Wiers RW. A high working memory load prior to memory retrieval reduces craving in non-treatment seeking problem drinkers. Psychopharmacology (Berl) 2018; 235:695-708. [PMID: 29181814 PMCID: PMC5847068 DOI: 10.1007/s00213-017-4785-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 11/07/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Reconsolidation-based interventions have been suggested to be a promising treatment strategy for substance use disorders. In this study, we aimed to investigate the effectiveness of a working memory intervention to interfere with the reconsolidation of alcohol-related memories in a sample of non-treatment seeking heavy drinkers. METHODS Participants were randomized to one of the two conditions that underwent a 3-day intervention: in the experimental condition, a 30-min working memory training was performed immediately after a 15-min memory retrieval session (i.e., within the memory reconsolidation time-window), whereas in the control condition, the working memory training was performed prior to a memory retrieval session. RESULTS In contrast to our original hypothesis, a high working memory load after memory retrieval did not interfere with the reconsolidation of those memories while a high working memory load prior to memory retrieval (the original control condition) strongly reduced retrieval-induced craving and craving for alcohol at follow-up. CONCLUSION Whereas the neurocognitive mechanism behind this effect needs to be further investigated, the current findings suggest that, if replicated, working memory training prior to addiction-related memory retrieval has the potential to become an effective (adjunctive) intervention in the treatment of substance use disorders.
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Affiliation(s)
- Anne Marije Kaag
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands.
| | - Anna E Goudriaan
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Arkin Mental Health Care & Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Taco J De Vries
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Tommy Pattij
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Reinout W Wiers
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
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Snider SE, Deshpande HU, Lisinski JM, Koffarnus MN, LaConte SM, Bickel WK. Working Memory Training Improves Alcohol Users' Episodic Future Thinking: A Rate-Dependent Analysis. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2017. [PMID: 29529411 DOI: 10.1016/j.bpsc.2017.11.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Episodic thinking, whether past or future, uses similar neural machinery, and individuals with alcohol dependence have clear challenges with both. Moreover, alcohol-dependent individuals' narrowed temporal window likely gives rise to greater valuation of immediate rewards. We aimed to strengthen working memory (WM) in alcohol-dependent individuals and measure performance on near-transfer (novel WM) and far-transfer delay discounting (DD) tasks, including episodic future thinking (EFT) performance. Importantly, heterogeneous intervention responses could obscure a treatment effect due to individuals' baseline differences. Therefore, we considered WM, DD, and EFT DD scores using rate-dependent analyses. METHODS A total of 50 alcohol-dependent individuals received either 20 active (Trained) or sham (Control) WM training sessions using the Cogmed adaptive WM training program. Participants completed a near-transfer novel WM task and far-transfer DD and EFT DD tasks before and after training. RESULTS Active WM training improved performance on the near-transfer task. As determined by Oldham's correlation [rmean(x,y),y-x], initially low near-transfer task scores improved more than initially high scores (i.e., rate dependence) in the Trained group only. Moreover, Trained group individuals with the highest rates of EFT DD at baseline rate-dependently decreased following training, whereas WM training had no effect on DD alone. CONCLUSIONS These data support the notion that WM training improves near-transfer task performance and may enhance the effects of EFT DD in a subset of alcohol-dependent individuals trapped within the narrowest temporal window. Rate-dependent changes highlight that we should attend to baseline performance to better identify individuals who would most benefit from an intervention.
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Affiliation(s)
- Sarah E Snider
- Virginia Tech Carilion Research Institute, Virginia Polytechnic Institute and State University, Roanoke, Virginia
| | - Harshawardhan U Deshpande
- Virginia Tech Carilion Research Institute, Virginia Polytechnic Institute and State University, Roanoke, Virginia
| | - Jonathan M Lisinski
- Virginia Tech Carilion Research Institute, Virginia Polytechnic Institute and State University, Roanoke, Virginia
| | - Mikhail N Koffarnus
- Virginia Tech Carilion Research Institute, Virginia Polytechnic Institute and State University, Roanoke, Virginia
| | - Stephen M LaConte
- Virginia Tech Carilion Research Institute, Virginia Polytechnic Institute and State University, Roanoke, Virginia
| | - Warren K Bickel
- Virginia Tech Carilion Research Institute, Virginia Polytechnic Institute and State University, Roanoke, Virginia.
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Brooks SJ, Funk SG, Young SY, Schiöth HB. The Role of Working Memory for Cognitive Control in Anorexia Nervosa versus Substance Use Disorder. Front Psychol 2017; 8:1651. [PMID: 29018381 PMCID: PMC5615794 DOI: 10.3389/fpsyg.2017.01651] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 09/07/2017] [Indexed: 01/20/2023] Open
Abstract
Prefrontal cortex executive functions, such as working memory (WM) interact with limbic processes to foster impulse control. Such an interaction is referred to in a growing body of publications by terms such as cognitive control, cognitive inhibition, affect regulation, self-regulation, top-down control, and cognitive–emotion interaction. The rising trend of research into cognitive control of impulsivity, using various related terms reflects the importance of research into impulse control, as failure to employ cognitions optimally may eventually result in mental disorder. Against this background, we take a novel approach using an impulse control spectrum model – where anorexia nervosa (AN) and substance use disorder (SUD) are at opposite extremes – to examine the role of WM for cognitive control. With this aim, we first summarize WM processes in the healthy brain in order to frame a systematic review of the neuropsychological, neural and genetic findings of AN and SUD. In our systematic review of WM/cognitive control, we found n = 15 studies of AN with a total of n = 582 AN and n = 365 HC participants; and n = 93 studies of SUD with n = 9106 SUD and n = 3028 HC participants. In particular, we consider how WM load/capacity may support the neural process of excessive epistemic foraging (cognitive sampling of the environment to test predictions about the world) in AN that reduces distraction from salient stimuli. We also consider the link between WM and cognitive control in people with SUD who are prone to ‘jumping to conclusions’ and reduced epistemic foraging. Finally, in light of our review, we consider WM training as a novel research tool and an adjunct to enhance treatment that improves cognitive control of impulsivity.
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Affiliation(s)
- Samantha J Brooks
- Functional Pharmacology, Department of Neuroscience, Uppsala UniversityUppsala, Sweden.,Department of Psychiatry and Mental Health, University of Cape TownCape Town, South Africa
| | - Sabina G Funk
- Department of Psychiatry and Mental Health, University of Cape TownCape Town, South Africa
| | - Susanne Y Young
- Department of Psychiatry, Stellenbosch UniversityBellville, South Africa
| | - Helgi B Schiöth
- Functional Pharmacology, Department of Neuroscience, Uppsala UniversityUppsala, Sweden
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von Hippel C, Henry JD, Terrett G, Mercuri K, McAlear K, Rendell PG. Stereotype threat and social function in opioid substitution therapy patients. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2017; 56:160-171. [PMID: 28070918 DOI: 10.1111/bjc.12128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 12/06/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES People with a history of substance abuse are subject to widespread stigmatization. It seems likely that this societal disapproval will result in feelings of stereotype threat, or the belief that one is the target of demeaning stereotypes. If so, stereotype threat has the potential to contribute to functional difficulties including poor social outcomes. METHODS Eighty drug users on opioid substitution therapy and 84 demographically matched controls completed measures of mental health and social function. The opioid substitution therapy group were additionally asked to complete a measure that focused on their feelings of stereotype threat in relation to their drug use history. Bivariate correlations and hierarchical regression analyses were conducted to establish the magnitude and specificity of the relationship between stereotype threat and social functioning. RESULTS Relative to controls, the opioid substitution therapy group reported higher levels of negative affect and schizotypy, and poorer social functioning, with all three of these indices significantly correlated with their feelings of stereotype threat. The results also showed that stereotype threat contributed significant unique variance to social functioning in the opioid substitution therapy group, even after taking into account other background, clinical, and mental health variables. CONCLUSIONS Social functioning is an important aspect of recovery, yet these data indicate that people with a history of drug abuse who believe they are the target of stereotypical attitudes have poorer social functioning. This relationship holds after controlling for the impact of other variables on social functioning, including mental health. The theoretical and practical implications of these findings are discussed. PRACTITIONER POINTS Concerns about being stereotyped can shape the social experiences of opioid substitution therapy patients. Opioid substitution therapy patients who feel negatively stereotyped experience greater social function deficits, and this relationship emerges after controlling for important clinical and mental health variables. Understanding the relationship between feeling stereotyped and social function may assist practitioners in their treatment. The study is cross-sectional, and thus, experimental or longitudinal research is required to determine the causal direction between stereotype threat and social function.
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Affiliation(s)
- Courtney von Hippel
- School of Psychology, University of Queensland, St Lucia, Queensland, Australia
| | - Julie D Henry
- School of Psychology, University of Queensland, St Lucia, Queensland, Australia
| | - Gill Terrett
- Cognitive and Emotion Research Centre, Australian Catholic University, Melbourne, Victoria, Australia
| | - Kimberly Mercuri
- Cognitive and Emotion Research Centre, Australian Catholic University, Melbourne, Victoria, Australia
| | - Karen McAlear
- Cognitive and Emotion Research Centre, Australian Catholic University, Melbourne, Victoria, Australia
| | - Peter G Rendell
- Cognitive and Emotion Research Centre, Australian Catholic University, Melbourne, Victoria, Australia
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Bickel WK, Moody L, Higgins ST. Some current dimensions of the behavioral economics of health-related behavior change. Prev Med 2016; 92:16-23. [PMID: 27283095 PMCID: PMC5085840 DOI: 10.1016/j.ypmed.2016.06.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/31/2016] [Accepted: 06/04/2016] [Indexed: 11/22/2022]
Abstract
Health-related behaviors such as tobacco, alcohol and other substance use, poor diet and physical inactivity, and risky sexual practices are important targets for research and intervention. Health-related behaviors are especially pertinent targets in the United States, which lags behind most other developed nations on common markers of population health. In this essay we examine the application of behavioral economics, a scientific discipline that represents the intersection of economics and psychology, to the study and promotion of health-related behavior change. More specifically, we review what we consider to be some core dimensions of this discipline when applied to the study health-related behavior change. Behavioral economics (1) provides novel conceptual systems to inform scientific understanding of health behaviors, (2) translates scientific understanding into practical and effective behavior-change interventions, (3) leverages varied aspects of behavior change beyond increases or decreases in frequency, (4) recognizes and exploits trans-disease processes and interventions, and (5) leverages technology in efforts to maximize efficacy, cost effectiveness, and reach. These dimensions are overviewed and their implications for the future of the field discussed.
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Affiliation(s)
- Warren K Bickel
- Virginia Tech Carilion Research Institute, Department of Psychology, Roanoke, VA, USA.
| | - Lara Moody
- Virginia Tech Carilion Research Institute, Department of Psychology, Roanoke, VA, USA
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; University of Vermont, Departments of Psychiatry and Psychology, USA
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Perry CJ, Lawrence AJ. Addiction, cognitive decline and therapy: seeking ways to escape a vicious cycle. GENES BRAIN AND BEHAVIOR 2016; 16:205-218. [DOI: 10.1111/gbb.12325] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/14/2016] [Accepted: 08/25/2016] [Indexed: 12/31/2022]
Affiliation(s)
- C. J. Perry
- Behavioural Neuroscience Division; The Florey Institute of Neuroscience and Mental Health; Melbourne VIC Australia
- Florey Department of Neuroscience and Mental Health; University of Melbourne; Melbourne VIC Australia
| | - A. J. Lawrence
- Behavioural Neuroscience Division; The Florey Institute of Neuroscience and Mental Health; Melbourne VIC Australia
- Florey Department of Neuroscience and Mental Health; University of Melbourne; Melbourne VIC Australia
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Sweeney MM, Rass O, Johnson PS, Strain EC, Berry MS, Vo HT, Fishman MJ, Munro CA, Rebok GW, Mintzer MZ, Johnson MW. Initial feasibility and validity of a prospective memory training program in a substance use treatment population. Exp Clin Psychopharmacol 2016; 24:390-399. [PMID: 27690506 PMCID: PMC5094364 DOI: 10.1037/pha0000091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Individuals with substance use disorders have shown deficits in the ability to implement future intentions, called prospective memory. Deficits in prospective memory and working memory, a critical underlying component of prospective memory, likely contribute to substance use treatment failures. Thus, improvement of prospective memory and working memory in substance use patients is an innovative target for intervention. We sought to develop a feasible and valid prospective memory training program that incorporates working memory training and may serve as a useful adjunct to substance use disorder treatment. We administered a single session of the novel prospective memory and working memory training program to participants (n = 22; 13 men, 9 women) enrolled in outpatient substance use disorder treatment and correlated performance to existing measures of prospective memory and working memory. Generally accurate prospective memory performance in a single session suggests feasibility in a substance use treatment population. However, training difficulty should be increased to avoid ceiling effects across repeated sessions. Consistent with existing literature, we observed superior performance on event-based relative to time-based prospective memory tasks. Performance on the prospective memory and working memory training components correlated with validated assessments of prospective memory and working memory, respectively. Correlations between novel memory training program performance and established measures suggest that our training engages appropriate cognitive processes. Further, differential event- and time-based prospective memory task performance suggests internal validity of our training. These data support the development of this intervention as an adjunctive therapy for substance use disorders. (PsycINFO Database Record
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Affiliation(s)
- Mary M. Sweeney
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Olga Rass
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Patrick S. Johnson
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eric C. Strain
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Meredith S. Berry
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hoa T. Vo
- Mountain Manor Treatment Center, Baltimore, Maryland, USA
| | - Marc J. Fishman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Mountain Manor Treatment Center, Baltimore, Maryland, USA
| | - Cynthia A. Munro
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - George W. Rebok
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Miriam Z. Mintzer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matthew W. Johnson
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Cognitive training for substance use disorders: Neuroscientific mechanisms. Neurosci Biobehav Rev 2016; 68:270-281. [DOI: 10.1016/j.neubiorev.2016.05.018] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 04/13/2016] [Accepted: 05/19/2016] [Indexed: 12/11/2022]
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Kiluk BD, Buck MB, Devore KA, Babuscio TA, Nich C, Carroll KM. Performance-Based Contingency Management in Cognitive Remediation Training: A Pilot Study. J Subst Abuse Treat 2016; 72:80-88. [PMID: 27590364 DOI: 10.1016/j.jsat.2016.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 07/12/2016] [Accepted: 08/04/2016] [Indexed: 01/13/2023]
Abstract
Impairments in attention, working memory, and executive function are common among substance users and may adversely affect SUD treatment outcomes. The ability of cognitive remediation (CR) interventions to improve these deficits is hindered in part because levels of engagement in CR training may be inadequate to achieve benefit. This pilot study aimed to increase CR engagement and improve outcome by implementing contingency management (CM) procedures that reinforce performance improvements on CR tasks. Participants were forty individuals (50% male; 65% African American) in an outpatient substance use treatment facility with mild cognitive impairment who had ≥30-days of abstinence from alcohol and drugs. They were randomized to standard (CR-S; n=21) or CM-enhanced (CR-CM; n=19) cognitive remediation training. CR consisted of 1-hour sessions, three times per week for four weeks (12 sessions). A neuropsychological assessment battery was administered prior to and after the four-week intervention. Both groups had high rates of CR session attendance (mean CR-S=11.7, CR-CM=10.9 sessions). Performance on 8 of the 9 CR tasks significantly improved over time for both conditions, with the CR-CM condition demonstrating greater improvement on a CR Sequenced Recall task [F(1,37)=5.81, p<.05]. Significant improvement was also evident on 4 of 9 neuropsychological assessment measures, with the CR-CM condition showing differential improvement on the Trail Making Test - Part B [F (1,37)=5.34, p<.05]. These findings support the feasibility of using CM procedures to enhance substance users' engagement with CR training and suggest the potential value of more research in this area.
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Affiliation(s)
- Brian D Kiluk
- Yale University School of Medicine, One Long Wharf Drive, New Haven, CT 06511, USA.
| | - Matthew B Buck
- Yale University School of Medicine, One Long Wharf Drive, New Haven, CT 06511, USA
| | - Kathleen A Devore
- Yale University School of Medicine, One Long Wharf Drive, New Haven, CT 06511, USA
| | - Theresa A Babuscio
- Yale University School of Medicine, One Long Wharf Drive, New Haven, CT 06511, USA
| | - Charla Nich
- Yale University School of Medicine, One Long Wharf Drive, New Haven, CT 06511, USA
| | - Kathleen M Carroll
- Yale University School of Medicine, One Long Wharf Drive, New Haven, CT 06511, USA
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Abstract
The maturing fields of behavioral- and neuro-economics provides conceptual understanding of the Competing Neurobehavioral Decision Systems theory (CNDS) and reinforcer pathology (i.e. high valuation of and excessive preference for drug reinforcers) allowing us to coherently categorize treatments into a theoretically comprehensive framework of addiction. In this chapter, we identify and clarify how existing and novel interventions can ameliorate reinforcer pathology in light of the CNDS and be leveraged to treat addiction.
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