Modified cognitive behavioral therapy (M-CBT) for cocaine dependence: Development of treatment for cognitively impaired users and results from a Stage 1 trial

Mixed amphetamine salts-extended release (MAS-ER) as a behavioral treatment augmentation strategy for cocaine use disorder: A randomized clinical trial

Psychosocial interventions remain the primary strategy for addressing cocaine use disorder (CUD), although many individuals do not benefit from these approaches. Amphetamine-based interventions have shown significant promise and may improve outcomes among individuals continuing to use cocaine in the context of behavioral interventions. One hundred forty-five adults (122 males) who used cocaine a minimum of 4 days in the prior month and met the criteria for a CUD enrolled in a two-stage intervention. All participants received a computer-delivered skills intervention and contingency management for reinforcing abstinence for a 1-month period. Participants demonstrating less than 3 weeks of abstinence in the first month were randomized to receive mixed amphetamine salts-extended release (MAS-ER) or placebo (80 mg/day) for 10 weeks under double-blind conditions. All participants continued with the behavioral intervention. The primary outcome was the proportion of individuals who achieved 3 consecutive weeks of abstinence as measured by urine toxicology confirmed self-report at the study end. The proportion of participants demonstrating 3 consecutive weeks of abstinence at study end did not differ between the medication groups: MAS-ER = 15.6% (7/45) and placebo = 12.2% (5/41). Participants who received MAS-ER reported greater reductions in the magnitude of wanting cocaine, although no group differences were noted in either the perceived improvement or the frequency of wanting cocaine. Retention rates were greater for both medication groups compared to behavioral responders. Overall, augmenting a behavioral intervention with MAS-ER did not significantly increase the abstinence rate among individuals continuing to use cocaine following a month of behavioral therapy alone. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Effect of Transcranial Direct Current Stimulation (tDCS) on Cocaine Addiction: A Narrative Review

Cocaine addiction is a significant problem worldwide. The development of addiction involves a reward system, which consists of certain brain regions like the ventral tegmental area, nucleus accumbens, and prefrontal cortex. Currently, there are no approved medications for treating cocaine dependence, so researchers are actively searching for effective treatments that can impact the brain. One potential treatment under investigation is transcranial direct current stimulation (tDCS), a non-invasive method of stimulating the brain to modulate its activity. In this review, we explore the use of tDCS in treating cocaine addiction. We found nine relevant articles via a literature search, and the results indicate that applying tDCS to the right dorsolateral prefrontal cortex (DLPFC) holds promise for reducing drug cravings in individuals with cocaine addiction. The review also discusses the possible mechanisms by which tDCS works and provides recommendations for future research in this field.

Environmental cues can indirectly acquire cocaine-eliciting changes in Heart Rate: A pilot study of derived relational responding, the transfer of function among cocaine users

Identifying the processes by which environmental stimuli can come to influence drug use is important for developing more efficacious interventions. This study investigated derived relational responding and the transfer of differential conditioned effects of environmental stimuli paired with "smoked" cocaine in accordance with the relations of symmetry, transitivity, and equivalence using Heart Rate as the measure of conditioning among 12 adults with significant histories of cocaine use. Match-to-sample (MTS) procedures were used to test for emergent relations among two four-member stimulus groupings. One member of a group was then paired with 25-mg of smoked cocaine and one member of the other group was paired with 0-mg of smoked cocaine. 10 participants completed the MTS protocol: 4 participants demonstrated two four-member equivalence classes, 3 participants demonstrated two three-member equivalence classes and 2 participants demonstrated symmetry only. One participant demonstrated no derived relations. Differential respondent elicited changes in HR was demonstrated in the presence of stimuli paired with smoked cocaine among 4 of the 6 participants completing the conditioning phase; all 4 of the participants demonstrated a bi-directional transfer of these functions in accordance with symmetry. Transfer was not reliably demonstrated in accordance with transitive or equivalence relations. The results suggest that drug respondent elicitation in the context of drug use may be a function of both direct conditioning and relational processes. These findings have implications for studying and understanding the processes by which stimuli in the natural ecology can set the occasion for cocaine use and developing cocaine use disorder.

Cognitive Alterations in Addictive Disorders: A Translational Approach

The cognitive decline in people with substance use disorders is well known and can be found during both the dependence and drug abstinence phases. At the clinical level, cognitive decline impairs the response to addiction treatment and increases dropout rates. It can be irreversible, even after the end of drug abuse consumption. Improving our understanding of the molecular and cellular alterations associated with cognitive decline could be essential to developing specific therapeutic strategies for its treatment. Developing animal models to simulate drug abuse-induced learning and memory alterations is critical to continue exploring this clinical situation. The main aim of this review is to summarize the most recent evidence on cognitive impairment and the associated biological markers in patients addicted to some of the most consumed drugs of abuse and in animal models simulating this clinical situation. The available information suggests the need to develop more studies to further explore the molecular alterations associated with cognitive impairment, with the ultimate goal of developing new potential therapeutic strategies.

Understanding eHealth Cognitive Behavioral Therapy Targeting Substance Use: Realist Review

BACKGROUND

There is a growing body of evidence regarding eHealth interventions that target substance use disorders. Development and funding decisions in this area have been challenging, due to a lack of understanding of what parts of an intervention work in which context.

OBJECTIVE

We conducted a realist review of the literature on electronic cognitive behavioral therapy (eCBT) programs for substance use with the goal of answering the following realist question: "How do different eCBT interventions for substance use interact with different contexts to produce certain outcomes?"

METHODS

A literature search of published and gray literature on eHealth programs targeting substance use was conducted. After data extraction, in order to conduct a feasible realist review in a timely manner, the scope had to be refined further and, ultimately, only included literature focusing on eCBT programs targeting substance use. We synthesized the available evidence from the literature into Context-Mechanism-Outcome configurations (CMOcs) in order to better understand when and how programs work.

RESULTS

A total of 54 papers reporting on 24 programs were reviewed. Our final results identified eight CMOcs from five unique programs that met criteria for relevance and rigor.

CONCLUSIONS

Five strategies that may be applied to future eCBT programs for substance use are discussed; these strategies may contribute to a better understanding of mechanisms and, ultimately, may help design more effective solutions in the future. Future research on eCBT programs should try to understand the mechanisms of program strategies and how they lead to outcomes in different contexts.

Cognition and addiction

In this targeted review, we summarize current knowledge on substance-use disorder (SUD)-related cognitive deficits, the link between these deficits and clinical outcomes, and the cognitive training, remediation, and pharmacological approaches that have the potential to rescue cognition. We conclude that: (i) people with SUDs have moderate deficits in memory, attention, executive functions, and decision-making (including reward expectancy, valuation, and learning); (ii) deficits in higher-order executive functions and decision-making are significant predictors of relapse; (iii) cognitive training programs targeting reward-related appetitive biases, cognitive remediation strategies targeting goal-based decision-making, and pharmacotherapies targeting memory, attention, and impulsivity have potential to rescue SUD-related cognitive deficits. We suggest avenues for future research, including developing brief, clinically oriented harmonized cognitive testing suites to improve individualized prediction of treatment outcomes; computational modeling that can achieve deep phenotyping of cognitive subtypes likely to respond to different interventions; and phenotype-targeted cognitive, pharmacological, and combined interventions. We conclude with a tentative model of neuroscience-informed precision medicine.


Social and Non-Social Cognitive Enhancement in Cocaine Users-A Closer Look on Enhancement Motives for Cocaine Consumption

BACKGROUND

Cognitive disturbances of chronic cocaine users (CU) have been repeatedly investigated. However, it is yet unknown how CU using cocaine for cognitive or social enhancement differ from stimulant-naïve controls and CU that do not have these motives. More precisely, we assumed that CU with an enhancement motive self-medicate deficits in specific cognitive abilities, i.e., they use cocaine to enhance their performance in either social (social motive) or non-social cognitive situations (cognitive motive).

METHODS

Forty-two CU were categorized according to their motives for cocaine consumption into social and non-social motive groups as well as cognitive and non-cognitive motive groups, respectively. Subsequently, CU motive groups were compared to 48 stimulant-naïve controls in their social and non-social cognitive functioning applying a comprehensive neuropsychological test battery.

RESULTS

The social motive group showed deficits in cognitive empathy compared to controls (Cohen's d = 0.65) and the non-social motive group (d = 0.60). No mentionable effects were found for emotional empathy and Theory-of-Mind. Cognitive and non-cognitive motive groups both showed general cognitive deficits but with different patterns of impairments compared to controls: the cognitive motive group had deficits mainly in working memory (d = 0.84) and declarative memory (d = 0.60), whereas the non-cognitive motive group also had deficits in working memory (d = 0.61) but additionally in executive functions (d = 0.67). For the domains declarative memory and executive functions, the respective other CU group displayed intermediate performance.

CONCLUSIONS

This study demonstrates that cocaine is partially instrumentalized by CU with specific enhancement motives to counteract related cognitive impairments.

Learning functions in short-term cocaine users

Objective

This study examined learning functions in short-term cocaine users and control participants.

Method

Seventeen active cocaine users (reporting 3.5 mean years of cocaine use) and seventeen non-cocaine-using controls (with similar reported levels of alcohol and marijuana use) were compared on tasks measuring different aspects of learning.

Results

The cocaine users performed more poorly on the Weather Prediction and List-Learning tasks, as well as supplementary executive and psychomotor function tasks, than controls.

Conclusions

Individuals with a relatively short duration of cocaine use exhibited moderate weaknesses in probabilistic category learning, verbal learning and psychomotor functions, relative to controls. These weaknesses may underpin difficulty in learning from the probabilistic consequences of behavior and hinder the ability to respond to cognitive-behavioral treatments.

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Learning functions in short-term cocaine users have been understudied.

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Short-term cocaine users performed worse than controls on probabilistic category and verbal learning tasks.

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Short-term cocaine users performed similarly to controls on an equivalence learning task.

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Clinicians should be aware that even short-term cocaine use may be associated with cognitive weaknesses.