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Liu XX, Huang PH, Wang YJ, Gao Y. Effects of Aerobic Exercise Combined With Attentional Bias Modification in the Care of Male Patients With a Methamphetamine Use Disorder. J Addict Nurs 2024; 35:E2-E14. [PMID: 38574107 DOI: 10.1097/jan.0000000000000565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
OBJECTIVE It remains unclear which individual or combined strategies are most beneficial for methamphetamine use disorders (MUDs). We compared the effects of aerobic exercise, attentional bias modification, and combined intervention on male patients with MUD. METHOD One hundred male patients with MUD were randomly assigned to combined intervention, aerobic exercise, attentional bias modification, or control groups (25 patients per group). The 8-week intervention protocol included three 60-minute sessions of aerobic exercises per week. Primary outcomes included high- and low-frequency heart rate variability, executive function, and cardiorespiratory fitness measured by customized software, computerized tests, and the Harvard step test, respectively. Secondary outcomes included psychiatric symptoms, drug craving, training acceptability, and persistence. RESULTS Participant characteristics were matched between groups at baseline. Executive function, heart rate variability, cardiorespiratory fitness, drug craving, and most psychiatric symptoms had significant time-group interactions at posttest (p < .05, η2 = .08-.28). Compared with the attentional bias modification and control groups, the combined intervention and aerobic exercise groups improved significantly in executive function, heart rate variability, cardiorespiratory fitness, and most secondary outcomes. In addition, high-frequency heart rate variability and cardiorespiratory fitness in the aerobic exercise group were significantly higher than those in the combined intervention group. CONCLUSIONS Combination strategies showed comparable efficacy to aerobic exercise alone in improving executive function, psychiatric symptoms, and drug craving and significantly exceeded other conditions. For heart rate variability and cardiorespiratory fitness, aerobic exercise alone was the most effective. For acceptability and persistence, combination strategies were preferred over single-domain training and health education intervention.
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Wiers RW, Pan T, van Dessel P, Rinck M, Lindenmeyer J. Approach-Bias Retraining and Other Training Interventions as Add-On in the Treatment of AUD Patients. Curr Top Behav Neurosci 2023. [PMID: 37221351 DOI: 10.1007/7854_2023_421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
In the past two decades, a variety of cognitive training interventions have been developed to help people overcome their addictive behaviors. Conceptually, it is important to distinguish between programs in which reactions to addiction-relevant cues are trained (varieties of cognitive bias modification, CBM) and programs in which general abilities are trained such as working memory or mindfulness. CBM was first developed to study the hypothesized causal role in mental disorders: by directly manipulating the bias, it was investigated to what extent this influenced disorder-relevant behavior. In these proof-of-principle studies, the bias was temporarily modified in volunteers, either temporarily increased or decreased, with corresponding effects on behavior (e.g., beer consumption), in case the bias was successfully manipulated. In subsequent clinical randomized controlled trials (RCTs), training (away from the substance vs. sham training) was added to clinical treatment. These studies have demonstrated that CBM, as added to treatment, reduces relapse with a small effect of about 10% (similar effect size as for medication, with the strongest evidence for approach-bias modification). This has not been found for general ability training (e.g., working memory training), although effects on other psychological functions have been found (e.g., impulsivity). Mindfulness also has been found to help people overcome addictions, and different from CBM, also as stand-alone intervention. Research on (neuro-)cognitive mechanisms underlying approach-bias modification has pointed to a new perspective in which automatic inferences rather than associations are influenced by training, which has led to the development of a new variety of training: ABC training.
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Affiliation(s)
- Reinout W Wiers
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Ting Pan
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Pieter van Dessel
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Mike Rinck
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Ruhr University Bochum, Bochum, Germany
| | - Johannes Lindenmeyer
- Salus Klinik, Lindow, Germany
- Medizinische Hochschule Brandenburg Theodor Fontane, Brandenburg, Germany
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Garfield JBB, Piccoli LR, Whelan D, Staiger PK, Reynolds J, Piercy H, Lubman DI, Verdejo-Garcia A, Manning V. The effect of approach bias modification during alcohol withdrawal treatment on craving, and its relationship to post-treatment alcohol use in a randomised controlled trial. Drug Alcohol Depend 2022; 239:109621. [PMID: 36087564 DOI: 10.1016/j.drugalcdep.2022.109621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 08/25/2022] [Accepted: 08/31/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Approach bias modification (ApBM) for alcohol use disorder helps prevent relapse, yet the psychological mechanisms underlying its efficacy remain unclear. Alcohol craving predicts relapse and appears to be related to the biased processing of alcohol stimuli which is reduced by ApBM. However, there is little research examining whether ApBM reduces alcohol craving. METHODS In a randomised controlled trial testing the effect of 4 ApBM sessions (vs. sham training) on post-treatment alcohol use in 300 alcohol withdrawal inpatients, we administered the Alcohol Craving Questionnaire - Short Form - Revised (ACQ-SF-R) pre and post-training and at 2-week, 3, 6 and 12-month follow ups; and a cue-induced craving measure pre and post training. RESULTS Groups did not significantly differ in terms of declines in ACQ-SF-R total scores (p = .712) or cue-induced craving (p = .841) between the first and last training session, nor in terms of ACQ-SF-R scores at follow-ups (p = .509). However, the ACQ-SF-R Expectancy subscale, which assesses craving based on anticipated positive reinforcement from alcohol, was significantly lower in the ApBM group than in controls following training (p = .030), although the group x time interaction for this subscale was non-significant (p = .062). Post-intervention Expectancy scores mediated only a small portion of ApBM's effect on post-discharge alcohol use (14% in intention-to-treat analysis, p = .046; 15% in per-protocol analysis, p = .020). CONCLUSIONS ApBM does not appear to have robust, sustained effects on alcohol craving. Reduced craving is unlikely to account for ApBM's relapse prevention effects. However, further research on whether ApBM's effects are related to devaluation of alcohol reward expectancy is warranted. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry Identifier: ACTRN12617001241325.
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Affiliation(s)
- Joshua B B Garfield
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia.
| | - Lara R Piccoli
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Australia.
| | - Danielle Whelan
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia.
| | - Petra K Staiger
- School of Psychology, Deakin University, Geelong, Australia; Centre for Drug Use, Addictive and Antisocial Behaviour Research, Deakin University, Geelong, Australia.
| | - John Reynolds
- Alfred Health and Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Hugh Piercy
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia.
| | - Dan I Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia.
| | - Antonio Verdejo-Garcia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Australia.
| | - Victoria Manning
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia.
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Manning V, Piercy H, Garfield JBB, Clark SG, Andrabi MN, Lubman DI. A Personalized Approach Bias Modification Smartphone App ("SWiPE") to Reduce Alcohol Use: Open-Label Feasibility, Acceptability, and Preliminary Effectiveness Study. JMIR Mhealth Uhealth 2021; 9:e31353. [PMID: 34890355 PMCID: PMC8709909 DOI: 10.2196/31353] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/19/2021] [Accepted: 10/24/2021] [Indexed: 01/15/2023] Open
Abstract
Background Approach bias modification (ApBM), a computerized cognitive intervention that trains people to “avoid” alcohol-related images and “approach” nonalcohol images, reduces the likelihood of relapse when administered during residential alcohol treatment. However, most individuals experiencing alcohol problems do not require, do not seek, or have difficulty accessing residential treatment. Smartphone-delivered ApBM could offer an easily accessible intervention to reduce alcohol consumption that can be personalized (eg, allowing selection of personally relevant alcohol and positive nonalcohol training images) and gamified to optimize engagement. Objective We examined the feasibility, acceptability, and preliminary effectiveness of “SWiPE,” a gamified, personalized alcohol ApBM smartphone app, and explored alcohol consumption and craving outcomes in people drinking at hazardous levels or above (Alcohol Use Disorders Identification Test [AUDIT] score ≥8) who wanted to reduce their alcohol use. Methods In this open-label trial, frequency and quantity of alcohol consumption, alcohol dependence severity, and craving were measured prior to participants downloading SWiPE. Participants (n=1309) were instructed to complete at least 2 sessions per week for 4 weeks. Recruitment and completion rates were indicators of feasibility. Functionality, aesthetics, and quality ratings were indicators of acceptability. Participants were prompted to report frequency and quantity of alcohol consumption weekly during training and 1 month after training. They completed measures of craving and dependence after 4 weeks of training. Results We recruited 1309 participants (mean age 47.0, SD 10.0 years; 758/1309, 57.9% female; mean AUDIT score 21.8, SD 6.5) over 6 months. Participants completed a median of 5 sessions (IQR 2-9); 31.2% (409/1309) completed ≥8 sessions; and 34.8% (455/1309) completed the posttraining survey. Mean Mobile Application Rating Scale scores indicated good acceptability for functionality and aesthetics and fair acceptability for subjective quality. Among those who completed the posttraining assessment, mean past-week drinking days reduced from 5.1 (SD 2.0) pre-training to 4.2 (SD 2.3) in week 4 (t454=7.87; P<.001), and mean past-week standard drinks reduced from 32.8 (SD 22.1) to 24.7 (SD 20.1; t454=8.58; P<.001). Mean Craving Experience Questionnaire frequency scores reduced from 4.5 (SD 2.0) to 2.8 (SD 1.8; t435=19.39; P<.001). Severity of Dependence scores reduced from 7.7 (SD 3.0) to 6.0 (SD 3.2; t435=12.44; P<.001). For the 19.4% (254/1309) of participants who completed a 1-month follow-up, mean past-week drinking days and standard drinks were 3.9 (SD 2.5) and 23.9 (SD 20.7), respectively, both significantly lower than at baseline (P<.001). Conclusions The findings suggest SWiPE is feasible and acceptable and may be effective at reducing alcohol consumption and craving in a predominantly nontreatment-seeking sample of adult Australians drinking at hazardous levels. SWiPE’s efficacy, relative to a control condition, now needs establishing in a randomized controlled trial. Smartphone-delivered personalized ApBM could be a highly scalable, widely accessible support tool for reducing alcohol use. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12620000638932; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000638932p International Registered Report Identifier (IRRID) RR2-10.2196/21278
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Affiliation(s)
- Victoria Manning
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia.,Turning Point, Eastern Health, Melbourne, Australia
| | - Hugh Piercy
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia.,Turning Point, Eastern Health, Melbourne, Australia
| | - Joshua Benjamin Bernard Garfield
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia.,Turning Point, Eastern Health, Melbourne, Australia
| | | | | | - Dan Ian Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia.,Turning Point, Eastern Health, Melbourne, Australia
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Effects of Aerobic Exercise Combined with Attentional Bias Training on Cognitive Function and Psychiatric Symptoms of Individuals with Methamphetamine Dependency: a Randomized Controlled Trial. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00686-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Liu XXL. A Systematic Review of Prevention and Intervention Strategies for Smartphone Addiction in Students: Applicability During the COVID-19 Pandemic. JOURNAL OF EVIDENCE-BASED PSYCHOTHERAPIES 2021. [DOI: 10.24193/jebp.2021.2.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
"During this coronavirus (COVID-19) pandemic, smartphones play an
important role in online classes, study, and entertainment. However,
excessive use may lead to smartphone addiction (SPA). The incidence of
SPA among students has increased with the spread of COVID-19 and
threatens to impair home-based students’ learning efficiency and physical
and mental health. This study aimed to provide a comprehensive overview
of the latest achievements in SPA prevention and treatment, and a theoretical
basis for future experimental research and clinical treatment, while
considering their applicability during the current pandemic. We researched
the core literature in Chinese, English, and Korean databases from 2000 to
2021; 3208 articles were identified. After reading the titles, abstracts, and
full texts, 53 articles were selected. Research on SPA interventions was
relatively limited; we identified six types of prevention and treatment
measures: psychotherapies, cognitive training, behavioral intervention,
application restriction, social intervention, and complementary and
alternative medicine. They can be implemented by students, parents, or
online experts. Future research should focus on developing early measures
to identify and prevent SPA and enhance students’ change motivation."
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Affiliation(s)
- Xiao-xia Liu Liu
- Department of Sports Science, College of Education, Zhejiang University, Hangzhou 310058, China
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Zhang MWB, Smith HE. Challenges When Evaluating Cognitive Bias Modification Interventions for Substance Use Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217821. [PMID: 33114579 PMCID: PMC7662791 DOI: 10.3390/ijerph17217821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 01/25/2023]
Abstract
In recent years, advances in experimental psychology have led to a better understanding in automatic, unconscious processes, referred to as attentional and approach biases amongst individuals with substance use disorders. Attentional biases refer to the relatively automatic tendencies for attention to be preferentially allocated towards substance-related cues. Whereas, approach bias refers to the relatively automatic behavioral tendencies of individuals to reach out to substance-related cues in their natural environment. While, several reviews confirm the existence of these biases, and the effectiveness of bias modification, the conduct of cognitive bias modification amongst substance-using individuals is not without its challenges. One of these is that cognitive biases, both attentional and approach biases, are not universally present; and several individual differences factors modulate the magnitude of the biases. Another challenge that investigators faced in their conduct of cognitive bias modification relates to the selection of the appropriate task for bias assessment and modification. Other challenges intrinsic to cognitive bias modification intervention relates to that of participant attrition, much like conventional psychotherapies. Negative findings, of the absence of biases at baseline, or the lack of effectiveness of bias modification have been reported in studies of cognitive bias modification. All these challenges could have an impact on bias assessment and modification. In this perspective paper, we will explore the literature surrounding each of these challenges and discuss potential measures that could be undertaken to mitigate these clinical and research challenges.
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Affiliation(s)
- Melvyn W. B. Zhang
- National Addiction Management Service, Institute of Mental Health, Singapore 539747, Singapore
- Correspondence:
| | - Helen E. Smith
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore 308232, Singapore;
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Manning V, Piercy H, Garfield JBB, Lubman DI. Personalized Approach Bias Modification Smartphone App ("SWIPE") to Reduce Alcohol Use Among People Drinking at Hazardous or Harmful Levels: Protocol for an Open-Label Feasibility Study. JMIR Res Protoc 2020; 9:e21278. [PMID: 32795989 PMCID: PMC7455870 DOI: 10.2196/21278] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 01/15/2023] Open
Abstract
Background Alcohol accounts for 5.1% of the global burden of disease and injury, and approximately 1 in 10 people worldwide develop an alcohol use disorder. Approach bias modification (ABM) is a computerized cognitive training intervention in which patients are trained to “avoid” alcohol-related images and “approach” neutral or positive images. ABM has been shown to reduce alcohol relapse rates when delivered in residential settings (eg, withdrawal management or rehabilitation). However, many people who drink at hazardous or harmful levels do not require residential treatment or choose not to access it (eg, owing to its cost, duration, inconvenience, or concerns about privacy). Smartphone app–delivered ABM could offer a free, convenient intervention to reduce cravings and consumption that is accessible regardless of time and place, and during periods when support is most needed. Importantly, an ABM app could also easily be personalized (eg, allowing participants to select personally relevant images as training stimuli) and gamified (eg, by rewarding participants for the speed and accuracy of responses) to encourage engagement and training completion. Objective We aim to test the feasibility and acceptability of “SWIPE,” a gamified, personalized alcohol ABM smartphone app, assess its preliminary effectiveness, and explore in which populations the app shows the strongest indicators of effectiveness. Methods We aim to recruit 500 people who drink alcohol at hazardous or harmful levels (Alcohol Use Disorders Identification Test score≥8) and who wish to reduce their drinking. Recruitment will be conducted through social media and websites. The participants’ intended alcohol use goal (reduction or abstinence), motivation to change their consumption, and confidence to change their consumption will be measured prior to training. Participants will be instructed to download the SWIPE app and complete at least 2 ABM sessions per week for 4 weeks. Recruitment and completion rates will be used to assess feasibility. Four weeks after downloading SWIPE, participants will be asked to rate SWIPE’s functionality, esthetics, and quality to assess acceptability. Alcohol consumption, craving, and dependence will be measured prior to commencing the first session of ABM and 4 weeks later to assess whether these variables change significantly over the course of ABM. Results We expect to commence recruitment in August 2020 and complete data collection in March 2021. Conclusions This will be the first study to test the feasibility, acceptability, and preliminary effectiveness of a personalized, gamified ABM intervention smartphone app for hazardous or harmful drinkers. Results will inform further improvements to the app, as well as the design of a statistically powered randomized controlled trial to test its efficacy relative to a control condition. Ultimately, we hope that SWIPE will extend the benefits of ABM to the millions of individuals who consume alcohol at hazardous levels and wish to reduce their use but cannot or choose not to access treatment. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000638932p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000638932p International Registered Report Identifier (IRRID) PRR1-10.2196/21278
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Affiliation(s)
- Victoria Manning
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Richmond, Victoria, Australia.,Turning Point, Eastern Health, Richmond, Victoria, Australia
| | - Hugh Piercy
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Richmond, Victoria, Australia.,Turning Point, Eastern Health, Richmond, Victoria, Australia
| | - Joshua Benjamin Bernard Garfield
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Richmond, Victoria, Australia.,Turning Point, Eastern Health, Richmond, Victoria, Australia
| | - Dan Ian Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Richmond, Victoria, Australia.,Turning Point, Eastern Health, Richmond, Victoria, Australia
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Melvyn Z, Chow A, Vallabhajosyula R, Fung DSS. Emotional Bias Modification in Youths with Attention Deficit Hyperactivity Disorder (ADHD): New Research Vista. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4028. [PMID: 32516993 PMCID: PMC7313023 DOI: 10.3390/ijerph17114028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/28/2020] [Accepted: 06/02/2020] [Indexed: 11/16/2022]
Abstract
Whilst cognitive bias modification was initially used in the treatment of anxiety disorders, it is also currently being used for the treatment of other psychopathologies. In fact, cognitive bias modification has been especially well-investigated amongst children and adolescents. A recent review suggests some evidence for the modification of interpretative biases amongst children with neurodevelopment disorders. There have since been other studies reporting of the existence of other cognitive biases, such as emotional biases, amongst individuals with attention deficit hyperactivity disorder (ADHD). This perspective article will discuss the epidemiology of ADHD and the nature of emotional biases that are present amongst individuals with ADHD. This perspective article also reviewed some of the studies that have assessed and modified emotional biases in individuals with ADHD. A total of three studies have been identified from the published literature that provide evidence for targeting emotional biases amongst individuals with ADHD. These studies provide us with preliminary evidence for the effectiveness of modifying emotional biases and how it could help in ameliorating symptoms related to emotional dysregulation. There needs to be future research in this area with further evidence supporting the effectiveness of modifying emotional biases. It is also crucial for future research to determine which of these tools is best at detecting such biases, and which of these tools are versatile enough and non-invasive that they could safely be implemented for both research and clinical needs.
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Affiliation(s)
- Zhang Melvyn
- Family Medicine & Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore;
| | - Aloysius Chow
- Family Medicine & Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore;
| | - Ranganath Vallabhajosyula
- Department of Anatomy, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore;
| | - Daniel SS Fung
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore 539747, Singapore;
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Abstract
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.
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Affiliation(s)
| | - Gloria Garcia-Fernandez
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia; Department of Psychology, University of Oviedo, Spain
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University (UA), Antwerp, Belgium
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