Cognitive Training and Work Therapy for the Treatment of Verbal Learning and Memory Deficits in Veterans With Alcohol Use Disorders

Abstract

Objective This study focused on the efficacy of cognitive training for verbal learning and memory deficits in a population of older Veterans with alcohol use disorders. Methods Veterans with alcohol use disorders, who were in outpatient treatment at VA facilities and in early phase recovery (N = 31), were randomized to receive a 3-month trial of daily cognitive training plus work therapy (n = 15) or work therapy alone (n = 16), along with treatment as usual. Participants completed assessments at baseline and at 3- and 6-month follow-ups; the Hopkins Verbal Learning Task (HVLT) was the primary outcome measure. Results Participants were primarily male (97%), in their mid-50’s (M = 55.16, SD = 5.16), and had been sober for 1.64 (SD = 2.81) months. Study retention was excellent (91% at 3-month follow-up) and adherence to treatment in both conditions was very good. On average, participants in the cognitive training condition had more than 41 hours of cognitive training, and both conditions had more than 230 hours of productive activity. HVLT results at 3-month follow-up revealed significant condition effects favoring cognitive training for verbal learning (HVLT Trial-3 T-score, p < .005; Cohen’s d = 1.3) and verbal memory (HVLT Total T-score, p < .01, Cohen’s d = 1.1). Condition effects were sustained at 6-month follow-up. At Baseline, 55.9% of participants showed a significant deficit in verbal memory and 58.8% showed a deficit in verbal learning compared with a premorbid estimate of Verbal IQ. At 3-month follow-up there was a significant reduction in the number of participants in the cognitive training condition with clinically significant verbal memory deficits (p < .01, NNT= 3.0) compared with the work therapy alone condition, and a trend toward significance for verbal learning deficits, which was not sustained at 6-month follow-up. Conclusions This NIDA-funded pilot study demonstrates that cognitive training within the context of another activating intervention (work therapy) may have efficacy in remediating verbal learning and memory deficits in patients with alcohol use disorder. Findings indicate a large effect for cognitive training in this pilot study, which suggests that further research is warranted. This study is is registered on Clinicaltrials.gov (NCT 01410110).

Contributions to Understanding the Neuropsychology of Alcoholism: An INS Legacy

“…These findings echo both earlier and more recent controlled studies of memory recovery with short-term or sustained sobriety showing a range of recovery, from little to extensive, after short-term (e.g., 1 week) to long-term (e.g., 1 year or more) sustained abstinence from alcohol (e.g., Bartels et al, 2007;Bates, Voelbel, Buckman, Labouvie, & Barry, 2005;Bell, Vissicchio, & Weinstein, 2016;Butters & Cermak, 1980;Fabian & Parsons, 1983; 852 E.V. Sullivan Leber, Jenkins, & Parsons, 1981;Mann, Gunther, Stetter, & Ackermann, 1999;Pitel et al, 2009;Rosenbloom et al, 2004;Rourke & Grant, 1999;Yohman, Parsons, & Leber, 1985) (for reviews, see Oscar-Berman et al, 2014;Pitel, Eustache, & Beaunieux, 2014).…”

A systematic review of treatments for alcohol-related cognitive impairment: lessons from the past and gaps for future interventions

“…Furthermore, cognitive training was also related to behavioural changes as a trend was found between working memory training and the reduction of drinks per drinking occasion (from 7.07 drinks to 5.58 drinks in the intervention group v. 5.58 drinks to (Khemiri et al, 2019). Verbal learning and verbal memory: One study assessed the effect of a computerised training tool (Posit Science software®) for the enhancement of verbal learning and memory (Bell, Vissicchio, & Weinstein, 2016). The tool is designed to improve several cognitive functions including attention, memory and sensory processing through visual and auditory tasks that progress from elementary to more complex and demanding games.…”

Addiction, cognitive decline and therapy: seeking ways to escape a vicious cycle

“…For example, a recent study showed that CET improved the rate of substance abuse in patients with schizophrenia (Eack et al , ). It has also been shown to be effective in improving cognition for veterans with alcohol‐use disorder (Bell et al ). This improvement may be related to an increase in activation in prefrontal, limbic and striatal regions that was observed in schizophrenia clients with comorbid alcohol‐ or cannabis‐use disorder that underwent a program of CET (Wojtalik et al ).…”