Integrating Cognitive Dysfunction Accommodation Strategies Into Behavioral Interventions for Persons on Medication for Opioid Use Disorder

Abstract

BackgroundCognitive dysfunction is disproportionately prevalent among persons with opioid use disorder (OUD). Specific domains of cognitive dysfunction (attention, executive functioning, memory, and information processing) may significantly impede treatment outcomes among patients on medication for OUD (MOUD). This limits patient's ability to learn, retain, and apply information conveyed in behavioral intervention sessions. Evidence-based accommodation strategies have been integrated into behavioral interventions for other patient populations with similar cognitive profiles as persons with OUD; however, the feasibility and efficacy of these strategies have not yet been tested among patients on MOUD in a drug treatment setting.MethodsWe conducted a series of focus groups with 25 key informants (10 drug treatment providers and 15 patients on MOUD) in a drug treatment program in New Haven, CT. Using an inductive approach, we examined how cognitive dysfunction impedes participant's ability to retain, recall, and utilize HIV prevention information in the context of drug treatment.ResultsTwo main themes capture the overall responses of the key informants: (1) cognitive dysfunction issues and (2) accommodation strategy suggestions. Subthemes of accommodation strategies involved suggestions about particular evidence-based strategies that should be integrated into behavioral interventions for persons on MOUD. Specific accommodation strategies included: use of a written agenda, mindfulness meditation, multi-modal presentation of information, hands-on demonstrations, and a formal closure/summary of sessions.ConclusionsAccommodation strategies to compensate for cognitive dysfunction were endorsed by both treatment providers and patients on MOUD. These accommodation strategies have the potential to enhance the efficacy of behavioral interventions to reduce HIV transmission among persons on MOUD as well as addiction severity, and overdose.

Exploring user experiences of a text message-delivered intervention among individuals on opioid use disorder treatment in Kenya: A qualitative study

“…Strategies on how to compensate for this cognitive deficit during behaviour interventions in these patients include having structure and consistency, simple and clear language, using a range of modalities, memory aids e.g. reminders and frequent assessments with immediate feedback during the intervention [ 64 , 67 ]. These point to potential barriers that need to be considered during future implementation of a text-based intervention in this study population.…”

Integrating Cognitive Dysfunction Accommodation Strategies into an HIV Prevention Session: A 2-Arm Pilot Feasibility Study

“…Based on research in other populations, a number of potential accommodation strategies were theorized to compensate the particular domains of cognitive dysfunction that are often present in persons on MOUD [ 14 ]. We presented this foundation of research to drug treatment providers and patients on MOUD to inform the current study and narrow down which specific strategies may demonstrate the greatest efficacy in a drug treatment setting [ 19 ]. The accommodation strategies examined in this pilot study included strategies shown to compensate the specific domains of cognitive dysfunction that are often present among persons on MOUD (i.e., attention, executive functioning, memory, information processing), and that were most frequently endorsed by key informants in focus group research [ 19 ].…”

“…We presented this foundation of research to drug treatment providers and patients on MOUD to inform the current study and narrow down which specific strategies may demonstrate the greatest efficacy in a drug treatment setting [ 19 ]. The accommodation strategies examined in this pilot study included strategies shown to compensate the specific domains of cognitive dysfunction that are often present among persons on MOUD (i.e., attention, executive functioning, memory, information processing), and that were most frequently endorsed by key informants in focus group research [ 19 ]. Outcomes from this study indicate that the accommodation strategies improved participants’ ability to learn and retain intervention content, and to accurately utilize the recalled HIV risk reduction skills over time.…”

“…These accommodation strategies included a written agenda, mindfulness meditation, use of white board, handouts, hands-on demonstrations, videos, and a formal closure (session summary). The strategies were selected based on a prior narrative review, as well as focus group research among patients and treatment providers in the same drug treatment setting [ 14 , 19 ]. Participants completed a HIV risk reduction skills checklist at pre-, post-, and 2-week follow-up, which allowed researchers to compare the two conditions in terms of the level of intervention content retained and utilized over time.…”

Application of the multiphase optimisation strategy (MOST) to optimise HIV prevention targeting people on medication for opioid use disorder (MOUD) who have cognitive dysfunction: protocol for a MOST study

“…The primary activity of the preparation phase is developing a detailed conceptual model that expresses how each component is expected to impact the process—in this case, the uptake of primary HIV prevention behaviours. The preparation phase was completed in our preliminary work,9–12 29 36 which resulted in the identification of four compensatory components (ie, attention, executive functioning, memory and information processing) that show promise in terms of enhancing participants’ ability to process and use primary HIV prevention intervention information13 (table 1).…”