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

Abstract

Cognitive impairments are associated with poor outcomes when treating cocaine dependent patients, but behavioral interventions to mitigate this impact have not been developed. In this Stage 1A/1B treatment development study, several compensatory strategies (e.g. content repetition, daily logs, diaries, visual presentation) were combined to create a modified cognitive behavioral therapy (M-CBT) for treating cocaine dependence. Initially, a select group of therapists, neuropsychology experts, and patients were asked to provide input on early drafts of the treatment manual and companion patient workbook. After an uncontrolled small trial (N=15) and two rounds of manual development (Stage 1A), a pilot randomized clinical trial (N=102) of cocaine dependent outpatients with and without cognitive impairments was conducted (Stage 1B). Participants were randomized to M-CBT (N=52) or CBT (N=50). Both treatments were individually delivered over 12 weeks with assessments conducted at baseline, end-of-treatment, and 3-month follow-up. The primary outcome was frequency of cocaine use, measured by number of days used in the prior 7 days. Participants in the two treatment groups did not differ significantly on drug use reduction or retention in treatment. However, among participants who completed at least 9 weeks of treatment, those in M-CBT showed a trend towards greater reduction in cocaine use compared to those in the CBT group. M-CBT is feasible for impaired and non-impaired cocaine dependent participants. However, M-CBT treatment did not show significant superiority over standard CBT in the present sample.

Galantamine and Computerized Cognitive Behavioral Therapy for Cocaine Dependence

“…Cognitive impairment is associated with poorer outcome and higher dropout in CBT among cocaine users 7–9 . Potential strategies for improving responses to cognitively demanding therapies such as CBT include simplifying treatment for patients with cognitive impairment 10 or targeting impairment directly via cognitive training exercises 11 ; both strategies have yielded mixed results to date 12–15 . A novel strategy is use of cognitive-enhancing agents (e.g., cholinesterase inhibitors) to improve attention and concentration as a means of addressing both cognitive function and substance use 11, 16, 17 .…”

Understanding eHealth Cognitive Behavioral Therapy Targeting Substance Use: Realist Review

“…Assessing neuropsychological functioning and tailoring content to the appropriate level of cognitive functioning is, therefore, important in order to improve understanding of the material. Simplifying content or targeting impairment directly via cognitive training are two other strategies [ 40 , 41 ]. The program strategy identified in CMOc 3 may be applied to this kind of impairment as well.…”

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

“…In general, social and non-social cognitive impairments have been proposed to diminish the efficacy of therapeutic interventions (50,51). Thus, psychotherapeutic but also psychopharmacological approaches were recently suggested to alleviate cognitive deficits in CU in order to improve addiction therapy success (51)(52)(53). For instance, cognitive enhancement with ADHD (or other) medications has been proposed as a treatment target for cognitive disturbances in cocaine use disorder in the past (53)(54)(55).…”