TY - JOUR

T1 - Cognitive training and remediation interventions for substance use disorders

T2 - a Delphi consensus study

AU - Verdejo-Garcia, Antonio

AU - Rezapour, Tara

AU - Giddens, Emily

AU - Khojasteh Zonoozi, Arash

AU - Rafei, Parnian

AU - Berry, Jamie

AU - Caracuel, Alfonso

AU - Copersino, Marc L

AU - Field, Matt

AU - Garland, Eric L

AU - Lorenzetti, Valentina

AU - Malloy-Diniz, Leandro

AU - Manning, Victoria

AU - Marceau, Ely M

AU - Pennington, David L

AU - Strickland, Justin C

AU - Wiers, Reinout

AU - Fairhead, Rahia

AU - Anderson, Alexandra

AU - Bell, Morris

AU - Boendermaker, Wouter J

AU - Brooks, Samantha

AU - Bruno, Raimondo

AU - Campanella, Salvatore

AU - Cousijn, Janna

AU - Cox, W Miles

AU - Dean, Andrew C

AU - Ersche, Karen D

AU - Franken, Ingmar

AU - Froeliger, Brett

AU - Gamito, Pedro

AU - Gladwin, Thomas E

AU - Goncalves, Priscila D

AU - Houben, Katrijn

AU - Jacobus, Joanna

AU - Jones, Andrew

AU - Kaag, Anne M

AU - Lindenmeyer, Johannes

AU - McGrath, Elly

AU - Nardo, Talia

AU - Oliveira, Jorge

AU - Pennington, Charlotte R

AU - Perrykkad, Kelsey

AU - Piercy, Hugh

AU - Rupp, Claudia I

AU - Schulte, Mieke H J

AU - Squeglia, Lindsay M

AU - Staiger, Petra

AU - Stein, Dan J

AU - Stein, Jeff

AU - Stein, Maria

AU - Stoops, William W.

AU - Sweeney, Mary

AU - Witkiewitz, Katie

AU - Woods, Stephen P.

AU - Yi, Richard

AU - Zhao, Min

AU - Ekhtiari, Hamed

N1 - © 2022 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction. Australian Medical Research Future Fund,Grant/Award Number: MRF1141214;National Health and Medical Research Council,Grant/Award Number: GNT2009464

PY - 2023/5

Y1 - 2023/5

N2 - AIMS: Substance use disorders (SUD) are associated with cognitive deficits that are not always addressed in current treatments, and this hampers recovery. Cognitive training and remediation interventions are well suited to fill the gap for managing cognitive deficits in SUD. We aimed to reach consensus on recommendations for developing and applying these interventions.DESIGN, SETTING AND PARTICIPANTS: We used a Delphi approach with two sequential phases: survey development and iterative surveying of experts. This was an on-line study. During survey development, we engaged a group of 15 experts from a working group of the International Society of Addiction Medicine (Steering Committee). During the surveying process, we engaged a larger pool of experts (n = 54) identified via recommendations from the Steering Committee and a systematic review.MEASUREMENTS: Survey with 67 items covering four key areas of intervention development: targets, intervention approaches, active ingredients and modes of delivery.FINDINGS: Across two iterative rounds (98% retention rate), the experts reached a consensus on 50 items including: (i) implicit biases, positive affect, arousal, executive functions and social processing as key targets of interventions; (ii) cognitive bias modification, contingency management, emotion regulation training and cognitive remediation as preferred approaches; (iii) practice, feedback, difficulty-titration, bias modification, goal-setting, strategy learning and meta-awareness as active ingredients; and (iv) both addiction treatment work-force and specialized neuropsychologists facilitating delivery, together with novel digital-based delivery modalities.CONCLUSIONS: Expert recommendations on cognitive training and remediation for substance use disorders highlight the relevance of targeting implicit biases, reward, emotion regulation and higher-order cognitive skills via well-validated intervention approaches qualified with mechanistic techniques and flexible delivery options.

AB - AIMS: Substance use disorders (SUD) are associated with cognitive deficits that are not always addressed in current treatments, and this hampers recovery. Cognitive training and remediation interventions are well suited to fill the gap for managing cognitive deficits in SUD. We aimed to reach consensus on recommendations for developing and applying these interventions.DESIGN, SETTING AND PARTICIPANTS: We used a Delphi approach with two sequential phases: survey development and iterative surveying of experts. This was an on-line study. During survey development, we engaged a group of 15 experts from a working group of the International Society of Addiction Medicine (Steering Committee). During the surveying process, we engaged a larger pool of experts (n = 54) identified via recommendations from the Steering Committee and a systematic review.MEASUREMENTS: Survey with 67 items covering four key areas of intervention development: targets, intervention approaches, active ingredients and modes of delivery.FINDINGS: Across two iterative rounds (98% retention rate), the experts reached a consensus on 50 items including: (i) implicit biases, positive affect, arousal, executive functions and social processing as key targets of interventions; (ii) cognitive bias modification, contingency management, emotion regulation training and cognitive remediation as preferred approaches; (iii) practice, feedback, difficulty-titration, bias modification, goal-setting, strategy learning and meta-awareness as active ingredients; and (iv) both addiction treatment work-force and specialized neuropsychologists facilitating delivery, together with novel digital-based delivery modalities.CONCLUSIONS: Expert recommendations on cognitive training and remediation for substance use disorders highlight the relevance of targeting implicit biases, reward, emotion regulation and higher-order cognitive skills via well-validated intervention approaches qualified with mechanistic techniques and flexible delivery options.

KW - Humans

KW - Delphi Technique

KW - Cognitive Training

KW - Substance-Related Disorders/therapy

KW - Behavior, Addictive/therapy

KW - Consensus

U2 - 10.1111/add.16109

DO - 10.1111/add.16109

M3 - Article

C2 - 36508168

VL - 118

SP - 935

EP - 951

JO - Addiction

JF - Addiction

SN - 0965-2140

IS - 5

ER -