This K23 career development program will prepare the Candidate, Raj K. Kalapatapu, M.D., as an independent investigator studying cognitive rehabilitation for individuals with substance use disorders. Specifically, using the Stage Model of Behavioral Therapies, this K23. As cognitive impairment moderates clinical outcomes in cocaine abusers, effectively treating cognitive impairment as part of a comprehensive treatment plan for cocaine abusers can potentially improve important clinical outcomes, such as abstinence, quality of life, and treatment completion. Because existing models of cognitive rehabilitation have yielded small effect sizes in improving cognition in cocaine abusers, newer models of cognitive rehabilitation are needed to enhance existing models to improve cognition more effectively in cocaine abusers. This K23 will allow Dr. Raj to learn cognitive rehabilitation principles from the OT field and adapt such principles to substance abusers. OT improves the function of various cognitively impaired patients (e.g., stroke, traumatic brain injury, schizophrenia) by using cognitive-adaptation to enhance cognition in daily quality of life/function and OT can address the cognitive and problem solving deficits that lead to a breakdown in daily life skills. A model of OT-based cognitive rehabilitation in cocaine abusers may strongly improve cognition, ultimately improving important clinical outcomes. A mentoring team led by Frances R. Levin, M.D., including experts from addiction psychiatry, occupational therapy, neuropsychology and biostatistics, will guide Dr. Raj in a 5-year multidisciplinary research and training in: 1) design, methodology, and logistics of substance abuse/psychiatric research in clinical trials, 2) cognitive rehabilitation interventions, 3) behavioral therapy development, 4) biostatistics, and 5) responsible conduct of research. The area of study is consistent with Objective #1 in the Treatment goal of NIDA's Strategic Plan, in that a behavioral intervention (OT-based cognitive rehabilitation) is being developed for drug abuse treatment. Based on The Stage Model of Behavioral Therapies, the Stage 1a feasibility study and the Stage 1b pilot study will be a 12-week, randomized, parallel-group outpatient study of treatment-seeking cocaine abusers (age 18- 65) who are mild-to-moderately cognitively impaired and dissatisfied with their quality of life Participants will be randomized to a Cog-Rehab arm (drug counseling plus OT-based cognitive rehabilitation), or to a Control arm (drug counseling + psychoeducation/games). Primary outcomes will be improvements in cognition, cocaine abstinence, and daily quality of life/function. Feasibility is demonstrated in our pilot data, where we have enrolled 4 participants
Cocaine use disorders remain a significant public health problem in the U.S., and cognitive impairment moderates clinical outcomes in cocaine abusers. Integrating OT-based cognitive rehabilitation in a comprehensive treatment plan for cocaine abusers would have a direct and significant positive impact on the public health burden of this population.
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