Project #1 Cognitive dysfunction is increasingly considered to be a defining feature of addiction. The cognitive functions most commonly found to be impaired among substance users (attention, working memory, and inhibitory control) are precisely those functions that may be necessary for engaging and benefiting in behavioral therapies. This may be particularly relevant for cognitive behavioral approaches (CBT), as these functions are needed in order to (1) engage in and attend to treatment, (2) acquire new cognitive and behavioral skills and strategies, and (3) implement them effectively. This project will evaluate the extent to which training designed to enhance those target functions (attention, working memory, inhibitory control) delivered prior to a trial of computerized CBT (CBT4CBT) improves treatment engagement and outcome: Treatment will be delivered in 2 phases. In the first phase, 150 individuals with cocaine use disorder, all of whom are attending an intensive outpatient program, will be randomized to one of the following 4-week 'preparatory'conditions: (1) no training (treatment as usual only, TAU);(2) 4 weeks of a rapid abstinence initiation procedure (RAI), or (3) 4 weeks of RAI plus cognitive control training (CCT) with monetary incentives for improved performance. In the second phase, all participants will receive an 8-week trial of CBT4CBT (12 weeks total). Changes in the targeted cognitive functions and cocaine use will be assessed at baseline, after the 4 week preparatory phase, after the 8-week CBT4CBT trial, and at 1-, 3, and 6-month follow-up interviews. Neuroimaging using tasks selected to assess cognitive correlates of working memory, cognitive control, and regulation of craving (N-Back, Stroop, Regulation of Craving) will be done at 3 time points (baseline, post preparatory'phase, post CBT4CBT phase). These will be used to evaluate (1) neurocognitive predictors of treatment response in both phases, (2) effects of preparatory procedures on neurocognitive targets, and (3) changes in neural function associated with the preparatory conditions and CBT4CBT. We hypothesize improved function in attention, working memory, and inhibitory control will be associated with better learning and implementation of CBT skills and hence to reduced cocaine use. A six-month follow-up is included to evaluate the durability of intervention effects. The novel strategy of providing incentives contingent on improved performance on cognitive training tasks is likely to substantially improve CCT's effectiveness within this sample. The strategy of cognitive enhancement prior to initiation of treatment goes beyond previous research in this area by evaluating the effect of cognition as a modifiable mediator of a response to treatment, rather than testing direct effects of improving cognitive function on drug use outcomes. If shown to be effective, the strategy of enhancing cognitive function prior to initiation of treatment may generalize to other substance use disorders as it targets cognitive dysfunction as a defining feature of addiction.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Specialized Center (P50)
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Study Section
Special Emphasis Panel (ZDA1-EXL-T (03))
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Yale University
New Haven
United States
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Jensen, Kevin P; DeVito, Elise E; Yip, Sarah et al. (2018) The Cholinergic System as a Treatment Target for Opioid Use Disorder. CNS Drugs 32:981-996
Boswell, Rebecca G; Sun, Wendy; Suzuki, Shosuke et al. (2018) Training in cognitive strategies reduces eating and improves food choice. Proc Natl Acad Sci U S A 115:E11238-E11247
Rash, Carla J; Petry, Nancy M; Alessi, Sheila M et al. (2018) Monitoring Alcohol Use in Heavy Drinking Soup Kitchen Attendees. Alcohol :
Petry, Nancy M; Zajac, Kristyn; Ginley, Meredith K (2018) Behavioral Addictions as Mental Disorders: To Be or Not To Be? Annu Rev Clin Psychol 14:399-423
Camenga, Deepa; Gutierrez, Kevin M; Kong, Grace et al. (2018) E-cigarette advertising exposure in e-cigarette naïve adolescents and subsequent e-cigarette use: A longitudinal cohort study. Addict Behav 81:78-83
Decker, Suzanne E; Morie, Kristen P; Malin-Mayo, Bo et al. (2018) Positive and negative affect in cocaine use disorder treatment: Change across time and relevance to treatment outcome. Am J Addict :
Kiluk, Brian D; Frankforter, Tami L; Cusumano, Michelle et al. (2018) Change in DSM-5 Alcohol Use Disorder Criteria Count and Severity Level as a Treatment Outcome Indicator: Results from a Randomized Trial. Alcohol Clin Exp Res :
Morie, Kristen P; Wu, Jia; Landi, Nicole et al. (2018) Feedback processing in adolescents with prenatal cocaine exposure: an electrophysiological investigation. Dev Neuropsychol 43:183-197
Yip, Sarah W; Worhunsky, Patrick D; Xu, Jiansong et al. (2018) Gray-matter relationships to diagnostic and transdiagnostic features of drug and behavioral addictions. Addict Biol 23:394-402
Yip, Sarah W; Potenza, Marc N (2018) Application of Research Domain Criteria to childhood and adolescent impulsive and addictive disorders: Implications for treatment. Clin Psychol Rev 64:41-56

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