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.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Specialized Center (P50)
Project #
2P50DA009241-21
Application #
8742766
Study Section
Special Emphasis Panel (ZDA1-EXL-T (03))
Project Start
2014-09-01
Project End
2019-08-31
Budget Start
2014-07-01
Budget End
2015-06-30
Support Year
21
Fiscal Year
2014
Total Cost
$503,258
Indirect Cost
$181,744
Name
Yale University
Department
Type
DUNS #
043207562
City
New Haven
State
CT
Country
United States
Zip Code
06520
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Kiluk, Brian D; Nich, Charla; Buck, Matthew B et al. (2018) Randomized Clinical Trial of Computerized and Clinician-Delivered CBT in Comparison With Standard Outpatient Treatment for Substance Use Disorders: Primary Within-Treatment and Follow-Up Outcomes. Am J Psychiatry 175:853-863
Paris, Manuel; Silva, Michelle; AƱez-Nava, Luis et al. (2018) Culturally Adapted, Web-Based Cognitive Behavioral Therapy for Spanish-Speaking Individuals With Substance Use Disorders: A Randomized Clinical Trial. Am J Public Health 108:1535-1542
Carroll, Kathleen M; Nich, Charla; Frankforter, Tami L et al. (2018) Accounting for the uncounted: Physical and affective distress in individuals dropping out of oral naltrexone treatment for opioid use disorder. Drug Alcohol Depend 192:264-270
DeVito, Elise E; Kiluk, Brian D; Nich, Charla et al. (2018) Drug Stroop: Mechanisms of response to computerized cognitive behavioral therapy for cocaine dependence in a randomized clinical trial. Drug Alcohol Depend 183:162-168
Petry, Nancy M; Alessi, Sheila M; Rash, Carla J et al. (2018) A randomized trial of contingency management reinforcing attendance at treatment: Do duration and timing of reinforcement matter? J Consult Clin Psychol 86:799-809
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

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