There is now ample evidence from multiple lines of research that chronic ingestion of alcohol and other psychoactive substances is associated with measurable cognitive impairment. Typically, individuals with extensive histories of substance abuse have relatively preserved verbal skills, but have deficits in verbal problem-solving, conceptual shifting, perceptual-spatial skills, abstract reasoning, information-processing speed, and memory. The presence of cognitive deficits among substance-abusing patients has important clinical implications; these deficits are likely to interfere with patients' abilities to receive, encode, and integrate new information presented in the course of treatment. Moreover, findings from several investigations indicate the presence of cognitive impairment among patients is associated with poorer treatment engagement and outcomes. There is also evidence to suggest cognitive functioning improves with extended abstinence. However, from a treatment perspective, the natural rate of cognitive recovery (i.e., time-dependent recovery) is, practically speaking, relatively slow. Although cognitive performance shows signs of improvement after as little as 1 month of sobriety, full recovery takes several months (or more) of abstinence. Given the relative brevity of most interventions for substance abuse, patients may not be cognitively able to engage fully in treatment until long after participation has been completed. It is plausible that methods designed specifically to accelerate the rate of cognitive recovery (i.e., experience-dependent recovery) could have important benefits for substance-abusing patients. Findings from Stage IA/B pilot studies provide preliminary support for this hypothesis. More specifically, use of computer-assisted cognitive stimulation exercises, developed for patients who have suffered traumatic brain injury, can accelerate the cognitive recovery of substance-abusing patients and, importantly, lead to improvements on measures of treatment engagement and posttreatment outcome. Thus, the primary aim of the proposed Stage II trial is to examine the effects of Computer-Assisted Cognitive Rehabilitation (CACR) on treatment response and outcome compared to two control conditions: (a) an equally intensive Computer-Assisted Typing Tutorial (CATT) and (b) Treatment-As-Usual (TAU). Substance-abusing patients (N = 240) from one of two long-term residential treatment programs (i.e., LRTs) will be randomly assigned to the above treatment conditions and will be compared on measures of treatment engagement (during the course of treatment) and 12-month posttreatment outcome (measured quarterly). It is hypothesized that participants who receive CACR will remain in treatment longer and will have better 1-year posttreatment substance use and other psychosocial outcomes compared to patients in the control conditions.
