Abstract
BackgroundExecutive functioning impairment is common in substance use disorder and is a major risk factor for poor treatment outcomes, including treatment drop-out and relapse. Cognitive remediation interventions seek to improve executive functioning and offer a promising approach to increase the efficacy of alcohol and other drug (AOD) treatments and improve long-term therapeutic outcomes. This protocol describes a study funded by the NSW Agency for Clinical Innovation that assesses the effectiveness of delivering a six-week group-based intervention of cognitive remediation in an ecologically valid sample of people attending residential AOD treatment services. We primarily aim to investigate whether cognitive remediation will be effective in improving executive functioning and treatment retention rates. We will also evaluate if cognitive remediation may reduce long-term AOD use and rates of health service utilisation, as well as improve personal goal attainment, quality of life, and client satisfaction with treatment. In addition, the study will involve an economic analysis of the cost of delivering cognitive remediation.Methods/designThe study uses a stepped wedge cluster randomised design, where randomisation will occur at the cluster level. Participants will be recruited from ten residential AOD treatment services provided by the non-government sector. The intervention will be delivered in 12 one-hour group-based sessions over a period of six weeks. All participants who are expected to receive treatment for the duration of the six-week intervention will be asked to participate in the study. The clusters of participants who are randomly assigned to the treatment condition will complete cognitive remediation in addition to treatment as usual (TAU). Primary and secondary outcome assessments will be conducted at pre-cognitive remediation/TAU phase, post-cognitive remediation/TAU phase, two-month follow-up, four-month follow-up, six-month follow-up, and eight-month follow-up intervals.DiscussionThis study will provide comprehensive data on the effect of delivering a cognitive remediation intervention within residential AOD treatment services. If shown to be effective, cognitive remediation may be incorporated as an adjunctive intervention in current treatment programs.Trial registrationAustralian and New Zealand Clinical Trials Register (ANZCTR): ACTRN12618001190291. Prospectively registered 17th July 2018.
Highlights
Executive functioning impairment is common in substance use disorder and is a major risk factor for poor treatment outcomes, including treatment drop-out and relapse
If shown to be effective, cognitive remediation may be incorporated as an adjunctive intervention in current treatment programs
executive functioning (EF) impairment is a significant predictor of treatment drop-out for individuals with Substance use disorder (SUD)
Summary
EF impairment is a significant predictor of treatment drop-out for individuals with SUD. There is an opportunity for AOD treatment providers to address cognitive impairment as part of routine care in order to potentially increase treatment efficacy and reduce treatment drop-out. The present study aims to examine the effectiveness of providing a group-based compensatory CR intervention as an adjunct to residential AOD treatment programs. It is anticipated that there will be reductions in harmful AOD use and associated health service utilisation, as well as significant improvements in personal goal achievement, quality of life, and treatment satisfaction. As the current study is the first stepped wedge cluster randomised trial of a compensatory CR intervention within a residential AOD population, the results potentially hold important implications for the way that interventions are delivered across treatment settings
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