A Web-Based Behavior Therapy Program Influences the Association Between Cognitive Functioning and Retention and Abstinence in Clients Receiving Methadone Maintenance Treatment

Abstract

Objective: Deficits in cognitive functioning have been well-documented in persons with substance use disorders. In addition, some evidence suggests that poorer cognitive functioning predicts poorer engagement in substance abuse treatment and worse treatment outcomes. This trial is a non-blind, randomized clinical trial with parallel design. Methods: Clients were recruited from a local methadone maintenance clinic within the first 30 days of treatment. All participants completed a comprehensive, computerized neuropsychological assessment (MicroCog) at the time they entered the clinical trial. Participants were randomized to receive 12 months of either standard methadone maintenance treatment or methadone maintenance treatment with an integrated web-based intervention as part of treatment. The aims of the current study were to (a) characterize the cognitive functioning of clients entering methadone maintenance treatment, (b) evaluate the impact of cognitive functioning on the primary outcomes of treatment retention and opioid abstinence, and (c) determine whether cognitive functioning had a differential impact on these outcomes across treatment conditions. Randomization was non-blind and participants were stratified on past-month cocaine use and prior history of methadone, LAAM, or buprenorphine treatment. Results: Eighty participants were randomized to each condition (N = 160). Mean scores on MicroCog scales fell in the average and low average ranges and there were no differences in scores between treatment groups. Lower scores on General Cognitive Proficiency predicted longer study retention (χ 2 = 5.03, p < .05), although this effect was quite small. Generalized linear modeling showed that scores on all MicroCog scales except for Spatial Processing significantly predicted opioid abstinence (defined as percent of total weeks and percent of tested weeks with continuous abstinence), with lower scores predicting smaller percentages of continuous weeks of abstinence. This pattern was not evident in regression analyses in which abstinence was defined as number of total weeks of abstinence. An interaction effect was observed, whereby lower cognitive scores predicted lower levels of abstinence for participants in standard methadone maintenance treatment, but not for those who received the web-based intervention as part of methadone maintenance treatment. Conclusions: Technology-based interventions may hold promise for minimizing the impact of poorer cognitive functioning on treatment outcomes.