Abstract
BackgroundCognitive dysfunction is disproportionately prevalent among persons with opioid use disorder (OUD). Specific domains of cognitive dysfunction (attention, executive functioning, memory, and information processing) may significantly impede treatment outcomes among patients on medication for OUD (MOUD). This limits patient's ability to learn, retain, and apply information conveyed in behavioral intervention sessions. Evidence-based accommodation strategies have been integrated into behavioral interventions for other patient populations with similar cognitive profiles as persons with OUD; however, the feasibility and efficacy of these strategies have not yet been tested among patients on MOUD in a drug treatment setting.MethodsWe conducted a series of focus groups with 25 key informants (10 drug treatment providers and 15 patients on MOUD) in a drug treatment program in New Haven, CT. Using an inductive approach, we examined how cognitive dysfunction impedes participant's ability to retain, recall, and utilize HIV prevention information in the context of drug treatment.ResultsTwo main themes capture the overall responses of the key informants: (1) cognitive dysfunction issues and (2) accommodation strategy suggestions. Subthemes of accommodation strategies involved suggestions about particular evidence-based strategies that should be integrated into behavioral interventions for persons on MOUD. Specific accommodation strategies included: use of a written agenda, mindfulness meditation, multi-modal presentation of information, hands-on demonstrations, and a formal closure/summary of sessions.ConclusionsAccommodation strategies to compensate for cognitive dysfunction were endorsed by both treatment providers and patients on MOUD. These accommodation strategies have the potential to enhance the efficacy of behavioral interventions to reduce HIV transmission among persons on MOUD as well as addiction severity, and overdose.
Highlights
The opioid epidemic is an on-going public health crisis that continues to plague the US, as Opioid Use Disorder (OUD) diagnoses and overdose rates have exponentially increased in the past 10 years [1]
One focus group session was with drug treatment providers, and the other focus group session was with patients on medication for opioid use disorder (MOUD)
We coded two main themes to describe the responses of 25 key informants, including 10 treatment providers and 15 patients on MOUD
Summary
The opioid epidemic is an on-going public health crisis that continues to plague the US, as Opioid Use Disorder (OUD) diagnoses and overdose rates have exponentially increased in the past 10 years [1]. Various psychoeducational counseling approaches are commonly provided in the context of MOUD [5] Such approaches are often used to increase knowledge, motivation, and coping skills related to addiction and health risk reduction [6]. By nature, these behavioral approaches often place cognitive demands on OUD patients, many of whom already experience cognitive dysfunction associated with drug use and related factors. Specific domains of cognitive dysfunction (attention, executive functioning, memory, and information processing) may significantly impede treatment outcomes among patients on medication for OUD (MOUD) This limits patient’s ability to learn, retain, and apply information conveyed in behavioral intervention sessions. Evidence-based accommodation strategies have been integrated into behavioral interventions for other patient populations with similar cognitive profiles as persons with OUD; the feasibility and efficacy of these strategies have not yet been tested among patients on MOUD in a drug treatment setting
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