Short communicationCognitive impairment, retention and abstinence among cocaine abusers in cognitive-behavioral treatment
Introduction
According to the 1997 National Household Survey on Drug Abuse, approximately 1.5 million adults use cocaine in the US, signaling a widespread problem that can often lead to dependence requiring therapeutic intervention. To address this need, a variety of psychopharmacological and psychosocial treatments have been developed to treat cocaine dependence. The use of manual-guided psychotherapy in pharmacotherapy clinical trials has been advocated on theoretical grounds, and it appears to improve compliance and reduce unwanted variance due to therapist differences (Klein, 1991, Nunes, 1997). One of these, cognitive-behavioral treatment (CBT), has shown considerable promise (Carroll et al., 1991, Maude-Griffin et al., 1998). However, for a substantial proportion of patients its efficacy remains limited. Documented dropout rates from CBT treatments have been reported to range from 33 to 64%. (Carroll et al., 1991, Carroll et al., 1994). Thus, it is important to identify factors associated with treatment drop-out or poor outcome.
A fundamental component of CBT is the use of cognitive processing as a mediator of behavioral change (Carroll, 1998). However, impairment in cognitive functioning has been found in a substantial proportion of cocaine dependent patients (Bolla et al., 1999, Bolla et al., 2000). Specifically, attention, learning, memory, and cognitive flexibility are often impaired in cocaine abusers (Ardila et al., 1991, Berry et al., 1993, Horner, 1997), It is reasonable to hypothesize that treatment-seeking cocaine abusers who cannot comprehend the interventions presented to them within the CBT framework (e.g. functional analysis, skills developing) are more likely to drop out of treatment or do poorly.
Surprisingly, only a few studies have investigated the effects of cognitive functioning on treatment outcome among cocaine abusers (Fals-Stewart and Schafer, 1992, Teichner et al., 2001), and none has investigated this specifically as pertaining to CBT. To address this gap in knowledge, we conducted an initial study of the relationship between cognitive functioning at treatment entry on retention and level of abstinence. The study was conducted among cocaine dependent users in short-term psychopharmacotherapy that included weekly individual manualized-CBT. We hypothesized that treatment completers (those completing at least 12 weeks in CBT) would score higher on cognitive measures than dropouts and that greater abstinence would be associated with higher cognitive functioning at baseline.
Section snippets
Participants
Eligible patients consecutively enrolled during a 12-month period (from 6/00 to 6/01) in an ongoing clinical trial for non-depressed cocaine patients were approached about participation in the present study. The placebo-controlled clinical trial consisted of 15 weeks of CBT+medication (either gabapentin or placebo). To evaluate eligibility for this trial, patients were administered an evaluation including the SCID I/P interview (DSM-IV version) administered by trained Ph.D. level psychologists.
Results
Completers and dropouts did not differ significantly on demographic variables or patterns of cocaine use. The mean age for completers was 41.8 (SD 6.6) vs. 37.1 (SD 6.6) for the dropouts; t(1; 16)=1.4; P=0.17. The mean years of education for the completers was 14.3 (SD 2.06) vs. 13.5 (SD 1.38) for the dropouts; t(1, 16)=1.02; P=0.32. African Americans constituted 66.6% of the completers vs. 58.3% of the dropouts; χ2(2)=2.04; P=0.35 and 27.7% of the completers vs. 38.8% of the dropouts were
Discussion
This study provides preliminary evidence that levels of cognitive functioning differ between treatment completers and dropouts. The low cognitive scores of the treatment dropouts indicate that compared with completers, these patients may suffer from difficulties in ability to focus, hold and sustain attention. These patients with deficits in attention and mental reasoning may have difficulties participating in CBT. For example, some patients may have difficulties attending throughout the 60
Acknowledgements
The authors thank Ivana Huang for assisting in data collection and Valerie Richmond for manuscript preparation, Drs Suzanne Vosburg for her comments on an earlier draft and Adam Bisaga for sharing his data on these patients. This research was supported by NIDA grant (PI 50 DA09236, H.D. Kleber). Support for Dr Hasin is acknowledged from NIAAA grant AA K02 AA00151. The New York State Psychiatric Institute also contributed support to this work.
References (18)
- et al.
Neuropsychological deficits in abstinent cocaine abusers: preliminary findings after two weeks of abstinence
Drug Alcohol Depend.
(1993) - et al.
Neuropsychological performance of individuals dependent on crack-cocaine, or crack-cocaine and alcohol, at 6 weeks and 6 months of abstinence
Drug Alcohol Depend.
(2002) Cognitive functioning in alcoholic patients with and without cocaine dependence
Arch. Clin. Neuropsychol.
(1997)- et al.
MicroCog: use in an impatient substance abuse treatment setting
Arch. Clin. Neuropsychol.
(1998) - et al.
Neuropsychological deficits in chronic cocaine abusers
Int. J. Neurosci.
(1991) - et al.
Dose-related neurobehavioral effects of chronic cocaine use
J. Neuropsychiatry Clin. Neurosci.
(1999) - et al.
Differential effects of cocaine and cocaine alcohol on neurocognitive performance
Neurology
(2000) - Carroll, K.M., 1998. A Cognitive-Behavioral Approach: treating cocaine addiction. Therapy manuals for drug addiction,...
- et al.
Psychotherapy and pharmacotherapy for ambulatory cocaine abusers
Arch. Gen. Psychiatry
(1994)
Cited by (246)
A pilot study investigating cognitive impairment associated with opioid overdose
2023, Drug and Alcohol DependenceApathy is associated with poorer abstinence self-efficacy in individuals with methamphetamine dependence
2021, Addictive Behaviors ReportsCitation Excerpt :This relationship may be further compounded by increased apathy, which is also independently associated with executive function deficits and learning difficulties (Castellon, Hinkin, & Myers, 2000; Cole, 2007). Combined with evidence linking NCI with a variety of other adverse health and functional outcomes in METH users, which may further interfere with treatment outcomes (Aharonovich, Nunes, & Hasin, 2003; Henry, Minassian, & Perry, 2010; Minassian, 2017; Sadek, 2007; Weber, 2012), individuals should be screened for NCI prior to treatment to appropriately tailor intervention strategies to their cognitive strengths and/or weaknesses. Recency of METH use was the only METH use characteristic significantly associated with abstinence self-efficacy at the univariable level.
Factors mediating pain-related risk for opioid use disorder
2021, Neuropharmacology