UCSF

Brief Statement of the Problem: Effectively treating cognitive impairment as part of a comprehensive treatment plan for adults with cocaine use disorder (CUD) could potentially improve important clinical outcomes, such as abstinence, quality of life, and treatment completion. Because existing models of cognitive rehabilitation have yielded small to medium effect sizes in improving cognition in CUD, newer models of cognitive rehabilitation are needed to improve cognition more effectively in CUD.

Description of the Methods and Procedures Used to Gather Data: This dissertation describes a pilot 12-week, randomized, parallel group outpatient study of treatment-seeking adults with CUD (age 18-65) who were mild-to-moderately cognitively impaired and dissatisfied with their quality of life. Participants were randomized to a “Cog-Rehab” arm (drug counseling + occupational therapy-based cognitive rehabilitation), or to a “Control” arm (drug counseling + psychoeducation/computer exercises).

Condensed Summary of the Findings: Study participants had a mean age of 57.5 years (SD 5.8), 30 (96.8%) were male, 19 (61.3%) were Black, 12 (38.7%) were White, 6 (19.4%) were Latino, 15 (48.4%) were single, and had a mean education of 12.8 years (SD 1.4). Some significant between-group effect sizes were found for certain neurocognitive measures (favoring Cog-Rehab arm: attentional bias 1.0 attention 0.7, visual memory 0.8, executive function 1.0) and one functional assessment (favoring Cog-Rehab arm: Drug User Quality of Life Score 0.8). This study was feasible, acceptable, and provides preliminary evidence for efficacy based on effect sizes. MET-R performance was significantly associated only with the overall impulsivity neurocognitive domain (adjusted coefficient 0.8, 95% CI 0.2 to 1.3) on a neurocognitive battery. The MET-R may be uniquely measuring the domain of impulsivity that is not captured by traditional neurocognitive testing.