Randomized clinical trial of Cognitive Remediation Therapy with Work Therapy in the early phase of substance use disorder recovery for older Veterans: 12-Month follow-up
Randomized clinical trial of Cognitive Remediation Therapy with Work Therapy in the early phase of substance use disorder recovery for older Veterans: 12-Month follow-up
复制标题
DOI：
10.1016/j.jsat.2020.01.018
复制
发表时间：
2020-05-01
影响因子：
3.9
通讯作者：
Fiszdon, Joanna M.
中科院分区：
文献类型：
--
作者：
Bell, Morris D.;Muppala, Bharath;Fiszdon, Joanna M.
目的：在之前的一份关于针对患有物质使用障碍 (SUD) 的老年退伍军人的为期 3 个月的认知矫正治疗 (CRT) 方案的随机临床试验报告中，结合工作疗法 (WT) 与单独的 WT 相比，我们报告了在 CRT + WT 条件下工作记忆和执行功能的神经认知结果在 6 个月的随访中显着改善。然而，不同条件下的 SUD 结果没有发现差异，两组都表现出异常高的禁欲水平。在这项研究中，我们将随访时间延长至 12 个月，以测试 CRT + WT 是否存在 SUD 结果“睡眠效应”。为了更好地了解 WT 的效果，我们添加了常规治疗 (TAU) 比较样本。方法：48 名接受标准门诊 VA 护理的 SUD 退伍军人被随机分为 CRT + WT 或 WT。对 43/48 名拥有最新医疗记录的参与者进行了临床总体印象 (CGI) 评级。分析中添加了具有相似人口和疾病特征的 TAU 对照组 (n = 44)。结果：治疗组在 12 个月时 CGI 方面没有显着差异 (p = 0.27)，其中 77% 接受 CRT + WT 的患者显示出良好的 SUD 结果，而接受 WT 的患者只有 62%。与 TAU 对照组 (27%) 相比，两组都有更好的 CGI 结果 (p < 0.01)。参与 WT 的时间（r = -0.49，p = 0.001）和 CRT 的时间（r = -0.45，p = 0.048）与更好的 CGI 分数相关。结论：虽然没有发现 CRT 的睡眠效应，但强烈支持 WT 对 SUD 结果的稳健影响。
Objective: In a previous report on a randomized clinical trial of a 3-month program of Cognitive Remediation Therapy (CRT) augmented by Work Therapy (WT) compared with WT alone for older veterans with substance use disorder (SUD), we reported significantly greater improvements at six-month follow-up on neurocognitive outcomes of working memory and executive functions for the CRT + WT condition. However, no difference was found between conditions on SUD outcomes, with both groups showing unusually high levels of abstinence. In this study, we extended follow-up to 12 months to test whether there was an SUD outcome "sleeper effect" from CRT + WT. To better understand the effects of WT, we added a treatment-as-usual (TAU) comparison sample.Method: Forty-eight veterans with SUD receiving standard outpatient VA care were randomized into CRT + WT or WT. Clinical Global Impression (CGI) ratings were performed on 43/48 participants with up-to-date medical records. A TAU comparison group (n = 44) with similar demographic and illness characteristics was added to the analysis.Results: Treatment groups did not differ significantly at 12 months on CGI (p = 0.27), with 77% receiving CRT + WT showing favorable SUD outcomes compared to 62% in WT. Both groups had better CGI outcomes (p < 0.01) compared to the TAU comparison group (27%). Hours of WT participation (r = -0.49, p = 0.001) and hours of CRT (r = -0.45, p = 0.048) were associated with better CGI scores.Conclusion: While no sleeper effect was found for CRT, a robust effect was strongly supported for WT on SUD outcomes.