Cognitive Deficits: Treatment Outcome in Cocaine Abusers

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DESCRIPTION (provided by applicant): The goal of this developmental project is to study the relationship of cognitive deficits to treatment outcome in cocaine dependent patients. We propose to investigate the hypothesis that cognitive deficits compromise treatment compliance and outcome. Chronic cocaine abuse is associated with cognitive deficits including attention, memory, problem solving; abstract reasoning; and cognitive flexibility. Cognitive-Behavioral Therapy (CBT), a widely used intervention for cocaine addiction, makes cognitive demands in the same areas of cognitive functioning that are impaired in some cocaine-dependent patients. Thus, cognitive deficits may compromise the ability to participate in CBT, impeding treatment compliance and successful outcome. Our aims include: (1) investigating whether cognitive deficits predict time to dropout, session compliance, and drug use; (2) characterizing pre-treatment cognitive deficit profiles that identify patients at risk for dropout and relapse; and (3) completing development and implementation of patient and therapist ratings for apparent cognitive performance in CBT sessions and determining whether such ratings are related to dropout. The questions will be investigated by adding the proposed study onto an existing 14-week CBT/medication treatment study in cocaine dependent patients. Prior to treatment, 90 patients will receive a neuropsychological assessment battery in conjunction with the existing diagnostic battery. The newly developed therapist and patient assessment forms of apparent and perceived cognitive functioning and performance will be completed after each CBT session. Survival and other statistical methods will be used to analyze time to dropout, number of treatment sessions, and drug use as indicated by urine toxicology. The proposed study is innovative in its focus on the relationship between cognitive functioning and success of CBT-RP therapy overall, as specifically related to CBT-RP in cocaine abusers, and also in its focus on patient functioning on a session-by-session basis. A clearer understanding of the relationship of specific cognitive deficits to treatment outcome in cocaine abusers may serve as a first step towards the development of improved therapeutic strategies for this subgroup of cocaine abusers, a long-term objective of the research.