Cognitive Deficits: Treatment Outcome in Cocaine Abusers

描述(由申请人提供)： 这一发展项目的目标是研究可卡因依赖患者的认知缺陷与治疗结果的关系。我们建议调查认知缺陷影响治疗依从性和结果的假设。慢性可卡因滥用与认知缺陷有关，包括注意力、记忆、解决问题、抽象推理和认知灵活性。认知行为疗法(CBT)是一种广泛使用的可卡因成瘾干预措施，它在一些可卡因依赖患者的认知功能受损的同一领域提出认知需求。因此，认知缺陷可能会损害参与CBT的能力，阻碍治疗依从性和成功结局。我们的目标包括：(1)调查认知缺陷是否可以预测辍学时间、疗程依从性和药物使用；(2)确定治疗前认知缺陷的特征，以识别面临辍学和复发风险的患者；以及(3)完成CBT治疗中患者和治疗师对外观认知表现的评级，并确定此类评级是否与辍学相关。这些问题将通过将拟议的研究添加到现有的为期14周的可卡因依赖患者CBT/药物治疗研究中来进行调查。在治疗之前，90名患者将在现有诊断组件的同时接受神经心理评估组件。新开发的表观和感知认知功能和表现的治疗师和患者评估表将在每次CBT治疗后完成。存活率和其他统计方法将被用来分析退出的时间、治疗疗程的数量以及尿毒学表明的药物使用情况。这项拟议的研究具有创新性，它关注认知功能与CBT-RP治疗的整体成功之间的关系，特别是与可卡因滥用者的CBT-RP有关，还在逐个疗程的基础上关注患者的功能。更清楚地了解可卡因滥用者特定认知缺陷与治疗结果的关系，可能是为这一亚群可卡因滥用者制定改进治疗策略的第一步，这是研究的长期目标。

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.