Cognitive Deficits: Treatment Outcome in Cocaine Abusers

描述（由申请人提供）： 这个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。我们建议调查的假设，认知缺陷损害治疗的依从性和结果。慢性可卡因滥用与认知缺陷有关，包括注意力，记忆力，解决问题;抽象推理;和认知灵活性。认知行为疗法（CBT）是一种广泛用于可卡因成瘾的干预措施，它在一些可卡因依赖患者的认知功能受损的相同领域提出认知需求。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的结果。我们的目标包括：（1）调查认知缺陷是否预测辍学时间，会话依从性和药物使用;（2）表征治疗前认知缺陷概况，识别有辍学和复发风险的患者;（3）完成患者和治疗师对CBT会话中明显认知表现的评级的开发和实施，并确定此类评级是否与辍学有关。将通过在可卡因依赖患者中现有的14周CBT/药物治疗研究中添加拟定研究来调查这些问题。在治疗前，90名患者将接受神经心理学评估组合与现有的诊断组合。新开发的治疗师和患者评估表观和感知认知功能和表现的形式将在每次CBT会议后完成。将使用生存和其他统计方法分析至脱落时间、治疗次数和尿液毒理学指示的药物使用。拟议的研究是创新的，其重点是认知功能和CBT-RP治疗的整体成功之间的关系，特别是与CBT-RP在可卡因滥用者，也在其重点是病人的功能，一个会话会话的基础上。更清楚地了解可卡因滥用者的特定认知缺陷与治疗结果的关系可能是为这一可卡因滥用者亚组制定改进的治疗策略的第一步，这是研究的一个长期目标。

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.