Cognitive Remediation and Work Therapy in the Initial Phase of Substance Abuse Tr

描述（由申请人提供）：本提案旨在试点测试认知补救疗法（CRT）结合工作疗法（WT）作为门诊药物滥用治疗初始阶段的辅助疗法。有充分的研究证据表明，在药物滥用障碍中存在认知障碍，特别是在康复的早期阶段。认知障碍与较差的药物滥用治疗结果有关，可以通过针对这些障碍的锻炼项目来纠正。我们之前曾报道过一种为精神病患者提供工作治疗（WT）的模式，该模式在门诊环境中显示出执行功能和工作记忆的显着改善，以及工作表现和持续工作活动等重要功能结果。我们建议将同样的方法应用于从一个30天的药物滥用者住宅项目中招募的参与者样本，他们正在开始康复。当他们出院时，他们将能够继续WT，这可能会鼓励他们参与CRT和药物滥用门诊服务。我们的具体目标是：1；测试CRT和WT在药物滥用治疗早期的可行性和耐受性。2. 获得CRT和WT与单独WT在主要药物滥用结果测量（戒断天数百分比，PDA）上的效应量，以供未来R01 RCT提交。3. 获得次要结局（认知、社会心理、职业）的效应量。3. 检查调节因素的影响，如年龄、药物滥用类型和认知功能，这些因素可能与确定RCT的纳入/排除标准有关。4. 检查结果的介质，如神经心理变化和治疗依从性，以了解治疗效果的机制。我们建议通过将50名希望接受WT服务的参与者随机分为两种情况来实现这些目标：25人将被分配到每周15小时的WT + 5小时的CRT (CRT+WT)， 25人将被分配到20小时WT的主动对照组。主动干预将持续13周。CRT将包括一个重复的训练层次渐进的视觉和听觉练习从Posit科学。WT将在他们选择的医疗中心校园内进行带薪工作活动。参与者在CRT和WT的时间将获得相同的小时工资（联邦最低工资的一半）。在入职、3个月和6个月时将进行全面评估。这些将包括药物滥用、认知和社会心理结果以及坚持治疗。在3个月的积极干预期间，参与者将每周观察尿液毒理学筛查、呼气酒精测试和PDA评估，以及每月的工作绩效评估。数据分析将包括随机效应回归模型，以及PDA主要结果的调节效应和中介效应模型。如果发现有意义的影响，这些结果将指导后续的R01提交。

DESCRIPTION (provided by applicant): This proposal aims to pilot test a cognitive remediation therapy (CRT) combined with work therapy (WT) as an adjunct to the initial phase of outpatient substance abuse treatment. There is ample research evidence of cognitive impairment across substance abuse disorders, particularly in the early phase of recovery. Cognitive impairment has been associated with poorer substance abuse treatment outcomes and may be remediated through programs of exercises that target these impairments. We have previously reported on a model of providing CRT with work therapy (WT) in an outpatient context for people with psychotic disorders, which showed significant improvements in executive function and working memory, and in important functional outcomes such as work performance and sustained work activity. We propose to apply this same approach to a sample of participants recruited from a 30-day residential program for substance abusers who are beginning their recovery. When they are discharged, they will be able to continue WT, which may encourage their engagement in CRT and in substance abuse outpatient services. Our Specific Aims are: 1. Test the feasibility and tolerability of CRT & WT in the early phase of substance abuse treatment. 2. Obtain effect size for CRT & WT compared to WT alone on a primary substance abuse outcome measure (Percent Days of Abstinence, PDA) for a future R01 RCT submission. 3. Obtain effect sizes for secondary outcomes (cognitive, psychosocial, vocational). 3. Examine effects of moderators such as age, type of substance abuse, and cognitive functioning that may be relevant for determining inclusion/exclusion criteria for an RCT. 4. Examine mediators of outcome such as neuropsychological change and treatment adherence to understand the mechanisms of treatment effects. We propose to accomplish these aims by randomizing 50 participants who wish to receive WT services into two conditions: 25 will be assigned to 15 hours of WT plus 5 hours of CRT each week (CRT+WT) and 25 will be assigned to an active control of 20 hours of WT. The active intervention will be for 13 weeks. CRT will be comprised of a repetitive training on a hierarchy of progressive visual and auditory exercise from Posit science. WT will involve paid work activity in a placement of their choosing on the medical center campus. Participants will be paid the same hourly rate (half federal minimum wage) for their time in CRT and WT. Comprehensive assessments will be performed at intake, 3 months and 6 months. These will include substance abuse, cognitive, and psychosocial outcomes as well as adherence to treatment. During the 3 months of active intervention participants will have weekly observed urine toxicology screens, breathalyzer tests and PDA assessments, as well as monthly work performance evaluations. Data analyses will include random effects regression models, as well as models of moderator and mediator effects on the primary outcome of PDA. If meaningful effects are found, these results will guide a subsequent R01 submission. PUBLIC HEALTH RELEVANCE: This study will pilot test the use of cognitive remediation therapy combined with work therapy to learn whether outpatients with primary substance use disorders will engage in this treatment and whether it will lead to better cognitive and substance abuse outcomes than having work therapy without cognitive remediation. Findings may offer guidance for further testing a new model of treatment that may engage outpatients more effectively and lead to more rapid recovery.