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

描述（由申请人提供）：本提案旨在对认知补救疗法（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进行试点测试。有充分的研究证据表明，物质滥用障碍中存在认知障碍，特别是在恢复的早期阶段。认知障碍与药物滥用治疗效果较差有关，可以通过针对这些障碍的锻炼计划进行补救。我们以前曾报道过一个模型，提供CRT与工作治疗（WT）在门诊背景下的精神病患者，这表明显着改善执行功能和工作记忆，并在重要的功能成果，如工作表现和持续的工作活动。我们建议将同样的方法应用于一个样本的参与者招募从30天的住宅计划的药物滥用者谁开始他们的复苏。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 & WT在药物滥用治疗早期阶段的可行性和耐受性。2.获得CRT和WT与WT单独相比在主要药物滥用结局指标（禁欲天数百分比，PDA）上的效应量，用于未来的R01 RCT提交。3.获得次要结局（认知、心理社会、职业）的效应量。3.检查可能与确定RCT入选/排除标准相关的调节因素（如年龄、药物滥用类型和认知功能）的影响。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名参与者将被分配到每周15小时的WT加5小时的CRT（CRT + WT），25名参与者将被分配到20小时WT的主动控制。积极干预将持续13周。CRT将包括对Posit科学渐进视觉和听觉练习层次的重复训练。WT将在他们选择的医疗中心校园内从事有偿工作活动。参与者在CRT和WT的时间将获得相同的小时工资率（联邦最低工资的一半）。将在入组、3个月和6个月时进行全面评估。这些将包括药物滥用，认知和心理社会结果以及坚持治疗。在3个月的积极干预期间，参与者将每周进行一次尿液毒理学筛查、呼吸测醉器测试和PDA评估，以及每月一次的工作表现评估。数据分析将包括随机效应回归模型，以及PDA主要结局的调节和中介效应模型。如果发现有意义的影响，这些结果将指导后续的R01提交。 公共卫生相关性：本研究将对认知补救疗法与工作疗法相结合的使用进行试点测试，以了解患有原发性物质使用障碍的门诊患者是否会参与这种治疗，以及它是否会导致比没有认知补救的工作疗法更好的认知和物质滥用结果。研究结果可能为进一步测试一种新的治疗模式提供指导，这种模式可能更有效地吸引门诊患者，并导致更快的康复。

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.