The Effectiveness of Cognitive Rehabilitation on Cognitive Flexibility, Working Memory, Response Inhibition, and Drug Craving in Abstinent Addicts

Document Type : Original Article

Authors

1 Department of Psychology, Semnan Branch, Islamic Azad University, Semnan, Iran

2 Department of Clinical Psychology, Islamic Azad University of Semnan, Semnan, Iran

3 Research Center and Department of Physiology, Semnan University of Medical Sciences, Semnan, Iran

10.34172/ahj.1654

Abstract

Introduction: Drug addiction leads to significant impairments in executive functions. This study aimed to assess the effectiveness of cognitive rehabilitation (NEAT) in addiction treatment, focusing on cognitive flexibility, working memory, response inhibition, and drug craving.
Method: A quasi-experimental pretest-posttest design with a control group was employed. Thirty participants undergoing treatment at a mandatory addiction center in Semnan were randomly assigned to experimental (n = 15) and control (n = 15) groups. The experimental group received 14 sessions of NEAT. Assessments included the Desires for Drug Questionnaire, N-back task, Wisconsin Card Sorting Test, and Go/No-Go task. Data were analyzed using MANCOVA.
Results: NEAT significantly improved all target outcomes. Compared to the control group, the experimental group showed statistically significant improvement in working memory (F = 24.53, P < 0.001, η² = 0.47), response inhibition (F = 17.33, P < 0.001, η² = 0.39), and cognitive flexibility (F = 6.98, P = 0.01, η² = 0.20), as well as a marked reduction in drug craving (F = 10.11, P = 0.004, η² = 0.27).
Conclusion: The findings showed that the Neurocognitive Empowerment for Addiction Treatment (NEAT) protocol was effective in enhancing executive function and reducing drug craving in abstinent individuals. Implementing this protocol in addiction treatment centers can serve as a valuable therapeutic supplement alongside drug therapy. It is also recommended that future studies be conducted on more diverse populations.
Trial Registeration: IRCT20230808059086N1.

Highlights

Mojtaba Rajabpour(Google Scholar)(Pubmed)

Keywords

References

  1. O’Brien CP, Volkow N, Li TK. What’s in a word? Addiction versus dependence in DSM-V. Am J Psychiatry. 2006;163(5):764-5. doi: 10.1176/ajp.2006.163.5.764.
  2. Rahbari Ghazani N, Atadokht A. The effectiveness of cognitive rehabilitation on executive functions in substance-dependent individuals. Research on Addiction. 2022;16(64):177-96. [Persian].
  3. Rochat L, Khazaal Y. Cognitive remediation therapy of working memory in addictive disorders: an individualized, tailored, and recovery-oriented approach. Expert Rev Neurother. 2019;19(4):285-7. doi: 10.1080/14737175.2019.1591950.
  4. Smyth BP, Barry J, Keenan E, Ducray K. Lapse and relapse following inpatient treatment of opiate dependence. Ir Med J. 2010;103(6):176-9.
  5. Olfson M, Crystal S, Wall M, Wang S, Liu SM, Blanco C. Causes of death after nonfatal opioid overdose. JAMA Psychiatry. 2018;75(8):820-7. doi: 10.1001/jamapsychiatry.2018.1471.
  6. Zhang JJ, Fong KN, Ouyang RG, Siu AM, Kranz GS. Effects of repetitive transcranial magnetic stimulation (rTMS) on craving and substance consumption in patients with substance dependence: a systematic review and meta-analysis. Addiction. 2019;114(12):2137-49. doi: 10.1111/add.14753.
  7. Alam Mehrjerdi Z, Noroozi A, Barr AM, Ekhtiari H. Attention deficits in chronic methamphetamine users as a potential target for enhancing treatment efficacy. Basic Clin Neurosci. 2012;3(4):5-14.
  8. Roebers CM. Executive function and metacognition: towards a unifying framework of cognitive self-regulation. Dev Rev. 2017;45:31-51. doi: 10.1016/j.dr.2017.04.001.
  9. Bruijnen C, Dijkstra BA, Walvoort SJ, Markus W, VanDerNagel JE, Kessels RP, et al. Prevalence of cognitive impairment in patients with substance use disorder. Drug Alcohol Rev. 2019;38(4):435-42. doi: 10.1111/dar.12922.
  10. Zhang X, Huang M, Yu Y, Zhong X, Dai S, Dai Y, et al. Is transcranial direct current stimulation effective for cognitive dysfunction in substance use disorders? A systematic review. Brain Sci. 2024;14(8). doi: 10.3390/brainsci14080754.
  11. Koob GF, Volkow ND. Neurobiology of addiction: a neurocircuitry analysis. Lancet Psychiatry. 2016;3(8):760-73. doi: 10.1016/s2215-0366(16)00104-8.
  12. Sachdeva A, Chandra M, Khullar S, Abbas SZ. Cognitive deficits persisting in patients with alcohol dependence syndrome after detoxification. Ind Psychiatry J. 2024;33(2):292-8. doi: 10.4103/ipj.ipj_236_24.
  13. Hofmann W, Schmeichel BJ, Baddeley AD. Executive functions and self-regulation. Trends Cogn Sci. 2012;16(3):174-80. doi: 10.1016/j.tics.2012.01.006.
  14. Rezapour T, Hatami J, Farhoudian A, Noroozi A, Daneshmand R, Sofuoglu M, et al. Baseline executive functions and receiving cognitive rehabilitation can predict treatment response in people with opioid use disorder. J Subst Abuse Treat. 2021;131:108558. doi: 10.1016/j.jsat.2021.108558.
  15. Rubenis AJ, Fitzpatrick RE, Lubman DI, Verdejo-Garcia A. Impulsivity predicts poorer improvement in quality of life during early treatment for people with methamphetamine dependence. Addiction. 2018;113(4):668-76. doi: 10.1111/ add.14058.
  16. Fernández-Serrano MJ, Pérez-García M, Verdejo-García A. What are the specific vs. generalized effects of drugs of abuse on neuropsychological performance? Neurosci Biobehav Rev. 2011;35(3):377-406. doi: 10.1016/j.neubiorev.2010.04.008.
  17. Rass O, Schacht RL, Buckheit K, Johnson MW, Strain EC, Mintzer MZ. A randomized controlled trial of the effects of working memory training in methadone maintenance patients. Drug Alcohol Depend. 2015;156:38-46. doi: 10.1016/j. drugalcdep.2015.08.012.
  18. Zhu Y, Jiang H, Su H, Zhong N, Li R, Li X, et al. A newly designed mobile-based computerized cognitive addiction therapy app for the improvement of cognition impairments and risk decision making in methamphetamine use disorder: randomized controlled trial. JMIR Mhealth Uhealth. 2018;6(6):e10292. doi: 10.2196/10292.
  19. Diamond A. Executive functions. Annu Rev Psychol. 2013;64:135-68. doi: 10.1146/annurev-psych-113011-143750.
  20. Sobell LC, Sobell MB, Connors GJ, Agrawal S. Assessing drinking outcomes in alcohol treatment efficacy studies: selecting a yardstick of success. Alcohol Clin Exp Res. 2003;27(10):1661- 6. doi: 10.1097/01.Alc.0000091227.26627.75.
  21. Mackey AP, Hill SS, Stone SI, Bunge SA. Differential effects of reasoning and speed training in children. Dev Sci. 2011;14(3):582-90. doi: 10.1111/j.1467-7687.2010.01005.x.
  22. Ekhtiari H, Rezapour T, Sawyer B, Yeh HW, Kuplicki R, Tarrasch M, et al. Neurocognitive Empowerment for Addiction Treatment (NEAT): study protocol for a randomized controlled trial. Trials. 2021;22(1):330. doi: 10.1186/s13063-021-05268- 8.
  23. Verdejo-Garcia A, Rezapour T, Giddens E, Khojasteh Zonoozi A, Rafei P, Berry J, et al. Cognitive training and remediation interventions for substance use disorders: a Delphi consensus study. Addiction. 2023;118(5):935-51. doi: 10.1111/ add.16109.
  24. Berg EA. A simple objective technique for measuring flexibility in thinking. J Gen Psychol. 1948;39:15-22. doi: 10.1080/00221309.1948.9918159.
  25. Nyhus E, Barceló F. The Wisconsin Card Sorting Test and the cognitive assessment of prefrontal executive functions: a critical update. Brain Cogn. 2009;71(3):437-51. doi: 10.1016/j.bandc.2009.03.005.
  1. Ghadiri F, Jazayeri A, Ashaeri H, Ghazi Tabatabaei M. Deficit in executive functioning in patients with schizo-obsessive disorder. Advances in Cognitive Sciences. 2006;8(3):11-24. [Persian].
  2. Le Berre AP, Fama R, Sullivan EV. Executive functions, memory, and social cognitive deficits and recovery in chronic alcoholism: a critical review to inform future research. Alcohol Clin Exp Res. 2017;41(8):1432-43. doi: 10.1111/acer.13431.
  3. Chan B, Freeman M, Kondo K, Ayers C, Montgomery J, Paynter R, et al. Pharmacotherapy for methamphetamine/amphetamine use disorder-a systematic review and meta-analysis. Addiction. 2019;114(12):2122-36. doi: 10.1111/add.14755.
  4. Franken IH, Hendriksa VM, van den Brink W. Initial validation of two opiate craving questionnaires: the Obsessive Compulsive Drug Use Scale (OCDUS) and the Desires for Drug Questionnaire (DDQ). Addict Behav. 2002;27(5):675- 85. doi: 10.1037/t18284-000.
  5. Rezapour T, Aupperle RL, Paulus MP, Ekhtiari H. Clinical translation and implementation neuroscience for novel cognitive interventions in addiction medicine. In: Verdejo- Garcia A, ed. Cognition and Addiction. Academic Press; 2020. p. 393-404. doi: 10.1016/b978-0-12-815298-0.00029-0.
  6. Fayaz Feyzi Y, Vahed N, Sadeghamal Nikraftar N, Arezoomandan R. Synergistic effect of combined transcranial direct current stimulation and matrix model on the reduction of methamphetamine craving and improvement of cognitive functioning: a randomized sham-controlled study. Am J Drug Alcohol Abuse. 2022;48(3):311-20. doi: 10.1080/00952990.2021.2015771.
  7. Rupp CI, Kemmler G, Kurz M, Hinterhuber H, Fleischhacker WW. Cognitive remediation therapy during treatment for alcohol dependence. J Stud Alcohol Drugs. 2012;73(4):625- 34. doi: 10.15288/jsad.2012.73.625.
  8. Rajeswaran J, Bennett CN. Cognitive rehabilitation in addictive disorders. Indian J Psychiatry. 2018;60(Suppl 4):S490-3. doi: 10.4103/psychiatry.IndianJPsychiatry_17_18.
  9. Wang SC, Chen YC, Lee CH, Cheng CM. Opioid addiction, genetic susceptibility, and medical treatments: a review. Int J Mol Sci. 2019;20(17):4294. doi: 10.3390/ijms20174294.
  10. Lee RS, Hoppenbrouwers S, Franken I. A systematic meta-review of impulsivity and compulsivity in addictive behaviors. Neuropsychol Rev. 2019;29(1):14-26. doi: 10.1007/s11065- 019-09402-x.
  11. Khemiri L, Brynte C, Stunkel A, Klingberg T, Jayaram- Lindström N. Working memory training in alcohol use disorder: a randomized controlled trial. Alcohol Clin Exp Res. 2019;43(1):135-46. doi: 10.1111/acer.13910.
Addiction & Health
Volume 18
Pages 1-8

Files

Share

How to cite

Statistics