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Randomized Controlled Trial
. 2015 Feb;161(2-3):478-83.
doi: 10.1016/j.schres.2014.11.017. Epub 2014 Dec 12.

Cognitive Enhancement Therapy in substance misusing schizophrenia: results of an 18-month feasibility trial

Shaun M Eack  1 , Susan S Hogarty  2 , Deborah P Greenwald  2 , Maralee Y Litschge  2 , Summer A F McKnight  3 , Srihari S Bangalore  2 , Michael F Pogue-Geile  4 , Matcheri S Keshavan  5 , Jack R Cornelius  2
Affiliations
Randomized Controlled Trial

Cognitive Enhancement Therapy in substance misusing schizophrenia: results of an 18-month feasibility trial

Shaun M Eack et al. Schizophr Res. 2015 Feb.

Abstract

Substance use is a frequent problem in schizophrenia, and although many substance misusing patients with the disorder also experience considerable cognitive impairments, such individuals have been routinely excluded from clinical trials of cognitive remediation that could support their functional and addiction recoveries. This study conducted a small-scale feasibility trial of Cognitive Enhancement Therapy (CET) in substance misusing schizophrenia patients to assess the feasibility and efficacy of implementing comprehensive neurocognitive and social-cognitive remediation in this population. A total of 31 schizophrenia outpatients meeting addiction severity criteria for alcohol and/or cannabis use were randomized to 18months of CET or usual care. Feasibility findings indicated high degrees of satisfaction with CET, but also presented significant challenges in the recruitment and retention of substance misusing patients, with high levels of attrition (50%) over the study period, primarily due to positive symptom exacerbation. Intent-to-treat efficacy analyses showed large and significant improvements in neurocognition (d=.86), social cognition (d=1.13), and social adjustment (d=.92) favoring CET. Further, individuals treated with CET were more likely to reduce alcohol use (67% in CET vs. 25% in usual care) during treatment (p=.021). These results suggest that once engaged and stabilized, CET is a feasible and potentially effective treatment for cognitive impairments in patients with schizophrenia who misuse alcohol and/or cannabis. Substance misusing patients who are able to engage in treatment may be able to benefit from cognitive remediation, and the treatment of cognitive impairments may help improve substance use outcomes among this underserved population.

Keywords: Cognitive rehabilitation; Cognitive remediation; Drug use; Social cognition; Substance use.

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Conflict of interest statement

Conflict of Interest

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Enrollment In An 18-Month Feasibility Trial of Cognitive Enhancement Therapy (CET) or Treatment as Usual (TAU).
Figure 2
Figure 2
Effects of Cognitive Enhancement Therapy (CET) Versus Treatment as Usual (TAU) on Substance Use Outcomes.
See this image and copyright information in PMC

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