A Patient-Tailored Evidence-Based Approach for Developing Early Neuropsychological Training Programs in Addiction Settings

Abstract

Substance use disorders (SUDs) are associated with impairments of cognitive functions, and cognitive training programs are thus rapidly developing in SUD treatment. However, neuropsychological impairments observed early after withdrawal (i.e., early impairments), that is, approximately in the first six months, may be widespread. Consequently, it might not be possible to train all the identified early impairments. In these situations, we propose that the priority of cognitive training should be given to the early impairments found to be associated with early dropout or relapse (i.e., relapse-related impairments). However, substance-specific relapse-related impairments have not been singled out among all early impairments so far. Using a systematic literature search, we identified the types of established early impairments for all SUDs, and we assessed the extent to which these early impairments were found to be associated with relapse-related impairments. All cognitive functions were investigated according to a classification based on current neuropsychological models, distinguishing classical cognitive, substance-bias, and social cognition systems. According to the current evidence, demonstrated relapse-related impairments in alcohol use disorder comprised impulsivity, long-term memory, and higher-order executive functions. For cannabis use disorder, the identified relapse-related impairments were impulsivity and working memory. For stimulant use disorder, the identified relapse-related impairments were attentional abilities and higher-order executive functions. For opioid use disorder, the only identified relapse-related impairments were higher executive functions. However, many early impairments were not explored with respect to dropout/relapse, particularly for stimulant and opioid use disorders. The current literature reveals substance-specific relapse-related impairments, which supports a pragmatic patient-tailored approach for defining which early impairments should be prioritized in terms of training among patients with SUDs.

Keywords: Alcohol; Cannabis; Cognitive impairments; Cognitive remediation; Opioid; Relapse; Stimulants; Substance-use disorders; Treatment dropout.