. 2023 May;118(5):935-951.

doi: 10.1111/add.16109. Epub 2022 Dec 28.

Cognitive training and remediation interventions for substance use disorders: a Delphi consensus study

Antonio Verdejo-Garcia¹, Tara Rezapour², Emily Giddens¹, Arash Khojasteh Zonoozi³, Parnian Rafei³, Jamie Berry⁴, Alfonso Caracuel⁵, Marc L Copersino⁶, Matt Field⁷, Eric L Garland⁸, Valentina Lorenzetti⁹, Leandro Malloy-Diniz¹⁰, Victoria Manning¹¹, Ely M Marceau¹², David L Pennington¹³, Justin C Strickland¹⁴, Reinout Wiers¹⁵, Rahia Fairhead¹, Alexandra Anderson¹, Morris Bell¹⁶, Wouter J Boendermaker¹⁷, Samantha Brooks¹⁸, Raimondo Bruno¹⁹, Salvatore Campanella²⁰, Janna Cousijn²¹, W Miles Cox²², Andrew C Dean²³, Karen D Ersche²⁴, Ingmar Franken²¹, Brett Froeliger²⁵, Pedro Gamito²⁶, Thomas E Gladwin²⁷, Priscila D Goncalves²⁸, Katrijn Houben²⁹, Joanna Jacobus³⁰, Andrew Jones³¹, Anne M Kaag³², Johannes Lindenmeyer³³, Elly McGrath³⁴, Talia Nardo³⁵, Jorge Oliveira²⁶, Charlotte R Pennington³⁶, Kelsey Perrykkad³⁷, Hugh Piercy³⁸, Claudia I Rupp³⁹, Mieke H J Schulte³², Lindsay M Squeglia⁴⁰, Petra Staiger⁴¹, Dan J Stein⁴², Jeff Stein⁴³, Maria Stein⁴⁴, William W Stoops⁴⁵, Mary Sweeney⁴⁶, Katie Witkiewitz⁴⁷, Steven P Woods⁴⁸, Richard Yi⁴⁹, Min Zhao⁵⁰, Hamed Ekhtiari⁵¹

Affiliations

¹ School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia.
² Department of Cognitive Psychology, Institute for Cognitive Science Studies, Tehran, Iran.
³ Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.
⁴ Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, NSW, Australia.
⁵ Mind, Brain and Behavior Research Center, Universidad de Granada, Granada, Spain.
⁶ McLean Hospital and Harvard Medical School, Belmont, MA, USA.
⁷ Department of Psychology, University of Sheffield, Sheffield, UK.
⁸ Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City, UT, USA.
⁹ Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioral Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, VIC, Australia.
¹⁰ Mental Health Department, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
¹¹ Turning Point Drug and Alcohol Centre and Monash Addiction Research Centre (MARC), Monash University, Melbourne, VIC, Australia.
¹² School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.
¹³ Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA.
¹⁴ Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹⁵ Addiction Development and Psychopathology (ADAPT) Laboratory, Department of Psychology, Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands.
¹⁶ Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
¹⁷ Addiction, Development, and Psychopathology (ADAPT) Laboratory, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands.
¹⁸ Research Centre for Brain and Behaviour, School of Psychology, Faculty of Health, Liverpool John Moores University, UK.
¹⁹ School of Psychology, University of Tasmania, TAS, Hobart, Australia.
²⁰ Laboratoire de Psychologie Médicale et d'Addictologie, ULB Neuroscience Institute (UNI), CHU Brugmann-Université Libre de Bruxelles, Bruxelles, Belgium.
²¹ Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, the Netherlands.
²² School of Human and Behavioural Sciences, Bangor University, Bangor, UK.
²³ Department of Psychiatry and Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, CA, USA.
²⁴ Department of Psychiatry, University of Cambridge, Cambridge, UK.
²⁵ Department of Psychiatry and Psychological Sciences, University of Missouri, Columbia, MO, USA.
²⁶ HEI-Lab, Lusófona University, Lisbon, Portugal.
²⁷ No affiliation/independent researcher, London, UK.
²⁸ Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
²⁹ Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.
³⁰ Department of Psychiatry, University of California San Diego, CA, USA.
³¹ Department of Psychology, University of Liverpool, UK.
³² Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands.
³³ Salus Klinik Lindow, Lindlow, Germany.
³⁴ Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
³⁵ School of Psychological Sciences, Macquarie University, NSW, Australia.
³⁶ School of Psychology, Aston University, Birmingham, UK.
³⁷ Cognition and Philosophy Laboratory, Monash Centre for Consciousness and Contemplative Studies, Monash University, Melbourne, VIC, Australia.
³⁸ Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia.
³⁹ Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Clinics of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria.
⁴⁰ Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA.
⁴¹ School of Psychology, Deakin University, Melbourne, VIC, Australia.
⁴² SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
⁴³ Center for Health Behaviors Research, Fralin Biomedical Research Institute at Virginial Tech, VA, USA.
⁴⁴ Department for Clinical Psychology and Psychotherapy, University of Bern, Switzerland.
⁴⁵ Department of Behavioral Science, University of Kentucky, Lexington, KY, USA.
⁴⁶ Behavioral Pharmacology Research Unit, Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁴⁷ Department of Psychology and Center on Alcohol, Substance Use and Addictions, University of New Mexico, NM, USA.
⁴⁸ Department of Psychology, University of Houston, Houston, TX, USA.
⁴⁹ Department of Psychology, University of Kansas, Lawrence, KS, USA.
⁵⁰ Shanghai Jiaotong University School of Medicine, Shanghai, China.
⁵¹ Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA.

PMID: 36508168
PMCID: PMC10073279
DOI: 10.1111/add.16109

Cognitive training and remediation interventions for substance use disorders: a Delphi consensus study

Antonio Verdejo-Garcia et al. Addiction. 2023 May.

. 2023 May;118(5):935-951.

doi: 10.1111/add.16109. Epub 2022 Dec 28.

Authors

Affiliations

¹ School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia.
² Department of Cognitive Psychology, Institute for Cognitive Science Studies, Tehran, Iran.
³ Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.
⁴ Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, NSW, Australia.
⁵ Mind, Brain and Behavior Research Center, Universidad de Granada, Granada, Spain.
⁶ McLean Hospital and Harvard Medical School, Belmont, MA, USA.
⁷ Department of Psychology, University of Sheffield, Sheffield, UK.
⁸ Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City, UT, USA.
⁹ Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioral Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, VIC, Australia.
¹⁰ Mental Health Department, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
¹¹ Turning Point Drug and Alcohol Centre and Monash Addiction Research Centre (MARC), Monash University, Melbourne, VIC, Australia.
¹² School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.
¹³ Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA.
¹⁴ Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹⁵ Addiction Development and Psychopathology (ADAPT) Laboratory, Department of Psychology, Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands.
¹⁶ Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
¹⁷ Addiction, Development, and Psychopathology (ADAPT) Laboratory, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands.
¹⁸ Research Centre for Brain and Behaviour, School of Psychology, Faculty of Health, Liverpool John Moores University, UK.
¹⁹ School of Psychology, University of Tasmania, TAS, Hobart, Australia.
²⁰ Laboratoire de Psychologie Médicale et d'Addictologie, ULB Neuroscience Institute (UNI), CHU Brugmann-Université Libre de Bruxelles, Bruxelles, Belgium.
²¹ Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, the Netherlands.
²² School of Human and Behavioural Sciences, Bangor University, Bangor, UK.
²³ Department of Psychiatry and Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, CA, USA.
²⁴ Department of Psychiatry, University of Cambridge, Cambridge, UK.
²⁵ Department of Psychiatry and Psychological Sciences, University of Missouri, Columbia, MO, USA.
²⁶ HEI-Lab, Lusófona University, Lisbon, Portugal.
²⁷ No affiliation/independent researcher, London, UK.
²⁸ Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
²⁹ Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.
³⁰ Department of Psychiatry, University of California San Diego, CA, USA.
³¹ Department of Psychology, University of Liverpool, UK.
³² Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands.
³³ Salus Klinik Lindow, Lindlow, Germany.
³⁴ Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
³⁵ School of Psychological Sciences, Macquarie University, NSW, Australia.
³⁶ School of Psychology, Aston University, Birmingham, UK.
³⁷ Cognition and Philosophy Laboratory, Monash Centre for Consciousness and Contemplative Studies, Monash University, Melbourne, VIC, Australia.
³⁸ Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia.
³⁹ Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Clinics of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria.
⁴⁰ Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA.
⁴¹ School of Psychology, Deakin University, Melbourne, VIC, Australia.
⁴² SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
⁴³ Center for Health Behaviors Research, Fralin Biomedical Research Institute at Virginial Tech, VA, USA.
⁴⁴ Department for Clinical Psychology and Psychotherapy, University of Bern, Switzerland.
⁴⁵ Department of Behavioral Science, University of Kentucky, Lexington, KY, USA.
⁴⁶ Behavioral Pharmacology Research Unit, Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁴⁷ Department of Psychology and Center on Alcohol, Substance Use and Addictions, University of New Mexico, NM, USA.
⁴⁸ Department of Psychology, University of Houston, Houston, TX, USA.
⁴⁹ Department of Psychology, University of Kansas, Lawrence, KS, USA.
⁵⁰ Shanghai Jiaotong University School of Medicine, Shanghai, China.
⁵¹ Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA.

PMID: 36508168
PMCID: PMC10073279
DOI: 10.1111/add.16109

Abstract

Aims: Substance use disorders (SUD) are associated with cognitive deficits that are not always addressed in current treatments, and this hampers recovery. Cognitive training and remediation interventions are well suited to fill the gap for managing cognitive deficits in SUD. We aimed to reach consensus on recommendations for developing and applying these interventions.

Design, setting and participants: We used a Delphi approach with two sequential phases: survey development and iterative surveying of experts. This was an on-line study. During survey development, we engaged a group of 15 experts from a working group of the International Society of Addiction Medicine (Steering Committee). During the surveying process, we engaged a larger pool of experts (n = 54) identified via recommendations from the Steering Committee and a systematic review.

Measurements: Survey with 67 items covering four key areas of intervention development: targets, intervention approaches, active ingredients and modes of delivery.

Findings: Across two iterative rounds (98% retention rate), the experts reached a consensus on 50 items including: (i) implicit biases, positive affect, arousal, executive functions and social processing as key targets of interventions; (ii) cognitive bias modification, contingency management, emotion regulation training and cognitive remediation as preferred approaches; (iii) practice, feedback, difficulty-titration, bias modification, goal-setting, strategy learning and meta-awareness as active ingredients; and (iv) both addiction treatment work-force and specialized neuropsychologists facilitating delivery, together with novel digital-based delivery modalities.

Conclusions: Expert recommendations on cognitive training and remediation for substance use disorders highlight the relevance of targeting implicit biases, reward, emotion regulation and higher-order cognitive skills via well-validated intervention approaches qualified with mechanistic techniques and flexible delivery options.

Keywords: Cognitive remediation; Delphi method; cognitive training; interventions; neuroscience; treatment.

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Figures

**Figure 1.**
Schema of the study procedure. We had two groups of participants: the Steering Committee (in black) who designed the initial survey draft and participated in all phases of the study, and the Expert Panel (in blue) which includes the Steering Committee along with a broader group of experts in the field derived from a systematic review (in grey) and recommendations by the Steering Committee. The study comprised three main phases including *survey development/revision phase* (in yellow), *survey rating phase* (in red), each happening in two discrete rounds based on reaching consensus and *analysis and reporting phase* (in green). The number of contributors from each source (i.e. Steering Committee [members or nominees] or Systematic Review) is displayed by ‘n=’.

**Figure 2.**
Diagram displaying the flow of the Delphi surveying process. It shows the number of items initially proposed by the Steering Committee for each of the four areas of interest (i.e. targets, approaches, mechanisms or active ingredients and delivery), and how they were subsequently endorsed or discarded by the Expert Panel across two consecutive rounds. (*Left*) The Steering Committee initially proposed 67 items; during the 1^st iteration, the Expert Panel endorsed 36 items (continuous left-to-right flux) and discarded 12 items (black boxes). (*Middle*) The remaining 19 items (which had reached over 50% but less than 70% agreement in the 1^st iteration) plus 3 newly proposed items (fading magenta) were carried forward to the second survey (n=22 items). *(Right)* During the 2^nd iteration, the Expert Panel endorsed 14 items and discarded 8 items, and thus reached consensus for 50 final items.

**Figure 3.**
Expert panel participants’ pooled responses to each survey item (i.e. response percentage for each of the Likert scale options), grouped by item category, across the first and second iterations of the Delphi survey.

**Figure 4.**
Expert panel participants’ endorsement (percentage responses) of different options regarding timing, frequency and duration parameters for the selected intervention approaches. *Note*. ERT emotion regulation training, CR cognitive remediation, CM contingency management, CBM cognitive bias modification.

See this image and copyright information in PMC

Comment in

Commentary on Verdejo-Garcia et al.: Cognitive training and remediation: identifying priorities for intervention research.
Quilty LC. Quilty LC. Addiction. 2023 May;118(5):952-953. doi: 10.1111/add.16155. Epub 2023 Feb 26. Addiction. 2023. PMID: 36843063 No abstract available.

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Cognitive training and remediation interventions for substance use disorders: a Delphi consensus study

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Cognitive training and remediation interventions for substance use disorders: a Delphi consensus study

Authors

Affiliations

Abstract

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Grants and funding

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Full Text Sources

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