None listed
Conditions
Brief summary
This research aims to examine the effectiveness of a six-week cognitive remediation intervention for adults in residential treatment for Alcohol and Other Drug (AOD) use. We aim to primarily investigate whether cognitive remediation will be effective in improving executive functioning and treatment retention rates, compared to treatment-as-usual. In addition, we will examine the effect of cognitive remediation on a number of secondary outcomes, including long-term AOD use, goal attainment, quality of life, health service utilisation and measures of cognition. This will be evaluated by conducting a number of self-report and performance-based measures before and after six weeks of cognitive remediation or treatment-as-usual, and for follow up (2-months, 4-months, 6-months and 8-months). Participants will undergo cognitive remediation in addition to receiving treatment as usual. The cognitive remediation will be administered in a group setting, in one-hour sessions, twice a week for six weeks. The intervention will take a strategy-based approach, with a strong emphasis on the training of executive functioning, and will include traditional instructional pedagogical approaches, modelling, exercises to demonstrate concepts, and role-plays. The intervention will be administered by trained staff at the residential AOD services. The proposed study will be conducted as a prospective stepped wedge cluster randomised trial, where randomisation will occur at the cluster level. The design involves random and sequential crossover of clusters from treatment as usual to Cognitive Remediation until all clusters have implemented the CRiDAS program. It is hypothesised that cognitive remediation will be associated with improved executive functioning and improved treatment retention.
Interventions
The intervention to be provided is the Cognitive Remediation in Drug and Alcohol Services (CRiDAS) Program.
The manualised Cognitive Remediation in Drug and Alcohol Services (CRiDAS) program will be used for CR, which consists of 12 one-hour group-based sessions that will take place across six weeks (two sessions per week). Each session will be dedicated to strategy training, which includes traditional instructional pedagogical approaches, modelling, exercises to demonstrate concepts, and role
The intervention to be provided is the Cognitive Remediation in Drug and Alcohol Services (CRiDAS) Program. The manualised Cognitive Remediation in Drug and Alcohol Services (CRiDAS) program will be used for CR, which consists of 12 one-hour group-based sessions that will take place across six weeks (two sessions per week). Each session will be dedicated to strategy training, which includes traditional instructional pedagogical approaches, modelling, exercises to demonstrate concepts, and role-plays. The CR intervention was developed with a strong emphasis on the training of EF in view of the finding that EF is particularly impaired in an AOD treatment population. Barkley’s (2001; 2012) evolutionary model of EF was used to structure a large part of the program. The CR program will use a “top-down” approach, including training in compensatory strategy use with a particular emphasis on EF. The modules cover the following topics: brain functioning, attention, visual and verbal working memory, emotion regulation, decision-making and problem-solving. Facilitators will be staff of the residential AOD treatment sites who will undergo training to administer the intervention. Facilitators will be selected by AOD service management based on a minimum skillset, including experience in AOD rehabilitation and confidence in leading groups. No formal qualification standards were set. Training will consist of a two-day workshop led by a senior clinical neuropsychologist, who will also provide regular supervision throughout the duration of the intervention. In addition, a website will be set up to allow discussion of the CRiDAS program between facilitators from different sites. Facilitators will be able to use this at their discretion, with no requirements for the amount of use. Facilitators will deliver the intervention in a face-to-face manner at the residential treatment site, to groups of approximately 20-26 residents. Once the CRiDAS program has been implemented in a residential drug and alcohol service, the program will continue to be run until the end of the study. An independent researcher/clinician will use the CRiDAS treatment fidelity measure to measure fidelity via audio/video recordings of 10% of the sessions at each site.
Sponsors
Dr Jamie Berry
Study design
Allocation
Randomised controlled trial
Intervention model
Other
Primary purpose
Treatment
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Ten drug and alcohol services in NSW have been invited to participate in the study. Participants will be attending the ten residential treatment programs and enrolled in treatment for alcohol and other drug problems. In order to maximise the ecological validity of the results, participants with comorbid medical, psychiatric or mental health disorders will be included, as will adults receiving opioid substituion therapy (e.g. methadone).
Exclusion criteria
Residents in treatment who are aged 17 and younger will be excluded from the present study.
Outcome results
None listed