None listed
Conditions
Brief summary
People in treatment for substance use disorders have high rates of cognitive impairment. Problematic substance use is likely to be both a cause and an effect of cognitive impairment. Cognitive Remediation (CR) has been shown to improve cognitive functioning in other clinical populations but is rarely available in Alcohol and Other Drug (AOD) treatment settings. We will add a CR program to an existing AOD residential rehabilitation program and evaluate its effectiveness and feasibility in this setting. Participants are residents of Wattlegrove, a 3-month residential AOD rehabilitation program in Orange NSW. We will compare standard care with standard care + CR with a non-randomised allocation. The CR intervention will follow the Neuropsychological Educational Approach to Cognitive Remediation (NEAR; Medalia et al, 2009, 2017) and will involve three, hour-long group sessions per week for the duration of treatment. Each group session involves participants working through an individualised program of computerised CR exercises and a manualised group intervention which aims to link the computerised exercises with real life tasks. We aim to determine: (1) whether CR results in better cognitive, AOD, mental health, wellbeing and functional outcomes than standard care, and (2) the feasibility and costs of implementing a cognitive remediation program in a residential rehabilitation setting, for possible future incorporation into routine care at Wattlegrove and other AOD rehabilitation facilities.
Interventions
Brief name of intervention: Cognitive remediation.
A cognitive remediation program will be added to routine care in a residential rehabilitation facility for substance use. The intervention will be added to the standard rehabilitation program from approximately April to December 2019. Everyone who is a resident of the facility during this time will participate in the cognitive remediation program. Our trial is comparing standard care with standard care plus cognitive remediation.
The cogni
Brief name of intervention: Cognitive remediation. A cognitive remediation program will be added to routine care in a residential rehabilitation facility for substance use. The intervention will be added to the standard rehabilitation program from approximately April to December 2019. Everyone who is a resident of the facility during this time will participate in the cognitive remediation program. Our trial is comparing standard care with standard care plus cognitive remediation. The cognitive remediation program we are using is the Neuropsychological Educational Approach to Cognitive Remediation (NEAR) developed and manualised by Prof Alice Medalia, Columbia University, New York (Medalia et al 2009, 2017). The intervention will consist of 2-3 individual sessions to develop an individual case plan and treatment goals, then three group sessions per week for the duration of a resident's stay in the facility (up to three months). Group sessions entail participants engaging in computerised activities selected for them by the therapist (45 minutes), followed by a 'bridging group' led by the therapist, linking the computerised activities with real world tasks and goals. The computerised activities will be selected from at least two software suites, BrainHQ (www.brainhq.com) and HappyNeuron Pro (www.happyneuron-pro.com). Examples of activities are: (a) selecting faces which were previously presented, (b) repeating back rhythms, and (c) scanning the screen for small visual details. At least one (maximum two) individual session(s) will conclude the intervention for each participant, reviewing progress on individual goals and discussing how progress can be continued. The number of individual sessions will be determined by how long it takes for the therapist to complete the tasks for the sessions with that participant. It is expected that for most participants, two individual sessions prior to the group program and one individual session post group program will be sufficient to achieve the goals of these sessions. However some participants may require more time (or shorter individual sessions), due, for example, to poor concentration, slowed thinking speed or verbosity. All interventions will be conducted face to face. The intervention will be implemented and overseen by a doctorate level Clinical Psychologist with over 15 years clinical experience, supported by Drug and Alcohol Workers at the residential rehabilitation facility. Intervention fidelity will be maintained through initial training and ongoing supervision provided by the NEAR team from New York, and minimising the number of therapists delivering the intervention (one, supported by other staff).
Sponsors
Lives Lived Well
Study design
Allocation
Non-randomised trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
All residents at Wattlegrove residential rehabilitation facility during the period of the trial.
Exclusion criteria
Inability to provide informed consent, due to: a) Inadequate level of English to understand information sheet and consent forms b) Severe cognitive impairment, as assessed by the Brief Assessment of Cognition (BAC; total score in severe range) c) active psychosis requiring referral to acute psychiatric treatment
Outcome results
None listed