Cognitive Training in the Treatment of AUD
Condition: Alcohol Use Disorder Cognitive Decline
MeSH terms: Alcoholism; Alcohol Drinking; Cognitive Dysfunction
Study type: Interventional

Summary: 
      Alcohol Use Disorders (AUDs) have a significant public health impact and are highly prevalent
      in Veterans. Alcohol related brain effects on neurocognition (attention, memory and executive
      function) reduce ability to benefit from current treatments. These cognitive impairments are
      especially common in the early phase of recovery, persist over years and get worse with age.
      Recent research suggests that cognitive remediation therapy (CRT) may improve attention,
      memory and executive function in other disorders, and the investigators just completed pilot
      study with AUD Veterans found significantly greater improvements for those receiving CRT. The
      proposed study examines AUD outcomes and neurocognitive improvements when CRT is combined
      with a standardized alcohol treatment. The investigators hypothesize that CRT will improve
      neurocognition and AUD outcomes more than standardized alcohol treatment alone. Findings will
      determine whether CRT augmentation can benefit Veterans with AUDs.
    

Detailed description: 
      This study aims to determine whether a combined intervention of cognitive remediation therapy
      (CRT) and Individual Drug Counseling (IDC) can benefit older Veterans in the initial phase of
      alcohol abuse treatment by improving abstinence outcomes and neurocognition. Substantial
      cognitive impairment is associated with alcohol use disorders (AUD), and becomes worse with
      years of use and the aging processes. In particular, Veterans entering treatment for AUD
      display cognitive deficits that may reduce their ability to benefit from treatment. While
      there is considerable variety in the severity and types of cognitive impairment found in
      newly recovering patients, problems with attention, learning and memory and executive
      function are common. Since treatment requires that the individual be able to sustain
      attention, remember what is learned, and apply it to recovery, impaired underlying cognitive
      processes make successful treatment less likely. Moreover, problems with executive
      functioning and other pre-frontal cognitive processes have been associated with decreased
      treatment retention and poorer AUD treatment outcomes. Although cognition can improve with
      sustained abstinence, it is during the early phase of recovery, when cognition is most
      impaired, that patients receive the most intensive treatment. AUD is a major cause of
      suffering and functional disability for older Veterans and a common co-morbidity with other
      physical and mental disorders. Finding more effective treatments of AUD remains a priority
      for VA healthcare.

      The purpose of the proposed study is to learn whether CRT plus IDC, an evidence-based
      outpatient AUD treatment is more effective than a Game-Play Placebo plus IDC. Game-Play
      Placebo has been used to provide equipoise between conditions in other CRT studies and in a
      current CRT study with mTBI Veterans funded by DoD being conducted by the PI. The current
      study is a randomized controlled trial (RCT) with a target enrollment of 90 Veterans in the
      initial phase of AUD treatment. The study is sufficiently powered to allow us to fulfill the
      following aims and test their related hypotheses:

      Specific Primary Aim # 1: To determine if CRT+IDC is more effective than Game-Play Placebo
      +IDC in decreasing alcohol use in older Veterans during the 3 month active intervention
      period.

      Ho1: CRT+IDC will be more effective than Game-Play Placebo+IDC in reducing heavy drinking
      days and decreasing days of use as measured by Breathalyzer and Timeline Follow-back Method
      (TLFB) during the 90 days of active intervention.

      Secondary Aim #1: To determine if CRT+IDC is more effective than Game-Play Placebo+ IDC in
      sustaining decreased alcohol use in older Veterans at the end of 6 months (3 months after the
      active intervention period).

      Ho2: CRT+IDC will be more effective than Game-Play Placebo+IDC in reducing heavy drinking
      days and decreasing days of use as measured by Breathalyzer and Timeline Follow-back Method
      (TLFB) for the 30 days preceding 6 month follow-up.

      Secondary Aim #2: To determine if the combination of CRT and IDC is more effective than game
      play placebo and IDC in improving neurocognitive functioning.

      Ho3: Veterans receiving CRT+IDC will show greater improvement than Veterans receiving
      Game-Play Placebo+IDC at 3 month follow-up on a global index of neurocognitive function, and
      on an index of working memory and an index of executive function.

      Ho4: Differential improvements in neurocognitive function will be sustained at 6 month
      follow-up.
    

Intervention name(s): Cognitive Remediation Training
Intervention type(s): Behavioral
Intervention description(s): Up to 65 hours of computer based cognitive training of attention, verbal and visual memory, verbal and visual working memory, and executive functions
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: AUD; Neuropsychology; Cognitive Remediation