Neurocognitive Empowerment for Addiction Treatment (NEAT) in Opioid Use Disorder and Amphetamine Use Disorder
Condition: Opioid-use Disorder; Amphetamine Use Disorders
MeSH terms: Opioid-Related Disorders; Substance-Related Disorders; Behavior, Addictive
Study type: Interventional

Summary: 
      Chronic drug addiction is not only associated with increased mental health symptoms, such as
      anxiety and depression, but also with brain (neural and cognitive) deficits. These
      neurocognitive deficits (NCDs) in memory, attention, decision-making, self-control and
      judgement disturb normal daily functioning and attempts for abstinence. These NCDs are also
      associated with worse long-term treatment outcomes. Current treatment programs for addiction
      to opioids and amphetamines are mainly focused on abstinence from illicit drugs with or
      without assistance of medications, with the assumption that these NCDs will subsequently
      heal. However, NCDs are found to persist even after a long-term abstinence and are thought to
      contribute to relapse, decreases quality of life, or lack of reintegration into society.
      Furthermore, NCDs (particularly related to attention and memory) are considered a potential
      obstacle for engagement in therapy services for addiction and associated mood, anxiety and
      trauma-related comorbidities (i.e., cognitive-behavioral therapies). Brain rehabilitation
      programs focused on compensatory strategies and training exercises for NCDs associated with
      traumatic brain injuries, stroke, multiple sclerosis and schizophrenia has consistently been
      found to improve functioning and long-term outcomes for these populations. There have been a
      few preliminary attempts to transplant cognitive rehabilitation with substance use
      populations, with some limited promise. However, these previous studies failed to link
      cognitive strategies with the drug use and affective/craving symptoms experienced by patients
      and also did not fully incorporate knowledge gained from neuroscientific research on opioid
      and/or methamphetamine addiction specifically.

      The aim of this study is to characterize clinical efficacy for an intervention targeting NCDs
      in opioid and/or methamphetamine addiction by enhancing awareness and use of neurocognitive
      skills in the context of substance use recovery. This aim will be accomplished by randomizing
      80 subjects with opioid and/or methamphetamine use disorder who are already enrolled in
      substance use treatment in the state of Oklahoma to also complete a novel "Neurocognitive
      Empowerment for Addiction Treatment" (NEAT) program developed by a group of investigators at
      Laureate Institute for Brain Research, Tulsa, Oklahoma. NEAT will be novel in (a) its use of
      cartoons, brain awareness games and real-life scenarios to ensure it is interactive and
      engaging, (b) the focus on the role of neurocognitive deficits in recovery from substance use
      and co-occurring mental health symptomatology, and (c) its incorporation of neuroscientific
      findings specific to substance use to the training and exercise strategies. Subjects will be
      followed up for twelve months after starting the program with different measures for
      addiction and mental health recovery to explore the efficacy of NEAT compared to the control
      intervention. Using LIBR's cutting-edge neuroimaging facilities before and after
      interventions, this study has the unique opportunity to monitor not only clinical outcomes
      but also potential changes NEAT may have on brain structure and function. In case of finding
      reasonable clinical efficacy for NEAT, it will be hopefully integrated as a manualized brain
      rehabilitation program to the substance use treatment programs.
    


Intervention name(s): Neurocognitive Empowerment for Addiction Treatment (NEAT); Active Control
Intervention type(s): Behavioral; Behavioral
Intervention description(s): NEAT will be conducted in person, in groups of 6-14, and consist of 14, 1.5-hour sessions. Each NEAT session will consist of (1) a didactic, psychoeducation portion describing the concepts and skills of focus, (2) written material with descriptions of the concepts/skills in verbal and pictorial (cartoon) formats, (3) practicing with cognitive tasks relevant for each skill, (4) discussion of how they can monitor and practice each skill in their daily life. Specifically, we will provide psychoeducation, cognitive exercises, time-management and daily practice focused on domains of attention (focused and divided attention; attentional biases), memory (declarative, prospective, emotional memory), flexibility and inhibition, and problem-solving. Each session will discuss the relevance of these functions for the recovery from drug addiction and for managing affective/motivational symptoms commonly related to substance use (i.e., craving, anxiety, depression, trauma).; The active control intervention will be composed of active, but non-essential aspects of the larger treatment program (i.e., those that treatment programs do not believe are necessary or central to their program, for example, art classes, exercise classes, chore time, or extra 12 steps meetings). This will ensure that subjects are not being prevented from accessing treatment that is already known to be helpful in substance use recovery, that the active control condition and NEAT intervention have equivalent credibility and expectancies, and optimizing the generalizability of findings.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Cognitive Rehabilitation; Brain Rehabilitation; Treatment; Addiction; Heroin; Opiates; Meth; Methamphetamine