Cognitive training and remediation interventions for substance use disorders: a Delphi consensus study
Authors: Verdejo‐Garcia Antonio , Rezapour Tara , Giddens Emily , Khojasteh Zonoozi Arash , Rafei Parnian , Berry Jamie , Caracuel Alfonso , Copersino Marc L. , Field Matt , Garland Eric L. , Lorenzetti Valentina , Malloy‐Diniz Leandro , Manning Victoria , Marceau Ely M. , Pennington David L. , Strickland Justin C. , Wiers Reinout , Fairhead Rahia , Anderson Alexandra , Bell Morris , Boendermaker Wouter J. , Brooks Samantha , Bruno Raimondo , Campanella Salvatore , Cousijn Janna , Cox W. Miles , Dean Andrew C. , Ersche Karen D. , Franken Ingmar , Froeliger Brett , Gamito Pedro , Gladwin Thomas E. , Goncalves Priscila D. , Houben Katrijn , Jacobus Joanna , Jones Andrew , Kaag Anne M. , Lindenmeyer Johannes , McGrath Elly , Nardo Talia , Oliveira Jorge , Pennington Charlotte R. , Perrykkad Kelsey , Piercy Hugh , Rupp Claudia I. , Schulte Mieke H. J. , Squeglia Lindsay M. , Staiger Petra , Stein Dan J. , Stein Jeff , Stein Maria , Stoops William W. , Sweeney Mary , Witkiewitz Katie , Woods Steven P. , Yi Richard , Zhao Min , Ekhtiari Hamed 
Published: December 2022

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.