Neurobiological Mechanisms of Chess as an Add-On Treatment Against SUD

Study Overview
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Brief Summary
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Neurobiological and neuropsychological approaches to investigate the potential mechanism of action of chess as an add-on therapy (chess based - cognitive remediation treatment, CB-CRT) to reduce cognitive deficits in individuals with alcohol use disorder (AUD) or tobacco use disorder (TUD).

Detailed Description
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The study aims to investigate the potential mechanism of action of chess as a chess based - cognitive remediation treatment, CB-CRT to reduce cognitive deficits in individuals with substance use disorder (SUD) seeking treatment using neurobiological and neuropsychological approaches. Furthermore, it will be assessed whether this chess intervention has a generalized positive effect on short-term abstinence. Interestingly, the functional domains and associated underlying neuronal networks observed to be affected in individuals with SUD overlap significantly with those that could be strengthened by chess-based cognitive training or formal chess. Specifically, strengthening of cortical control regions (dorsolateral prefrontal cortex, DLPFC) and brain areas relevant for decision-making (orbitofrontal cortex, OFC) could prevent future relapse. Therefore, chess as an add-on therapy to complement other standard treatments of SUD could lead to improved therapeutic outcomes.

Official Title
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Investigating Neurobiological Mechanisms of Chess as an Add-On Treatment Against Substance Use Disorder

Conditions
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Substance Use Disorders

Intervention / Treatment
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* Behavioral: Standard therapy for AUD plus Chess-based cognitive treatment
* Behavioral: Standard therapy for AUD
* Behavioral: Standard smoking cessation therapy for TUD plus Chess-based cognitive treatment
* Behavioral: Standard therapy for TUD


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: severe alcohol (AUD) or tabacco use disorder (SUD) according to DSM-5 abstinence from alcohol for at least 72 hours (AUD) sufficient ability to communicate with investigators and answer questions in both written and verbal format ability to provide fully informed consent and to use self-rating scales main diagnosis AUD: inpatient or outpatient treatment in our clinic main diagnosis TUD: participation in 6 weeks smoking cessation treatment Normal or corrected to normal vision Signed consents for data security Exclusion Criteria: severe internal, neurological, and/or psychiatric comorbidities; other Axis I mental disorders other than TUD according to ICD-10 and DSM 5 (except for other substance use disorders - if AUD or TUD is still the main diagnosis -, ADHD, remitted depression, mild or moderate depression, adjustment disorder, generalized anxiety disorder, phobias, panic disorder or other mild or moderate personality disorders) in the last 12 months Severe withdrawal symptoms (CIWA-Ar > 7; Sullivan et al. 1989) alcohol intoxication (>0‰) history of brain injury severe cognitive impairments common exclusion criteria for MRI (e.g. metal, claustrophobia, pregnancy) suicidality or endangerment of others positive Covid-19 screening

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: CB-CRT AUD group<br>experimental group AUD: patients receive standard clinical therapy and an add-on chess based - cognitive remediation treatment (CB-CRT) | Behavioral: Standard therapy for AUD plus Chess-based cognitive treatment<br>* Behavioral: standard AUD Cognitive Behavioral Therapy (CBT) in Clinical setting. Patients who voluntarily submit to enter a qualified detoxification treatment program will be examined, either in-patient, out-patient, or in a day-clinic setting at the Department of Addictive Behaviour and Addiction Medicine. Additional, the experimental group receives chess based cognitive remediation treatment (CB-CRT) for 1,5 hours three times a week. The tasks of the treatment were created by our cooperation partner, the psychologist Juan Antonio Montero. He is currently successfully applying this battery as an add-on therapy. The training battery is designed to strengthen cognitive functioning in specific domains such as short-term memory, focal attention, selective attention, pattern recognition, visuospatial abilities, metacognition and also inhibition.<br>|
| Active Comparator: Control group AUD<br>control group: patients with AUD receive standard clinical therapy | Behavioral: Standard therapy for AUD<br>* Behavioral: standard AUD Cognitive Behavioral Therapy (CBT) in Clinical setting. Patients who voluntarily submit to enter a qualified detoxification treatment program will be examined, either in-patient, out-patient, or in a day-clinic setting at the Department of Addictive Behaviour and Addiction Medicine.<br>|
| Experimental: CB-CRT TUD group<br>experimental group TUD: patients receive standard smoking cessation therapy and an add-on CB-CRT | Behavioral: Standard smoking cessation therapy for TUD plus Chess-based cognitive treatment<br>* Behavioral: standard smoking cessation therapy for TUD in group therapy setting. Patients who voluntarily submit to enter a qualified smoking cessation program will be examined in an out-patient setting at the Department of Addictive Behaviour and Addiction Medicine. They receive a six-week standard therapy (one 1,5 hours group therapy per week). Additional, the experimental group receives chess based cognitive remediation treatment (CB-CRT) for 1,5 hours three times a week. The tasks of the treatment were created by our cooperation partner, the psychologist Juan Antonio Montero. He is currently successfully applying this battery as an add-on therapy. The training battery is designed to strengthen cognitive functioning in specific domains such as short-term memory, focal attention, selective attention, pattern recognition, visuospatial abilities, metacognition and also inhibition.<br>|
| Active Comparator: Control group TUD<br>control group: patients with TUD receive standard smoking cessation therapy | Behavioral: Standard therapy for TUD<br>* Behavioral: standard smoking cessation therapy for TUD in group therapy setting. Patients who voluntarily submit to enter a qualified smokind cessation program will be examined in an out-patient setting at the Department of Addictive Behaviour and Addiction Medicine. They receive a six-week standard therapy (one 1,5 hours group therapy per week). Additional, the experimental group receives chess based cognitive remediation treatment (CB-CRT) for 1,5 hours three times a week.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| change in neural alcohol cue-reactivity | fMRI alcohol cue-reactivity task (Vollstädt-Klein et al. 2010) | 2 time points: before and after 6 weeks chess-based cognitive training | 
| change in neural tobacco cue-reactivity | fMRI tobacco cue-reactivity task (Vollstädt-Klein et al. 2011) | 2 time points: before and after 6 weeks chess-based cognitive training | 
| change in neural correlates of inhibition | fMRI stop-signal task (Whelan et al. 2012) | 2 time points: before and after 6 weeks chess-based cognitive training | 
| substance use (alcohol consumption and tabacco use) | self-report | 3 months follow-up after the end of treatment | 
| change in neural working memory processes | fMRI working memory task N-back (Charlet et al. 2014) | 2 time points: before and after 6 weeks chess-based cognitive training | 
| Change in working memory capacity | working memory capacity measured by letter-number sequencing task of the [Wechsler Memory Scale (Kent 2013)]; raw values will be transformed to IQ-like scales (mean 100, SD 15); the higher the value, the higher the working memory capacity | 2 time points: before and after 6 weeks SCP | 
| Change in impulsivity | impulsivity measured with BIS scale [Barratt impulsiveness scale (Patton et al. 1995)];range 15-60; total score will be used; high values represent high impulsivity | 3 time points: before and after 6 weeks SCP plus after 3 months | 
| Change in decision-making | [Iowa Gambling Task (Bechara et al. 1994)] | 2 time points: before and after 6 weeks SCP | 
| Change in mental flexibility | [Dimensional Change Card Sort (Zelazo et al. 2014)] | 2 time points: before and after 6 weeks SCP | 
| Change in attentional capacity | [d2 Test of Attention (Brickenkamp 2002)]. | 2 time points: before and after 6 weeks SCP | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| change in functional connectivity within the salience network (SN) and executive control network (ECN) | [measured with fMRI] | 2 time points: before and after 6 weeks therapy and chess-based cognitive training | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Alcohol Dependence, Alcoholism, Craving, Cognitive Change, cognitive remediation, Chess based cognitive training, Working Memory, Decision Making, Executive Control, Chess, fMRI, Nicotine use disorder, Tobacco use disorder