Cognitive Training in the Treatment of AUD

Study Overview
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Brief Summary
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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
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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.

Official Title
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Cognitive Training in the Treatment of Alcohol Use Disorders in Older Veterans

Conditions
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Alcohol Use Disorder Cognitive Decline

Intervention / Treatment
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* Behavioral: Cognitive Remediation Training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Veterans enrolled in VA AUD treatment as usual and Non-Veteran community members in AUD treatment Have a primary diagnosis of AUD and are within 30 days of detoxification or last use at time of recruitment Exclusion Criteria: Other medical illnesses that compromise neurocognition Active use of prescribed opioids or benzodiazepines that may hinder new learning Commitment to complete active phase and attend follow-up No pending incarceration or plans to leave the state

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 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: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: CRT+IDC<br>Cognitive Remediation Therapy for 13 weeks plus Individual Drug Counseling | Behavioral: Cognitive Remediation Training<br>* Up to 65 hours of computer based cognitive training of attention, verbal and visual memory, verbal and visual working memory, and executive functions<br>|
| Active Comparator: Computer Game Play+IDC<br>Computer arcade games for 13 weeks plus Individual Drug Counseling | Behavioral: Cognitive Remediation Training<br>* Up to 65 hours of computer based cognitive training of attention, verbal and visual memory, verbal and visual working memory, and executive functions<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Alcohol and other drug use assessed by weekly Time Line Follow-back and breathalyzer | Heavy Drinking Days and Days of use over 90 days | 3 months of active treatment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Alcohol and other drug use assessed by weekly Time Line Follow-back and breathalyzer | Heavy Drinking Days and Days of use over 30 days | 30 days preceding 6 month follow-up, 3 months after active treatment. | 
| Penn Alcohol Craving Scale | Changes in self-ratings of alcohol craving from baseline. | 3 months of active treatment and 6 month follow-up | 
| Neurocognitive assessments using neurocognitive tests of attention, processing speed, executive function and memory | Changes from baseline on neurocognitive domains of attention, processing speed, executive function, working memory and learning and memory. | 7 weeks, 3 month and 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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AUD, Neuropsychology, Cognitive Remediation