Cognitive Training for Alcoholism

(CCT-A Trial)

Overseen By Kate Shirley

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Portland VA Medical Center

Disqualifiers: Intoxication, Major Neurocognitive Disorder, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 8

Duration: 8 weeks

30 Participants Needed

Trial Summary

Do I have to stop taking my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the trial coordinators or your healthcare provider.

What data supports the idea that Cognitive Training for Alcoholism is an effective treatment?

The available research shows that Cognitive Training for Alcoholism can be effective. One study found that cognitive retraining improved attention, memory, and information processing in alcoholics, although it didn't affect family functioning or long-term abstinence. Another study showed that a cognitive remediation therapy program, enhanced with a brain-computer interface, led to 89% of participants maintaining sobriety 18 months after treatment, compared to only 31% in the non-treatment group. This suggests that Cognitive Training can significantly improve sobriety rates compared to traditional methods. ^{1 2 3 4 5}

What data supports the effectiveness of the treatment Motivationally Enhanced Compensatory Cognitive Training for Addictions Group for alcoholism?

Research shows that cognitive remediation therapy (CRT) can improve cognitive functions like attention and memory in alcoholics, which are important for recovery. Additionally, a study found that a similar cognitive training program helped 89% of participants maintain sobriety 18 months after treatment, compared to 31% who did not receive the treatment. ^{1 2 3 4 5}

What safety data exists for cognitive training in alcoholism treatment?

The provided research does not directly address the safety data for cognitive training treatments like Motivationally Enhanced Compensatory Cognitive Training for Addictions. However, related therapies such as Coping-skills training (CST) and Cue-exposure therapy (CET) have been studied for their effectiveness in reducing relapse and drinking severity. Cognitive remediation therapy (CRT) has shown improvements in neurocognitive and substance use outcomes. While these studies focus on effectiveness, they do not specifically mention safety data, suggesting a need for further research to evaluate the safety of these cognitive training approaches. ^{5 6 7 8 9}

Is cognitive training for alcoholism safe for humans?

The available research does not provide specific safety data for cognitive training for alcoholism, but similar cognitive therapies have been used in other treatments without reported safety concerns. ^{5 6 7 8 9}

Is the treatment Motivationally Enhanced Compensatory Cognitive Training for Addictions Group a promising treatment for alcoholism?

Yes, this treatment is promising because cognitive training can improve attention, memory, and reasoning in people recovering from alcoholism, which helps them better respond to therapy and manage cravings. ^{1 2 3 5 10}

How is the Motivationally Enhanced Compensatory Cognitive Training for Addictions treatment different from other treatments for alcoholism?

This treatment is unique because it combines cognitive training, which helps improve thinking skills like memory and attention, with motivational strategies to enhance engagement and effectiveness in treating alcoholism. Unlike traditional therapies that focus mainly on behavior change, this approach specifically targets cognitive deficits that can hinder recovery. ^{1 2 3 5 10}

What is the purpose of this trial?

Most individuals entering treatment for alcohol use disorders (AUDs) present with cognitive deficits across a range of cognitive domains, and these deficits frequently persist for six months or longer following remission. Cognitive deficits are associated with increased relapse rates, less treatment compliance, and poorer treatment outcomes in individuals seeking substance use treatment. Despite the high rates of cognitive impairments among adults with AUDs and their negative impact on treatment outcomes, current evidence-based treatments for AUDs do not specifically treat or address cognitive symptoms. Accessible (e.g., brief, manualized, delivered via telehealth) and effective treatments for adults with AUDs and cognitive deficits are urgently needed. The primary objective of this study is to assess the feasibility and acceptability of a manualized, 8-week, Compensatory Cognitive Training (CCT) intervention delivered via telehealth for Veterans in early remission from alcohol use disorder (AUD). The investigators hypothesize that Motivationally Enhanced Compensatory Cognitive Training for Addictions (ME-CCT-A) will be feasible and acceptable in a pilot trial of ME-CCT-A delivered via telehealth.

Eligibility Criteria

This trial is for Veterans over 18 with alcohol use disorder in early remission (1-12 months). They must be concerned about mild cognitive decline, want treatment for it, and have internet and webcam access. It's not for those intoxicated or unable to understand study risks, with major neurocognitive disorders like dementia, or severe hearing/vision issues.

Inclusion Criteria

I am worried about my slight memory or thinking problems and want treatment.

You need to have internet and a webcam.

Exclusion Criteria

I am not under the influence of substances and can understand the study's risks and benefits.

I have been diagnosed with a significant memory or thinking problem, like Alzheimer's.

I do not have hearing or vision problems that would stop me from joining a cognitive rehab group.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive Motivationally Enhanced Compensatory Cognitive Training for Addictions (ME-CCT-A) via telehealth, focusing on cognitive skills, mindfulness, and motivational interviewing

8 weeks

8 sessions (virtual, 2 hours each)

Follow-up

Participants are monitored for retention, feasibility, and acceptability of the intervention

4 weeks

Treatment Details

Interventions

• Motivationally Enhanced Compensatory Cognitive Training for Addictions Group

Trial Overview The trial tests an 8-week Compensatory Cognitive Training program delivered via telehealth aimed at improving cognitive deficits in Veterans recovering from alcoholism. The training is designed to be accessible and will evaluate its feasibility and acceptability among participants.

Participant Groups

Group I: Motivationally Enhanced Compensatory Cognitive Training for Addictions Group Experimental Treatment 1 Intervention

Motivationally Enhanced Compensatory Cognitive Training for Addictions (ME-CCT-A) is a manualized group-based behavioral intervention (8 weeks, 2 hour per week) designed to improve cognitive functioning in Veterans with substance use disorders (SUDs) and cognitive complaints.

Motivationally Enhanced Compensatory Cognitive Training for Addictions Group is already approved in United States for the following indications:

Approved in United States as Compensatory Cognitive Training (CCT) for:

• Alcohol Use Disorder
• Substance Use Disorder
• Cognitive Deficits

Who Is Running the Clinical Trial?

Portland VA Medical Center

Lead Sponsor

Trials

44

Recruited

7,800+

Findings from Research

Cognito-behavioral therapy for alcohol dependence emphasizes improving social integration and conditioning, which are crucial for effective treatment.

The therapy can be tailored to individual needs or conducted in groups, adapting to the patient's level of neuropsychological impairment and motivation, enhancing its efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Alcoholism: cognitive-behavioral therapy]. Uehlinger, C.[2019]

Cognitive retraining significantly improved cognitive functions such as attention, memory, and information processing in a study of 8 detoxified male alcoholics over six weeks, with daily one-hour sessions for the treatment group.

The control group, which received less frequent counseling, showed no changes in cognitive function, highlighting the effectiveness of structured cognitive rehabilitation for addressing neuropsychological deficits in abstinent alcoholics.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Neuropsychological rehabilitation of alchoholics : a preliminary report. Mathai, G., Rao, SL., Gopinath, PS.[2021]

Alcohol-dependent individuals show significant deficits in their ability to regulate cue-induced cravings compared to social drinkers, with a study involving 19 alcohol-dependent and 21 social drinkers demonstrating that social drinkers could reduce cravings about twice as effectively.

These deficits in cognitive regulation are not limited to alcohol cravings but also extend to food cravings, suggesting a broader issue in self-regulation among those with alcohol dependence.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive regulation of craving in alcohol-dependent and social drinkers. Naqvi, NH., Ochsner, KN., Kober, H., et al.[2022]

A study involving 321 adult poly-substance users found that a cognitive remediation therapy (CRT) program enhanced with a brain-computer interface (BCI) significantly improved cognitive control and self-agency.

At an 18-month follow-up, 89% of participants who underwent the BCI/CRT treatment maintained sobriety, compared to only 31% in the non-treatment group, indicating a substantial increase in sobriety rates due to the augmented therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improved Sobriety Rates After Brain-Computer Interface-Based Cognitive Remediation Training. Cripe, CT., Mikulecky, P., Sucher, M., et al.[2022]

Cognitive remediation therapy (CRT) significantly improved working memory and executive function in outpatient veterans with substance use disorders, compared to standard work therapy alone, based on a pilot study with 48 participants over 6 months.

Both treatment groups showed excellent substance use outcomes, with high rates of abstinence, indicating that while CRT enhanced cognitive functions, it did not significantly change overall substance use recovery rates compared to work therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomized controlled trial of cognitive remediation and work therapy in the early phase of substance use disorder recovery for older veterans: Neurocognitive and substance use outcomes. Bell, MD., Laws, HB., Petrakis, IB.[2018]

Coping-skills training (CST) has been shown to be more effective than other treatments in reducing the frequency and severity of relapses in alcoholics, by enhancing patients' abilities to handle high-risk situations for drinking.

Cue-exposure treatment (CET) allows patients to confront alcohol-related cues in a controlled environment, helping them practice coping responses, and preliminary studies suggest it leads to reduced drinking severity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Coping-skills training and cue-exposure therapy in the treatment of alcoholism. Monti, PM., Rohsenow, DJ.[2019]

Cue exposure therapy (CET) shows similar effects to cognitive-behavior therapies (CBTs) for treating Alcohol Use Disorder, but it does not consistently enhance the outcomes of CBT alone, indicating limited added benefit.

The effectiveness of CET may be reduced due to many alcohol-dependent patients not experiencing strong cravings, suggesting that alternative strategies like multisensory motivational imagery could be more beneficial in helping patients develop coping skills in real-life situations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cue exposure for alcohol use disorders: A commentary on Kiyak et al. (2023). Kavanagh, DJ.[2023]

The new technique called 'affective counterattribution' (ACA) has been shown to enhance the effectiveness of alcohol addiction treatment by linking negative emotional experiences with positive hallucinatory images related to alcohol.

This method not only helps in changing patients' attitudes towards alcohol but also aids in correcting their harmful personality traits associated with addiction.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Treatment of alcoholism by affective counterattribution]. Grinenko, AIa., Krupitskiĭ, EM., Paleĭ, AI., et al.[2013]

Cognitive bias modification of attention (CBM-A) training effectively reduced alcohol attentional bias in heavy drinking students, but this effect was only observed in the regular training condition, not in the gamified version.

The introduction of gamification in the training did not improve motivation to train and may have even had negative effects on motivation, highlighting the need for careful evaluation of gamified interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Attentional Bias Modification With Serious Game Elements: Evaluating the Shots Game. Boendermaker, WJ., Sanchez Maceiras, S., Boffo, M., et al.[2020]

Cognitive training has the potential to improve cognitive recovery in individuals with alcohol use disorders (AUDs), although it has been studied infrequently in this population.

While cognitive improvements are often observed with abstinence from alcohol, the effectiveness of training protocols in enhancing performance on tasks that are not directly trained is less consistent, indicating a need for more robust research in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive training as a component of treatment of alcohol use disorder: A review. Nixon, SJ., Lewis, B.[2020]

References

1. Switzerland pubmed.ncbi.nlm.nih.gov

[Alcoholism: cognitive-behavioral therapy]. [2019]

2. India pubmed.ncbi.nlm.nih.gov

Neuropsychological rehabilitation of alchoholics : a preliminary report. [2021]

3. England pubmed.ncbi.nlm.nih.gov

Cognitive regulation of craving in alcohol-dependent and social drinkers. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Improved Sobriety Rates After Brain-Computer Interface-Based Cognitive Remediation Training. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

A randomized controlled trial of cognitive remediation and work therapy in the early phase of substance use disorder recovery for older veterans: Neurocognitive and substance use outcomes. [2018]

6. United States pubmed.ncbi.nlm.nih.gov

Coping-skills training and cue-exposure therapy in the treatment of alcoholism. [2019]

7. England pubmed.ncbi.nlm.nih.gov

Cue exposure for alcohol use disorders: A commentary on Kiyak et al. (2023). [2023]

8. Russia (Federation) pubmed.ncbi.nlm.nih.gov

[Treatment of alcoholism by affective counterattribution]. [2013]

9. Canada pubmed.ncbi.nlm.nih.gov

Attentional Bias Modification With Serious Game Elements: Evaluating the Shots Game. [2020]

10. United States pubmed.ncbi.nlm.nih.gov

Cognitive training as a component of treatment of alcohol use disorder: A review. [2020]