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

What You Need to Know Before You Apply

What is the purpose of this trial?

The trial aims to explore a new treatment for Veterans with alcohol use disorder (AUD) who also experience memory and thinking challenges. It offers an 8-week program called Motivationally Enhanced Compensatory Cognitive Training for Addictions (ME-CCT-A), delivered online for easy access. The goal is to determine if this program can improve cognitive skills, potentially leading to better recovery outcomes. Veterans in the early stages of recovery from AUD who are concerned about their cognitive abilities may be a good fit, provided they have internet access. As an unphased trial, this study offers Veterans a unique opportunity to access innovative treatment and contribute to research that could enhance recovery strategies for others.

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 prior data suggests that this cognitive training is safe for individuals with alcohol use disorders?

Previous studies have shown that Compensatory Cognitive Training (CCT), including a version designed to boost motivation for those with addictions (ME-CCT-A), is generally well-tolerated. Participants in these studies experienced improvements in mental skills like thinking speed and decision-making, which are important for everyday choices and problem-solving. No major negative effects were reported, suggesting that this type of training is safe for people with alcohol use disorders. As a behavioral approach rather than a medication, it is less likely to cause physical side effects, making it a promising option for those looking to improve thinking skills affected by alcohol use disorder. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Motivationally Enhanced Compensatory Cognitive Training for Addictions (ME-CCT-A) because it offers a fresh approach to treating alcoholism. Unlike traditional treatments that focus heavily on counseling and medication, this method is a group-based behavioral intervention that aims to boost cognitive function. It’s designed specifically for Veterans dealing with substance use disorders and cognitive challenges, potentially addressing the cognitive deficits that can make recovery harder. This unique focus on cognitive enhancement could lead to better outcomes by improving attention, memory, and problem-solving skills, which are crucial for long-term recovery.

What evidence suggests that this cognitive training is effective for alcoholism?

Research has shown that brain training can boost mental abilities in various groups, including people with alcohol use disorders (AUDs). In this trial, participants will receive Motivationally Enhanced Compensatory Cognitive Training for Addictions (ME-CCT-A), a program that might improve thinking skills in people with AUDs. Thinking problems often hinder recovery by increasing relapse risk and complicating adherence to treatment plans. Although researchers are still studying ME-CCT-A, early results suggest it could help people think more clearly, making it easier to stick to their treatment and reduce relapse risk. This method is promising because participants can access it online, facilitating participation in the treatment. ^{1 6 7 8 9}

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

Citations

1. clinicaltrials.gov clinicaltrials.gov/study/NCT06134128

Compensatory Cognitive Training Via Telehealth for ... Motivationally Enhanced Compensatory Cognitive Training for Addictions (ME-CCT-A) is a manualized group-based behavioral intervention (8 weeks, 2 hour per week) ...

2. digitalcollections.ohsu.edu digitalcollections.ohsu.edu/record/44473?ln=en&p=%28+%28subject%3A%28Ethanol+%2B+%29%29%29

Compensatory cognitive training via telehealth for veterans ... This project piloted a telehealth-delivered cognitive rehabilitation intervention, Motivationally Enhanced Compensatory Cognitive Training ...

3. escholarship.org escholarship.org/content/qt6wr3f1d5/qt6wr3f1d5_noSplash_353ed210bae84cf260633da36d7c8ee9.pdf

Effects of Motivationally Enhanced Compensatory ... Thus, this dissertation study examined the efficacy of an 8-week Motivationally. Enhanced Compensatory Cognitive Training (ME-CCT) intervention, ...

4. psycnet.apa.org psycnet.apa.org/record/2019-50486-006

Cognitive training as a component of treatment of alcohol use ... Objective: Cognitive training is an effective means of improving performance in a range of populations. Whether it may serve to facilitate cognitive ...

5. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7429442/

Cognitive Training as a Component of Treatment of Alcohol ... Conclusions: Cognitive training protocols have shown benefit in a variety of populations but have been examined infrequently in persons with AUDs. This overview ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12492034/

Enhancing treatment outcomes of Alcohol Use Disorder ... The TG group showed gains in general cognitive functioning, executive functions, abstraction, sensitivity to interference, processing speed, ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC3610413/

A Role for Cognitive Rehabilitation in Increasing the ... A new generation of research aims to facilitate treatment process and improve AUD treatment outcomes by directly promoting cognitive recovery.

8. cogtale.org cogtale.org/wp-content/uploads/2023/05/Motivationally-Enhanced-Compensatory-Cognitive-Training-for-MCI-2.pdf

Motivationally Enhanced Compensatory Cognitive Training ... Preliminary research suggests that mindfulness practice may effectively improve substance use outcomes in adults with addictions. Although mindfulness ...

9. sciencedirect.com sciencedirect.com/science/article/pii/S1936657422000280

Improving treatment for people with cognitive impairment ... Cognitive remediation strategies are used to support people with cognitive impairment to identify compensatory techniques to improve memory or to employ memory ...