Internet-delivered psychosocial interventions, like the Therapeutic Education System (TES), have been found to be effective in delivering quality-controlled, evidence-based treatment for substance use disorders. Because of their flexible design, which makes them easier to individualize, they may be useful for those with cognitive impairment as well.
This study investigated the association between cognitive functioning and treatment outcomes in a large (N=507) randomized controlled effectiveness trial of TES compared to treatment-as-usual conducted within outpatient programs in the NIDA CTN (CTN-0044, “Web Delivery of Evidence-Based, Psychosocial Treatment for Substance Use Disorders”).
Participants in the study completed a computer-based cognitive assessment at baseline. Scores on subtests of attention, reasoning, and spatial perception were tested as moderators of the treatment effect on abstinence and retention at the end of the 12-week treatment phase.
Cognitive functioning was not found to impact treatment in terms of retention or abstinence, suggesting that TES does not differ in its effectiveness across levels of cognitive functioning.
Analysis of the main effect of cognitive functioning on retention and abstinence found that impaired reasoning and cognitive flexibility were associated with lower retention across both treatment arms, but there were no other main effects of cognitive functioning on either abstinence or retention for the study population.
Conclusions: The internet-delivered intervention TES appears to be equally effective across a spectrum of cognitive functioning among diverse patients. Further study is needed to determine what influence cognitive functioning may have on retention in treatment and to optimize technology-based interventions for those with cognitive impairment.
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Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center National Office, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA.
Articles were written based on the following published research:
Shulman M, et al. Cognitive Functioning and Treatment Outcomes in a Randomized Controlled Trial of Internet-Delivered Drug and Alcohol Treatment. American Journal on Addictions 2018 (in press).