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Internet-Delivered Intervention Equally Effective for People with Diverse Cognitive Function

January 10, 2018
Shulman M, et al.
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).
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  • People with substance use disorders often exhibit signs of compromised cognitive function, such as issues with attention, reasoning, or spatial processing, compared to the general population.
  • Additionally, cognitive impairment is associated with poorer outcomes in treatment, suggesting that interventions that are compatible with a broad range of neuropsychological function are vital.

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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