The intersection of neuroscience and addiction treatment has paved the way for innovative interventions aimed at addressing cognitive alterations that can hinder the effectiveness of current treatments for substance use disorders. The study published on Wiley Online Library presents a comprehensive overview of expert-endorsed cognitive rehabilitation interventions, such as cognitive bias modification, contingency management, cognitive remediation, and emotion regulation training, as adjuncts to traditional substance use disorder treatments. Here, we delve into the therapeutic mechanisms, clinical implications, and translation challenges associated with these interventions:

Cognitive Bias Modification

By resetting drug-related biases through various forms of computerised cognitive training, cognitive bias modification aims to redirect tendencies towards substance use to alternative targets. This intervention targets addiction-related alterations in the incentive salience system, diminishing the value of drug rewards while enhancing the value of alternative reinforcers.

Contingency Management

Contingency management offers tangible incentives, like monetary payments, for achieving therapeutic goals such as treatment attendance or abstaining from substance use. By reducing the value of drug rewards and increasing the value of non-substance-related reinforcers, this intervention addresses addiction-related alterations in the incentive salience system.

Through mental strategies designed to restore cognitive deficits and enhance everyday functioning, cognitive remediation focuses on improving cognitive skills to support adaptive behaviour. Strategies like “pause – check your goal – choose” help individuals thwart impulsive decisions in high-risk scenarios, thereby strengthening executive control of behaviour.

Emotion Regulation Training

Emotion regulation training utilises mental strategies to manage negative emotions and amplify positive affect, fostering improved emotional control and enhancing well-being. By targeting addiction-related alterations in the executive control system, this intervention strengthens top-down control over behaviour and emotions.

The Delphi consensus endorsed applying these interventions post-acute detoxification, maintaining them weekly for at least three months. Individualised neuropsychosocial assessments guide the selection of specific interventions tailored to each individual’s needs and substance use disorder profile.

Despite the evidence-informed nature of these interventions, their translation into clinical practice faces several barriers. Controversies around addiction models, the gap between research and clinical realms, limited technology and resource availability, and complex policy landscapes present hurdles to integrating cognitive rehabilitation into addiction treatment.

Source: Wiley Online Library