Modified Cognitive Behavioral Therapy (M-CBT) for Cocaine Dependence: Development of Treatment for Cognitively Impaired Users and Results From a Stage 1 Trial

• Published in: Psychology of addictive behaviors 2018-11, Vol.32 (7), p.800-811
• Main Authors: Aharonovich, Efrat, Hasin, Deborah S., Nunes, Edward V., Stohl, Malka, Cannizzaro, Daniela, Sarvet, Aaron, Bolla, Karen, Carroll, Kathleen M., Genece, Kamala Greene
• Format: Article
• Language: English
• Subjects: Adult; Behavior modification; Clinical research; Clinical trials; Cocaine; Cocaine-Related Disorders - complications; Cocaine-Related Disorders - psychology; Cocaine-Related Disorders - therapy; Cognitive Behavior Therapy; Cognitive behavioral therapy; Cognitive Behavioral Therapy - methods; Cognitive Development; Cognitive Dysfunction - complications; Cognitive Dysfunction - psychology; Cognitive Dysfunction - therapy; Cognitive Impairment; Cognitive therapy; Diaries; Dominance; Drafts; Drug abuse; Drug Dependency; Experts; Female; Human; Humans; Intervention; Male; Middle Aged; Neuropsychology; Outpatient; Outpatients; Repetition; Substance abuse treatment; Substance Use Disorder; Substance Use Treatment; Therapists; Treatment Outcome
• ISSN: 0893-164X; 1939-1501
• DOI: 10.1037/adb0000398

Cognitive impairments are associated with poor outcomes when treating cocaine dependent patients, but behavioral interventions to mitigate this impact have not been developed. In this Stage 1A/1B treatment development study, several compensatory strategies (e.g., content repetition, daily logs, diaries, visual presentation) were combined to create a modified cognitive behavioral therapy (M-CBT) for treating cocaine dependence. Initially, a select group of therapists, neuropsychology experts, and patients were asked to provide input on early drafts of the treatment manual and companion patient workbook. After an uncontrolled small trial (N = 15) and two rounds of manual development (Stage 1A), a pilot randomized clinical trial (N = 102) of cocaine dependent outpatients with and without cognitive impairments was conducted (Stage 1B). Participants were randomized to M-CBT (N = 52) or CBT (N = 50). Both treatments were individually delivered over 12 weeks with assessments conducted at baseline, end-of-treatment, and 3-month follow-up. The primary outcome was frequency of cocaine use, measured by number of days used in the prior 7 days. Participants in the two treatment groups did not differ significantly on drug use reduction or retention in treatment. However, among participants who completed at least 9 weeks of treatment, those in M-CBT showed a trend toward greater reduction in cocaine use compared to those in the CBT group. M-CBT is feasible for impaired and nonimpaired cocaine dependent participants. However, M-CBT treatment did not show significant superiority over standard CBT in the present sample.