Researchers Say To Improve Addiction Recovery Outcomes, Improve Cognitive Impairment
According to research recently published in the journal Genes, Brain and Behavior, improving cognitive impairment in persons who struggle with substance abuse may aid in addiction recovery. That is, many people with addiction also exhibit impaired cognitive functioning – a condition that makes long-term recovery from addiction a greater challenge.
Researchers note that certain aspects of cognitive functioning may be the cause rather than the effect of substance use. They cite clinical evidence:
“…rats with maladaptive decision-making patterns showed increased drug-seeking responses during cocaine self-administration, and a marked increase in cue-elicited drug seeking, compared with ‘optimal’ rats, after an incubation period of 30 days.
Not only did this trait predict traits of addiction-like behavior, but also subsequent exposure to cocaine enhanced the risk-preferring choice pattern while having no effect on choice style for optimal rats.”
Common Types Of Cognitive Impairment
Impulsivity is the propensity to make decisions or act without thinking things through. Moreover, sound judgment may be lacking, and there is little or no consideration of the consequences involved.
Cognitive flexibility is the ability to shift thinking between two concepts, or consider multiple concepts simultaneously.
An example of attentional bias occurs when a person does not examine all possible outcomes when making a judgment about an association. That is, only one or two possibilities are focused upon, while the rest are discarded. Thus, this impairment may be closely related to impulsivity.
All of these components, however, are critical to successful completion of the most common (and effective) behavioral modification programs, such as cognitive behavioral therapy (CBT). CBT focuses on the development of coping mechanisms through cognitive techniques, skill-building, and motivational enhancement therapy – a technique intended to strengthen a client’s motivations to recover from substance abuse.
If these techniques are to be effective, a certain level of cognitive involvement is critical. This involvement, however, can be impaired by drug or alcohol use, or as noted above, the impairments may be a direct cause of the abuse itself.
For example, long-term cocaine users have exhibited impairments in memory encoding. In addition, alcohol abuse has been linked to impaired long-term memory, and decreases in behavioral flexibility have been seen in users of opioids and other psychoactive drugs:
“It is clear that the cognitive profile of presents an obstacle for the recovery process.”
Medication-assisted therapy has been shown to prevent or reduce relapses; however, patients using these medications often still have impaired cognitive functioning. Also, these treatments usually require frequent doses – and quite often, a long-term schedule.
One example of medication-assisted treatment is naltrexone, which reduces the “buzz” associated with alcohol and opioids, and also mitigates cravings. However, it must be administered every day, and a course of at least 3 months is usually required.
Researchers say that instead, the the focus should be on medicines that promote a more permanent change, in which the “subject learns to inhibit their original behavior because it no longer has any value.”
In the study, they proposed various alternatives, including glutamatergic agents. Glutamatergic means “related to glutamate”, and therefore, a glutamatergic agent is a chemical that directly modulates the excitatory amino acid system in the body or brain. Glutamatergic agents have been shown to increase inhibitions (thus reducing impulsivity.)
Glutamatergic agents include medication such as Chantix, a drug shown to increase memory and attention span smokers who have remained abstinent. In addition, some stimulants have been shown to improve cognition.
In addition, several non-medicinal interventions were suggested, such as magnetic stimulation, a method used to stimulate small regions of the brain. This technique has been shown to mitigate symptoms of Parkinson’s disease, as well as reduce depression.
It may also reduce cue reactivity (a learned response seen in individuals with addiction, involving significant physiological reactions to drug-related stimuli) as well attentional biases in substance abusers.
Also, deep brain stimulation could be useful in treating substance abuse. Deep brain stimulation is a neurosurgical procedure that involves the implantation of a medical device called a neurostimulator. This device sends electrical impulses, via implanted electrodes, to specific targets in the brain for the treatment of movement and neuro-psychiatric disorders.
In addition, exercise may improve memory and alter cue reactivity. Indeed, animal tests have revealed that exercise may reduce the self-administration of cocaine and opioids, and may facilitate the extermination of drug-seeking behaviors.
Finally, there are other cognitive training programs that could be facilitated during addiction recovery that could improve cognitive functioning.
These include cognitive enhancement therapy (CET), a technique that requires a patient to engage in cognitive exercises on a regular basis, and cognitive bias modification (CBM), which trains patients to focus their attention away from drug-associated cues.
In conclusion, researchers posit that by combining behavioral therapy with agents that improve cognitive functioning, results may offer “the best possible chance of effecting a behavioral change.”
~ G. Nathalee Serrels, M.A., Psychology