Executive functions (EF) are a primary mediator of both typical and atypical functioning, influencing the progression of psychopathology due to their role in supporting self-monitoring/regulation and top-down control of cognitive processes. According to recent models, EF impairments may contribute to the functional decline of patients with substance use disorder (SUD), exacerbating secondary affective and social symptoms. Despite these potential implications, the tools now commonly used to outline neurocognitive, and specifically EF, impairments in patients with addiction are not tailored to this clinical population, having been developed to assess cognitive or dysexecutive deficits in neurology or geriatric patients. Because of their different clinical focus, such tools are frequently unable to fully delineate the dysfunctional EF profile of addiction patients. We here present the development and validation of a novel specific screening battery for executive disorders in addiction: Battery for Executive Functions in Addiction (BFE-A).

151 SUD patients and 55 control persons were recruited for the validation of the BFE-A battery. The battery consists of two computerized neurocognitive tasks (Stroop and Go/No-go tasks) and five digitalized neuropsychological tests (focus: short/long-term memory, working memory, focused attention, verbal/non-verbal cognitive flexibility). The tests are designed to assess executive control, inhibition mechanisms, and attention bias toward drugs of abuse.

In tests of verbal memory, focused attention, and cognitive flexibility, as well as in computerized tasks, inferential statistical analyses revealed lower performance in SUD patients compared to control participants, indicating a lack of inhibitory processes and dysfunctional management of cognitive resources. The investigation of Cohen’s d values has revealed that inhibitory control, verbal/nonverbal fluency, and short/long-term memory are the areas with the most significant impairments.

While the evaluation of EF dysfunctions associated to addiction is a currently underrepresented component of the diagnostic procedure in drug assistance/treatment programs, is also is an essential step for both profiling of patients and design of rehabilitation protocols. Clinical interviews should be complemented by early assessment of cognitive weaknesses and preserved EF skills in order to establishing personalized therapy strategy and perhaps organizing a concurrent phase of cognitive rehabilitation.

Opioid use disorder (OUD) has been declared a national public health emergency leading to increased enrollment in medication assisted treatment (MAT) programs. Cognitive deficits are seen among those with OUD which can persist even with MAT. Moreover, cognitive deficits predict poor community and treatment outcomes. Neuropsychological evaluations can identify, diagnose, and provide treatment recommendations, and are associated with improved outcomes in non-substance use patient populations. Yet, patients with OUD rarely undergo neuropsychological assessment when participating in opioid use treatment. Teleneuropsychology (TNP) may increase access to care but has not been evaluated with people with substance use disorders (SUDs). This project used a mixed-method design to evaluate the feasibility and impact of a pilot hybrid TNP service with new patients with OUDs entering a MAT program.

Participants were >18 years old and new patients enrolling in MAT for OUD. Participants were excluded if they planned to move out of town within six months or were pending incarceration. Participants were identified by triage questions at MAT intake based on frequency of relevant co-occurring conditions indicating those with greatest need. Positively triaged individuals were referred to the TNP service which was conducted by a hybrid approach (i.e., patient presents to the clinic and is evaluated from a separate room using video-teleconferencing technology). We aimed to schedule participants within two-weeks of 30-days from intake to the MAT program. Consented participants completed questionnaires of feasibility and acceptability (e.g., satisfaction, usefulness) after undergoing a screening TNP evaluation and feedback of the results and recommendations. Participants also were invited to undergo a brief qualitative interview to further assess facilitators and barriers.

Of 57 individuals screened positive, 51 were referred, and 14 were reached to offer TNP. Ten (71.4%) agreed to the TNP evaluation and scheduled an appointment, though 50% had the first appointment scheduled within two weeks of 30-days after intake to MAT. Seven (70%) did not keep the first appointment (no show or cancellation) or were rescheduled due to clinic scheduling. Three were reached to reschedule. All three were unable to keep the appointment, but one did reschedule and keep the third appointment. Of the 4 who attended TNP, only 1 (25%) was within two weeks of 30-days after intake. Of those who attended the TNP appointment, 100% completed the protocol, 75% were satisfied with the evaluation overall, 75% found the evaluation useful, and 67% would recommend TNP to others (one participant did not respond to this question).

Neuropsychological assessment may provide valuable information to improve treatment for those with OUDs. This pilot project revealed that individuals with OUDs can tolerate and are satisfied with a screening TNP evaluation and find the evaluation useful. The primary barrier was reaching referred patients. Treatment engagement among those with SUDs is a common challenge. Those with counselors who coordinated with the clinic schedulers were more likely to be reached and scheduled, suggesting support for regular case management. Other lessons learned and potential future steps are discussed.

This was a pilot study testing a cognitive enhancement program to improve rate of cognitive recovery in early substance abuse treatment. It is hypothesized that if patients were able to accelerate the rate of cognitive improvement, they may be able to better engage in substance abuse treatment and potentially have better long-term outcomes.

Participants were 47 adults newly admitted to a residential substance abuse treatment facility (74.5% male, 76.6% white, mean age=34.5 years, education=12+ years). All were post-detox. All were being treated for opioid abuse, with the majority in treatment for polysubstance abuse. Participants were randomly assigned to either the intervention group (BrainHQ research cognitive training program) or active control group (inert computer games) and completed 34 training sessions per week for a minimum of 3 weeks. NIH Toolbox cognition battery was administered at baseline and endpoint.

Regardless of study group, most participants had a significant improvement in cognitive performance across most subtests and composite scores of the NIH Toolbox cognition battery. The RAVLT and Oral Symbol Digit subtests had the greatest change (p<.001) for both groups, as well as a significant improvement (p=.002) in Cognitive Function Composite Score for both groups. The only difference between the control and intervention group was on the Pattern Comparison subtest, with the intervention group scoring significantly higher at endpoint (p=.004).

Although substance abuse is known to cause injury to the brain that may not be fully repaired by sobriety, cognitive recovery was significant in this group of patients during early inpatient treatment for opioid abuse. Although it has yielded significant effect in other patient populations, the BrainHQ program did not show a significant enhancement in cognitive recovery, compared to the active control group, in this pilot study of patients in treatment for opioid abuse. This study was limited by a small sample size and potential future variations should be considered, such as changes to intervention intensity and specific intervention exercises.

Early life adversity is strongly correlated with a number of negative health outcomes, with some of the highest risks are related to later illicit drug use and substance use disorders (SUDs). Specifically, it has been found that an ACEs score of >4 confers a 7-10-fold risk of substance abuse. Subsequent research has identified a number of neurobiological effects of childhood trauma, including structural and functional disruptions of the LHPA axis, the brain's primary stress-response system. It has been hypothesized that various trauma-induced neurobiological changes may lead to later physical health, mental health, and psychosocial problems in persons with early life adversity. One area that such changes might affect is a person's ability to stop abusing substances, with factors such as trauma-related mood, self-efficacy, or cognitive functioning as considerations in early treatment success. This study followed a group of participants in a residential substance abuse treatment program across their first month of abstinence, to assess natural change in cognitive performance as well as potential effect of early life adversity on changes in neuropsychiatric outcomes.

Participants were 37 adults (mean age=33.9 years, SD=6.7) who had completed detoxification and were first assessed during their first week of residential treatment. Follow-up assessment was completed 4 weeks later. Participants were primarily male (62%) and white (62%). They were all in treatment for opioid abuse, with a majority of participants reporting a history of polysubstance abuse. To measure adverse and protective factors, participants completed the Adverse Childhood Experiences scale and Protective And Compensatory Experiences Scale at baseline. Participants also completed the NIH Toolbox cognition battery and a set of self-report measures of cognitive functioning, mood, anxiety, and self-efficacy at baseline and follow up.

Results of paired samples t-test comparison between baseline and follow-up testing found a significant improvement in self-reported depression symptoms, anxiety symptoms, and self-efficacy (all p<.001). Interestingly, participants overall reported an increase in cognitive problems between baseline and retest, even though on objective cognitive testing (NIH Toolbox cognition battery) there was significant improvement in cognitive performance. Participants generally had a high level of childhood adversity (mean ACE score of 4.5), with an average level of childhood compensatory experiences. Considering the specific effect for childhood adversity, ACE score was found to be predictive in amount of anxiety and self-reported cognitive change but not for objective cognitive performance or change in other factors.

Consistent with previous research, these patients had a high level of past trauma, which interacted with a number of other neuropsychiatric measures and support the importance of assessing for trauma history and integrating trauma-focused treatment into substance abuse treatment programs.