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Abstract
Cognitive-behavioral therapy (CBT), because of its comparatively high level of cognitive demand, is likely to be challenging for substance users with limitations in cognitive function. However, it is not known whether computer-assisted versions of CBT will be particularly helpful (e.g., allowing individualized pace and repetition) or difficult (e.g., via complexity of computerized delivery) for such patients. In this secondary analysis of data collected from a randomized clinical trial evaluating computer-assisted CBT, four aspects of cognitive functioning were evaluated among 77 participants. Those with higher levels of risk taking completed fewer sessions and homework assignments and had poorer substance use outcomes.
THE AUTHORS
Kathleen M. Carroll, Ph.D., is Professor of psychiatry at the Yale University School of Medicine, Scientific Director of the Center for Psychotherapy Development at Yale, and Principal Investigator of the New England Node of the National Institute on Drug Abuse's Clinical Trials Network. The author of over 250 journal articles, chapters, and books, Dr. Carroll's research and clinical interests lie in the area of developing, specifying, and evaluating evidence-based treatments for substance use disorders. Dr. Carroll is the past President of Division 50 (Addictions) of the American Psychological Association and currently holds both K05 (Senior Scientist) and MERIT awards from the National Institute on Drug Abuse. An ISI Thompson Highly Cited Researcher, she has received the Distinguished Scientific Contributions to Education and Training Award from Division 50 and numerous other awards for her work in improving treatment outcome for addictive disorders.
Brian D. Kiluk, Ph.D. is a postdoctoral fellow at the Yale University School of Medicine, Department of Psychiatry. He has worked for several years as a Research Associate in the Division of Substance Abuse at the Yale University School of Medicine and has started a postdoctoral fellowship funded by the National Institutes of Health at Yale upon the completion of his Ph.D. in August 2009.
Charla Nich, M.S., is the senior statistician for the Psychotherapy Development Center of the Department of Psychiatry at Yale University School of Medicine.
Theresa A. Babuscio, M.A., is a statistician and data manager at the Department of Psychiatry, Yale University School of Medicine. Her primary research interest is schooling junior faculty on research methodology and integrity. She is also focused on substance abuse treatment for special populations.
Judson A. Brewer, M.D., Ph.D., is Assistant Professor of psychiatry at the Yale University School of Medicine and Medical Director of the Therapeutic Neuroimaging Center of the Division on Addictions. His primary research interest is the elucidation of neurobiological mechanisms underlying the interface between stress, mindfulness, and the addictive process and in developing effective means for the modulation of these processes to better treat substance use disorders. The principal focus of his laboratory is on studying mindfulness training as a mechanistic probe and treatment for addictions.
Marc N. Potenza, M.D., Ph.D., is Associate Professor of psychiatry and child study. Dr. Potenza is Principal Investigator of Yale's Center of Excellence in Gambling Research and the affiliated Yale Problem Gambling Clinic and Yale Program for Research on Impulsivity and Impulse Control Disorders. He is also Director of the Women and Addictions Core of Women's Health Research at Yale and Director of Neuroimaging for the Veterans Administration New England healthcare System (VISN1) Mental Illness Research, Education, and Clinical Center (MIRECC). Dr. Potenza's research focuses on the neurobiologies of “behavioral” and drug addictions, sex differences therein, and the translation of neurobiological understandings into treatment advances.
Samuel A. Ball, Ph.D., is Professor of psychiatry at the Yale University School of Medicine and Director of Research for the APT Foundation in New Haven, Connecticut. He also coordinates psychology training in the Division of Substance Abuse, supervises and teaches psychology interns, and mentors and coaches junior faculty at Yale and other universities. His research focuses on the assessment and treatment implications of personality dimensions, personality disorders, and multidimensional subtypes in substance abuse. Dr. Ball is the developer of Dual Focus Schema Therapy that has shown promising results in several clinical trials with substance abuse patients who have co-occurring personality disorders.
Steve Martino, Ph.D., is Associate Professor of psychology in psychiatry at the Yale University School of Medicine. Dr. Martino is Education Director of the Center for Psychotherapy Development at Yale, Training Director of the New England Node of the National Institute on Drug Abuse's Clinical Trials Network, and Principal Investigator of the National Institute of Mental Health's Yale Program of Excellence for training fellows in scientifically validated behavioral treatments for addictions. Dr. Martino's research focuses on the motivational interviewing, therapist treatment fidelity rating systems, and the development and testing of strategies for teaching therapists evidence-based psychosocial treatments.
Bruce J. Rounsaville, M.D., is Professor of psychiatry at the Yale University School of Medicine. He has focused his clinical research career on the diagnosis and treatment of patients with alcohol and drug dependence. As a member of the Work Group to Revise Diagnostic and Statistical Manual of Mental Disorders–Third Edition, Dr. Rounsaville was a leader in adopting the drug dependence syndrome concept into the Diagnostic and Statistical Manual of Mental Disorders–Third Edition, Revised and DSM-IV substance use disorder criteria. Dr. Rounsaville has been a strong advocate for adopting behavioral treatments shown to be efficacious in rigorous clinical trials. Dr. Rounsaville has played a key role in clinical trials on the efficacy of a number of important treatments, including naltrexone for treatment of alcohol dependence, CBT for cocaine dependence, and disulfiram treatment for cocaine abusers.
Carl W. Lejuez, Ph.D., is Professor in the Clinical Psychology Program at the University of Maryland and the Founding Director of the Center for Addictions, Personality, and Emotion Research (CAPER). His research is translational in nature, using rigorous laboratory methods to understand real-world clinical phenomena and to develop novel assessment and treatment strategies. His work spans the clinical domains of addictions, personality pathology, and mood disorders, and he is most interested in the common processes across these conditions.
Notes
1 The journal's style utilizes the category substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be abused. Editor's note.
2 Treatment can be briefly and usefully defined as a planned, goal-directed, temporally structured change process, of necessary quality, appropriateness, and conditions (endogenous and exogenous), which is bounded (by culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual-help-based (such as Alcoholic Anonymous and Narcotics Anonymous), and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users—of whatever types and heterogeneities—that are not also used with substance nonusers. In the West, with the relatively new ideology of “harm reduction” and the even newer quality-of-life treatment-driven model there are now a new set of goals in addition to those derived from/associated with the older tradition of abstinence-driven models. Editor's note.