Vocci Frank J
Division of Pharmacotherapies and Medical Consequences of Drug Abuse, National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Boulevard, Bethesda, MD 20892, USA.
Exp Clin Psychopharmacol. 2008 Dec;16(6):484-97. doi: 10.1037/a0014101.
Treatment of substance abuse disorders is often characterized by high dropout rates. Patients who fail to complete a treatment course often are worse at follow-up than those patients who received the full treatment course. Cognitive deficits, including impulsivity, have been noted as a major determinant of treatment retention and successful outcomes. This review summarizes the recent literature on cognitive deficits in stimulant users and their remediation. Cognitive deficits can be remediated through computer-assisted cognitive rehabilitation in residential settings. A few studies have shown this can be transferred to the outpatient setting although much research remains to be done in this setting. Pharmacological remediation of cognitive deficits is a new target for medications development in the treatment of substance abuse disorders. Psychiatric disorders; for example, attention deficit hyperactivity disorder, are amenable to pharmacological remediation of cognitive deficits. Several cognitive deficits (set-shifting, attentional bias, reversal learning, impulsivity, and risky decision making) and their possible remediation with pharmacological agents are presented in the review. Recommendations for the research agenda include comments on testing hierarchies, clinical trial design issues, and types of pharmacological agents.
物质使用障碍的治疗往往具有高辍学率的特点。未完成治疗疗程的患者在随访时往往比接受完整治疗疗程的患者情况更差。认知缺陷，包括冲动性，已被视为治疗依从性和成功治疗结果的主要决定因素。这篇综述总结了关于兴奋剂使用者认知缺陷及其补救方法的最新文献。认知缺陷可以通过住院环境中的计算机辅助认知康复来补救。一些研究表明，这可以转移到门诊环境中，尽管在该环境中仍有许多研究有待开展。认知缺陷的药物补救是物质使用障碍治疗中药物开发的一个新靶点。精神障碍，例如注意力缺陷多动障碍，适合进行认知缺陷的药物补救。综述中介绍了几种认知缺陷（定势转换、注意偏向、逆向学习、冲动性和风险决策）及其可能的药物补救方法。对研究议程的建议包括对测试层次、临床试验设计问题和药物类型的评论。
