Cognitive remediation in the treatment of stimulant abuse disorders: a research agenda.

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.