Monash Institute of Cognitive and Clinical Neuroscience, Monash University, 18 Innovation Walk, Clayton, VIC, 3800, Australia.
Department of Biological & Health Psychology, School of Psychology, Madrid Autonomous University, 28049, Madrid, Spain.
Neuropsychol Rev. 2019 Mar;29(1):79-92. doi: 10.1007/s11065-018-9384-6. Epub 2018 Sep 26.
Decision-making deficits are strong predictors of poor clinical outcomes in addiction treatment. However, research on interventions that address decision-making deficits among people with addiction is scarce and has not been analyzed. We aimed to systematically review evidence on neuropsychological interventions for decision-making deficits in addiction to identify promising therapies. Eligibility criteria were (1) participants with a diagnosis of substance use or behavioral addictive disorders, (2) interventions consisting of (neuro) psychological treatments that address decision-making, (3) comparators comprising control (sham) interventions, treatment as usual or no-treatment, (4) outcomes including a decision-making task, and (5) studies including RCTs and non-randomized trials. Search terms included addiction (or alcohol/drug/substance use/gambling) AND treatment (or specific interventions) AND decision-making (or specific tasks). The search yielded 728 hits, and two independent assessors agreed on the final selection of 12 articles. Interventions included Contingency Management (3 studies), Working Memory Training (2 studies) Goal Management Training (2 studies), Cognitive Behavioral Therapy (2 studies), Reality Therapy, Motivational Interview and Monetary Management. The main outcome measures were tasks of delay discounting, risk-taking and reward-based decision-making. Results showed that Goal Management Training improves reward-based decision-making, while Contingency Management combined with Cognitive Behavioral Therapy has beneficial effects on delay discounting. The evidence on Working Memory Training and Cognitive Behavioral Therapy as stand-alone treatments was mixed. Motivational Interview and Monetary Management had no significant effects on decision-making. Bias control across studies was moderate. We conclude that Goal Management Training and Contingency Management combined with Cognitive Behavioral Therapy have potential to modify decision-making in people with addiction. RCTs are needed to establish the efficacy of these interventions.
决策缺陷是成瘾治疗中临床预后不良的强有力预测因素。然而，针对成瘾者决策缺陷的干预措施的研究很少，也没有进行分析。我们旨在系统地综述成瘾者决策缺陷的神经心理干预措施的证据，以确定有前途的治疗方法。入选标准为：（1）有物质使用或行为成瘾障碍诊断的参与者；（2）包括解决决策问题的（神经）心理治疗的干预措施；（3）对照组（假对照）干预措施、常规治疗或无治疗；（4）包括决策任务的结果；（5）包括 RCT 和非随机试验的研究。搜索词包括成瘾（或酒精/药物/物质使用/赌博）和治疗（或特定干预措施）和决策（或特定任务）。搜索结果为 728 项，两名独立评估员对最终选择的 12 篇文章达成一致。干预措施包括：（1）Contingency Management（3 项研究）；（2）Working Memory Training（2 项研究）；（3）Goal Management Training（2 项研究）；（4）Cognitive Behavioral Therapy（2 项研究）；（5）Reality Therapy；（6）Motivational Interview；（7）Monetary Management。主要结果测量为延迟折扣、冒险和基于奖励的决策任务。结果表明，Goal Management Training 可改善基于奖励的决策，而 Contingency Management 与 Cognitive Behavioral Therapy 联合使用对延迟折扣有有益的影响。关于单独使用 Working Memory Training 和 Cognitive Behavioral Therapy 的证据存在矛盾。Motivational Interview 和 Monetary Management 对决策没有显著影响。跨研究的偏倚控制中等。我们得出结论，Goal Management Training 和 Contingency Management 联合 Cognitive Behavioral Therapy 有可能改变成瘾者的决策。需要进行 RCT 以确定这些干预措施的疗效。
