School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia.
Department of Cognitive Psychology, Institute for Cognitive Science Studies, Tehran, Iran.
Addiction. 2023 May;118(5):935-951. doi: 10.1111/add.16109. Epub 2022 Dec 28.
Substance use disorders (SUD) are associated with cognitive deficits that are not always addressed in current treatments, and this hampers recovery. Cognitive training and remediation interventions are well suited to fill the gap for managing cognitive deficits in SUD. We aimed to reach consensus on recommendations for developing and applying these interventions.
DESIGN, SETTING AND PARTICIPANTS: We used a Delphi approach with two sequential phases: survey development and iterative surveying of experts. This was an on-line study. During survey development, we engaged a group of 15 experts from a working group of the International Society of Addiction Medicine (Steering Committee). During the surveying process, we engaged a larger pool of experts (n = 54) identified via recommendations from the Steering Committee and a systematic review.
Survey with 67 items covering four key areas of intervention development: targets, intervention approaches, active ingredients and modes of delivery.
Across two iterative rounds (98% retention rate), the experts reached a consensus on 50 items including: (i) implicit biases, positive affect, arousal, executive functions and social processing as key targets of interventions; (ii) cognitive bias modification, contingency management, emotion regulation training and cognitive remediation as preferred approaches; (iii) practice, feedback, difficulty-titration, bias modification, goal-setting, strategy learning and meta-awareness as active ingredients; and (iv) both addiction treatment work-force and specialized neuropsychologists facilitating delivery, together with novel digital-based delivery modalities.
Expert recommendations on cognitive training and remediation for substance use disorders highlight the relevance of targeting implicit biases, reward, emotion regulation and higher-order cognitive skills via well-validated intervention approaches qualified with mechanistic techniques and flexible delivery options.
物质使用障碍（SUD）与认知缺陷相关，而当前的治疗方法并不总是能解决这些缺陷，这阻碍了康复。认知训练和矫正干预非常适合弥补 SUD 中认知缺陷的管理空白。我们旨在就开发和应用这些干预措施达成共识。
设计、地点和参与者：我们使用德尔菲法进行了两个连续阶段的研究：调查制定和专家迭代调查。这是一项在线研究。在调查制定阶段，我们邀请了来自国际药物成瘾医学学会（指导委员会）工作组的 15 名专家组成一个小组。在调查过程中，我们通过指导委员会的建议和系统评价，确定了一个更大的专家群体（n=54）参与调查。
调查包括 67 个项目，涵盖干预措施开发的四个关键领域：目标、干预方法、有效成分和传递模式。
在两轮迭代（保留率为 98%）中，专家们就 50 个项目达成了共识，包括：（i）内隐偏见、积极情绪、唤醒、执行功能和社交处理是干预的关键目标；（ii）认知偏差修正、条件性管理、情绪调节训练和认知矫正作为首选方法；（iii）实践、反馈、难度调整、偏差修正、设定目标、策略学习和元意识作为有效成分；（iv）成瘾治疗工作队伍和专门的神经心理学家共同促进干预措施的实施，同时采用新颖的数字化传递模式。
关于物质使用障碍认知训练和矫正的专家建议强调了通过经过充分验证的干预方法，针对内隐偏见、奖励、情绪调节和高级认知技能的相关性，这些方法结合了机制技术和灵活的传递选择。
