Cognitive Assessment, Management & Training in Addiction Treatment

Cognitive impairments (CI) are common in the context of substance use disorders (SUDs). In addition to the direct effects that substance can have upon the brain, there are a range of associated factors that may further compound cognitive deficits in SUD across the life span. Due to the high prevalence of CI in this cohort and negative impact CI can have upon treatment engagement, retention and outcomes as well as broader functioning and quality of life, its identification and management is critical. This chapter discusses factors that may be associated with CI in SUD, encouraging readers to employ a biopsychosocial lens to assessment and management. A variety of practical identification and screening methods are discussed, including factors to explore when taking a clinical history and self/informant questionnaires available for use. This chapter discusses ways in which CI may manifest behaviorally and explores cognitive screening tools and their suitability in the SUD context. Ultimately, the use of a combination of these methods in identification of CI in SUD is recommended, with neuropsychological assessment considered the “gold standard.” With a view to maximizing functioning and participation, cognitive rehabilitation in SUD ideally targets both implicit (“bottom-up”) as well as reflective cognitive control (“top-down”) processes, using both cognitive compensatory and remediation methods. In order to support individuals with CI, this chapter describes pragmatic adaptations to existing therapies, cognitive compensatory strategies, and the existing evidence base for a range of cognitive training programs in SUD, including working memory training, inhibitory control training, goal management training, and cognitive bias modification.