Goal-based interventions for executive dysfunction in addiction treatment

People with substance use disorders have deficits in executive functions, and these deficits predict clinical outcomes in addiction treatment. Goal-based interventions utilize interactive tasks, strategy learning, and real-life examples to strengthen executive functions and enable participants to control impulsive responses and align behavior with goals. In this chapter, the evidence on the effects of three goal-based interventions in the context of addiction treatment is summarized: (1) Goal Management Training (GMT), which involves instruction and practice on response inhibition, mindfulness, goal setting, strategy application, and decision-making, as well as an overarching strategy to link these trainings (Stop–State goal–Check); (2) Cognitive Remediation (CR) for substance users, which combines GMT and other executive function rehabilitation programs and training on implementation of intentions; and (3) an ecological intervention based on chess, which uses the game as a platform to train goal-related strategies, including response inhibition and planning and strategic decision-making during the preparation of chess movements. Preliminary trials of GMT have shown beneficial effects on executive functions, including working memory, response inhibition, and strategy application. CR and chess training have beneficial effects on executive functions and self-regulation, although their active ingredients and specific outcomes are still unclear. Altogether, goal-based interventions are theoretically relevant and practically feasible and have beneficial effects on executive skills that are critical to achieve addiction treatment outcomes. However, goal-based interventions still need to be tested in rigorous randomized clinical trials including clinical outcomes (e.g., drug relapse, quality of life) and mechanistic accounts of treatment effects.