Tânia Caetano

Background: Cognitive deficits are frequently observed in individuals with Substance use disorders (SUD) and have been linked to poorer treatment outcomes and a heightened risk of relapse. We aimed to study the effectiveness of a 6-week virtual reality-based cognitive training program (VRainSUD-VR) on neuropsychological outcomes, specifically memory, executive functioning, and processing speed, as well as on treatment dropout rates in individuals with SUD. We hypothesized that adding VRainSUD-VR to treatment as usual (TAU) would lead to greater cognitive improvements compared to TAU alone. As a secondary hypothesis, we expected VRainSUD-VR to reduce false memories relative to TAU.Methods: A non-randomized design with a control group, pre- and post-test assessments, and convenience sampling was employed. Patients (N = 47) were assigned to either the control group (CG), which received TAU (n = 22), or the experimental group (EG), which received VRainSUD-VR in addition to TAU (n = 25). Cognitive and treatment outcomes (e.g., dropout rates) were assessed at pre- and post-test.Results: Statistically significant time × group interactions were found for overall executive functioning [F_{(1, 75)} = 20.05, p < 0.001] and global memory [F_{(1, 75)} = 36.42, p < 0.001], indicating the effectiveness of VRainSUD-VR. No significant time × group interactions were found for most processing speed outcomes (p > 0.05).Conclusion: VRainSUD-VR could be integrated into residential programs to improve general executive functioning, perceptual reasoning, and working memory, including visual working memory, as well as different aspects of global memory, such as visual, auditory, immediate, and delayed recall. Future research should explore the long-term effects of this intervention and consider additional potential mediating factors to gain a deeper understanding of the mechanisms underlying its effectiveness.

Cognitive deficits have been shown to increase the likelihood of relapse in individuals with substance use disorders (SUD). As such, cognitive training programs are important interventions for this population. In this study, we describe the development and test the usability of a virtual reality (VR)-based cognitive training program for individuals with SUD – VRainSUD. A total of 17 patients receiving inpatient treatment for SUD at an Addiction Treatment Center agreed to participate in the study. Participants completed 9 tasks designed to test the platform’s usability. The key performance indicators (e.g., time to complete the task) as well as any relevant observations were recorded. Finally, each participant completed a brief survey and the Post-Study System Usability Questionnaire (PSSUQ). VRainSUD was considered easy and pleasant to use but additional instructions were required on certain cognitive training tasks. The total PSSUQ score confirmed an overall high level of satisfaction concerning the platform’s usability (2.72 ± 1.92). Among the three subscales, system usefulness presented the most satisfactory score (1.76 ± 1.37) and information quality presented the least satisfactory score (3.00 ± 1.95). Changes were made to the platform to improve the on-screen information and instructions. Overall, participants showed interest in integrating VRainSUD into their standard treatment. Despite limited prior VR experience, they quickly adapted to the controllers and navigation. VRainSUD can be a potentially successful add-on to SUD treatment.

Substance abuse has undeniable effects on a number of cognitive dimensions, namely memory and executive functioning. In turn, deficits in these dimensions have been associated with poorer treatment outcomes for Substance Use Disorders (SUD). The main goal of this study was to validate VRainSUD, a cognitive training program composed of a virtual reality platform and a mobile follow-up application that proposes to reduce cognitive deficits in individuals with SUD. The Delphi method was used to reach a consensus on each of the program’s characteristics (e.g., structure, cognitive training tasks). A panel of experts was invited to participate in the content validation by answering two rounds of questions (scale and free-text boxes) regarding the program. Changes were made between the rounds according to the results of the first round. The consensus was defined as at least 70% of the experts agreeing on the validity of a characteristic. From 39 invited experts, 11 completed the first round, and 6 completed both rounds. The structure of the program reached a consensus on the first round, along with most tasks (with the exception of two mobile application tasks). Significant changes were made following the feedback received, namely turning the program personalizable, and adding positive feedback to the tasks in order to improve adherence and engagement. The Delphi method was a valuable tool to improve VRainSUD. The experts’ opinions not only allowed for the validation of main features, but also informed important additional changes.

Background: Substance abuse has an impact on various cognitive domains, including memory. Even though this impact has been extensively examined across different subdomains, false memory has been sparsely studied. This systematic review and meta-analysis seek to synthesize the current scientific data concerning false memory formation in individuals with a history of substance abuse.Methods: PubMed, Scopus, the Cochrane Library, Web of Science, and PsycINFO were searched to identify all experimental and observational studies in English, Portuguese, and Spanish. Studies were then examined by four independent reviewers and, if they met the inclusion criteria, assessed for their quality. The Cochrane Risk of Bias Tool for randomized controlled trials (RCT) and the Joanna Briggs Institute (JBI) critical appraisal checklists for quasi-experimental and analytic cross-sectional studies were used to assess the risk of bias.Results: From the 443 screened studies, 27 (and two more from other sources) were considered eligible for full-text review. A final 18 studies were included in the present review. Of these, 10 were conducted with alcoholics or heavy drinkers, four focused on ecstasy/polydrug users, three were done with cannabis users and one focused on methadone maintenance patients with current cocaine dependence. Regarding false memory type, 15 studies focused on false recognition/recall, and three on provoked confabulation.Conclusions: None but one of the studies considering false recognition/recall of critical lures found any significant differences between individuals with a history of substance abuse and healthy controls. However, most of the studies taking into account false recognition/recall of related and unrelated events found that individuals with a history of substance abuse showed significantly higher rates of false memories than controls. Future research should continue to consider different types of false memories as well as their potential association with relevant clinical variables.Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=266503, identifier: CRD42021266503.

Objectives: This systematic review aimed to understand the current state of the art about the effectiveness of mindfulness-based relapse prevention (MBRP) on individuals with substance use disorders (SUD), taking into account not only SUD variables (e.g., cravings, frequency of use) but also other relevant clinical variables (e.g., anxiety and depressive symptoms, quality of life). Methods: A comprehensive search of electronic databases was conducted to identify studies that investigate MBRP interventions on individuals with SUD. Studies that met the inclusion criteria were synthesized and assessed using systematic review methods. Results: Thirteen studies were included in the present review. The methodological quality of the included studies was moderately strong. Nine studies (69.2%) used the traditional 16 h MBRP program. Six studies (46.1%) chose to use a co-intervention treatment ranging from the treatment as usual (TAU) to cognitive behavioral therapy. All but one study indicated that their interventions produced positive effects on at least one addiction outcome measure. None of the interventions were evaluated across different settings or populations. Conclusions: Despite some heterogeneity regarding the type of MBRP program used, results support the effectiveness of these interventions in the SUD population, especially in reducing cravings, decreasing the frequency of use, and improving depressive symptoms.

Background: Cerebral neuroplasticity is compromised due to substance abuse. There is damage to neuronal areas that are involved in memory and executive functioning. Treatments with worse outcomes are often associated with cognitive deficits that have resulted from substance dependence. However, there is evidence that cognitive training can lead to improvements in cognitive functions and can be useful when treating addictions. This systematic review aims to synthesize evidence on the effectiveness of cognitive training in memory, executive functioning, and processing speed in individuals with substance use disorder (SUD).Methods: The Joanna Briggs Institute's PICO strategy was used to develop this systematic literature review. Four databases were searched (PubMed, the Cochrane Library, Web of Science, and PsycINFO) to identify controlled randomized clinical studies and quasi-experimental studies, in English, Portuguese, and Spanish, from 1985 to 2019. The literature found was examined by two independent reviewers, who assessed the quality of studies that met the inclusion criteria. The Cochrane risk-of-bias tool for the randomized controlled trials and the ROBINS-I tool for non-randomized studies were used to assess the risk of bias. In data extraction, the Cochrane Handbook for Systematic Reviews was considered.Results: From a total of 470 studies, 319 were selected for analysis after the elimination of duplicates. According to the inclusion criteria defined, 26 studies were eligible and evaluated. An evaluation was performed considering the participant characteristics, countries, substance type, study and intervention details, and key findings. Of the 26 selected studies, 14 considered only alcoholics, six included participants with various SUD (alcohol and other substances), three exclusively looked into methamphetamine-consuming users and another three into opioid/methadone users. Moreover, 18 studies found some kind of cognitive improvement, with two of these reporting only marginally significant effects. One study found improvements only in measures similar to the training tasks, and two others had ambiguous results.Conclusions: The included studies revealed the benefits of cognitive training with regard to improving cognitive functions in individuals with SUD. Memory was the most scrutinized cognitive function in this type of intervention, and it is also one of the areas most affected by substance use.Systematic Review Registration: [PROSPERO], identifier [CRD42020161039].

The last years have seen a paradigm shift concerning addictive disorders, indicating the necessity to study alternative therapeutic models. In this longitudinal study, the objective was to explore the impact of the Change & Grow^® therapeutic model developed and used by VillaRamadas on certain psychological variables that frequently appear associated with addiction. A repeated measures (first and last weeks of treatment) design was used, and the psychological measurements were Beck’s Depression Inventory II (BDI-II), Suicide Ideation Questionnaire (SIQ), State-Trait Anxiety Inventory (STAI), and Montreal Cognitive Assessment (MoCA). Results include 26 (16 male and 10 female) patients. Age varied between 17 and 64 years (M = 35.62, SD = 12.60) and duration of treatment between 91 and 193 days (M = 147.35, SD = 27.05). The MoCA total result was significantly higher in the last week of treatment. The results of BDI-II, SIQ, and STAI (both state and trait) were all significantly lower. Neither duration of treatment nor self-reported motivation presented significant correlation values with the difference between measures for any of the variables. The Change & Grow^® therapeutic model appears to have an impact on relevant psychological variables in patients admitted into treatment for addictive disorders.