LONG TERM NEUROCOGNITIVE CHANGES AND ADDICTION. EFFECTS ON THE COURSE OF TREATMENT. Egon Hagen Stavanger University hospital Norway

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1 LONG TERM NEUROCOGNITIVE CHANGES AND ADDICTION. EFFECTS ON THE COURSE OF TREATMENT Egon Hagen Stavanger University hospital Norway

2 Aims: Examine long-term changes of neurocognitive functions in a patient cohort entering into a new treatment sequence within the region of Stavanger University Hospital. Investigate the role of specific neurocognitive functions as a mediator or moderator of long-term treatment trajectories and outcome.

3 Design: Participants (N=250) Observational study consisting of a 5 years prospective follow- up of a patient cohort. Participants will be interviewed and tested by a trained psychometric staff at a)start of therapy (Baseline), b)biweekly by SMS tracker and c) quarterly and d) annually. Duration of PHD project 5 years ambition to track cohort for a substantially longer time.

4 Setting and participants Convenient sampled patients from both outpatient and residential treatment facilities within the region A total of 10 enrollment sites were set up. Enrollment as a consecutive process until the required number of participants was recruited. Participants were consenting patients aged 16 and over Broad inclusions criteria including comorbid somatic and psychiatric pathology, premorbid risk factors, multitude of addictions.

5 Measurment: Demographics, MOCA, WASI, Iowa Gambling Task, Stroop (golden), BRIEF- A, Word fluency, CPT II, ver. 5, Audit, Dudit, Scl -90- R, Pitsburgh Sleep Quality Index (PSQI), Snaith-Hamilton Pleasure Scale (SHAPS), Satisfaction with life scale (SWLS), Preliminary version of regional quality register for addiction treatment Region West and finally Neo pi-r for personality assessment.

6 Why? Chronic drug abuse is associated with neurophysiological and neuroanatomical changes that give rise to evident cognitive impairment Spontaneous recovery may be too little, too late to be of any real consequence with respect to treatment outcome. NP impairment have impact on quality of life, occupational functioning and the ability to profit from therapy subsequently affecting the course of rehabilitation Findings indicate that as much as % of patients relapse within 6 months after treatment cessation, regardless of patient characteristics, type of discharge or type of addictive drug

7 Why cont.. Negative psychological features previously accredited to clients such as denial of problem severity, dearth of motivation and impulsivity may derive from specific neuropsychological insufficiencies, rather than other psychological and psychosocial factors Temporal mismatch where the greatest amount of therapy may be given at a time when a person have the most pronounced cognitive impairments and has the least ability to learn from it. Neuropsychological functional problems are neglected in treatment settings, and does not contribute with design guidelines aimed at treatment programs for this group of patients

8 Initial stages of treatment Interventions requiring extensive cognitive processing in order to facilitate cognitive, motivational and behavioral change Rules, treatment philosophy, information on harmful effects of various drugs Look backwards and plan ahead Abstract reasoning and evaluation of consequences Handling of emotional themes Stress management Motivation = skills x motivation x opportunities Driving high dropout numbers

9 Eksekutive funksjoner og motivasjonsmekanismer

10 Key Challenges Multicausality and heterogenity of population Psychiatric comorbidity, medical risk factors (head trauma, HIV malnutrition, overdoses), genetic predispositions, premorbid vulnerability (genetic, psychosocial and environmental), cooccurring use of multiple drugs Attrition Ensure long term commitment at enrollment sites Involvement, feedback and partnership for research

11 Summary Long term follow up of a patient cohort entering into a new treatment sequence within the region Perform baseline, quarterly and annual evaluation of a number of neurocognitive and psychological parameters. Investigate associations between level of neuropsychological recovery and treatment outcome. Use this knowledge for better timing of treatment efforts Investigate whether physical training can facilitate cognitive recovery

12 Project outline Baseline IQ Wasi (word comprehension, matrices) Executive functional description: Brief - A Working memory, CPT II ver. 5 Decision making, Iowa gambling task Stroop (Golden versjonen) Trail- making Word fluency MOCA Audit - Dudit PSQL (Sleep quality index) ASRS v.1.1 Shaps (Hedonic tone) SWLS Neo pi-r Quality register Biweekly Sms tracker Quarterly CPT II ver. 5 Audit Dudit Shaps MOCA SWLS SCL- 90 Annually Same as baseline ex; demographics and Neo- pi-r