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Bridging the gap between neurocognitive models and treatment in alcohol, opiates and stimulants addiction

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In 1997, summarising the findings of Project MATCH, its Authors concluded that “the intuitively appealing notion that matching can appreciably enhance treatment effectiveness has been severely challenged”. Fifteen years later, widely accepted ways to match treatment to treatment-user remain elusive. However, ...

In 1997, summarising the findings of Project MATCH, its Authors concluded that “the intuitively appealing notion that matching can appreciably enhance treatment effectiveness has been severely challenged”. Fifteen years later, widely accepted ways to match treatment to treatment-user remain elusive. However, there have been considerable advances in research on outcome predictors. Arguably the most substantial challenge to those conclusions of Project MATCH has come from the growing literature on neurocognitive predictors of clinical outcome. The increasingly detailed evidence of a relationship between aspects of neurocognitive function and clinical outcome in opiate, alcohol, stimulants and tobacco addiction suggests theoretical and clinical implications.

From a theoretical perspective, this evidence suggests a neurobehavioural model of addiction, relevant to our understanding of individual vulnerabilities in addiction. For example, cognitive domains like impulsivity, error-learning or emotion regulation may function as novel matching criteria to select the best possible treatment (e.g., contingency management for high impulsive subjects, therapeutic communities for patients with decision-making problems). A more detailed understanding of the neural mechanisms underlying impulsivity might lead to novel pharmacological interventions aimed at minimising the effects of impulsivity on treatment outcome.

From a clinical perspective, this research highlights opportunities for intervention besides the matching of specific psychological treatments to specific treatment-users. Measures of neurocognitive performance may be used to guide specific case management decisions, such as placement matching, the timing for instigating detoxification, the length of aftercare treatment and the use of relapse prevention medication. In addition, there is now preliminary evidence of feasibility and effectiveness of cognitive remediation interventions (e.g., errorless learning, emotion regulation techniques), and these may in future become effectiveness enhancing adjuncts to mainstream aspects of treatment.

This Research Topic aims to provide a forum for evidence based discussion of each of these strands, focusing particularly on alcohol, opiates and stimulants.


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