Occupational Therapy-Based Cognitive Rehabilitation of Cocaine Abusers: A Pilot Study

occupational-therapy based cognitive rehabilitation as part of a comprehensive treatment plan for cocaine abusers

Inclusion criteria

• Age 18-65
• Primary cocaine use disorder (based on DSM-5 criteria) and in at least 3 months of remission
• At least mild cognitive impairment, defined as = or > 1.5 standard deviations impairment on any 2 performance-based neurocognitive measures
• Needing to change quality of life, defined as self-identifying at least 2 life areas as needing to change on the Drug User Quality of Life Scale
• A Veteran at the San Francisco Veterans Affairs Medical Center
• Currently receiving weekly drug counseling (individual or group; at least 1 hour/week) through an outpatient substance use disorder treatment program

Exclusion criteria

• Inability to speak, read, write, and understand English
• Inadequate hearing or vision
• Concurrent substance use disorder (except tobacco or caffeine) not in at least 3 months of remission
• A psychiatric disorder that will interfere with study participation or will make participation hazardous (e.g., psychosis, suicidal or homicidal ideations, severe anxiety)
• A depressive disorder classified as severe, defined as a Beck Depression Inventory-II score >29
• Current diagnosis of a bipolar disorder needing acute inpatient psychiatric hospitalization
• Currently symptomatic from attention-deficit/hyperactivity disorder (DSM-5 criteria)
• Any learning disorder, any type of dementia, any type of delirium, or an amnestic disorder due to any general medical condition
• Wechsler Test of Adult Reading standard score <70
• Mini-Mental State Examination score <24
• Current use of scheduled (i.e., prescribed) regular (i.e., daily) psychotropics or other medicines with a high likelihood of sedation & cognitive impairment (e.g., benzodiazepines, clozapine, anticholinergics)
• Currently prescribed stimulants (e.g., methylphenidate) or cognitive enhancers (e.g., donepezil, memantine)
• Active medical illnesses - uncontrolled diabetes, uncontrolled hypertension, uncontrolled thyroid dysfunction, or uncontrolled B12/folate deficiency; central nervous system illness with potential cognitive aspects (Parkinson's, or Huntington's dementia); Cirrhosis with complications (e.g., ascites, encephalopathy, jaundice, gastrointestinal bleeding); Needing acute medical hospitalization from HIV sequelae, such as HIV-related opportunistic infection
• Any history of any type of stroke or brain hemorrhage
• Any history of traumatic brain injury, intracranial pathology (e.g., tumor), or brain surgery
• Currently on probation or parole
• Concurrent participation in another study that medically/administratively interferes with this study