Cognitive Functioning During Methadone and Buprenorphine Treatment: Results of a Randomized Clinical Trial Contingency management reduces drug-related human immunodeficiency virus risk behaviors in cocaine-abusing methadone patients. Treatment responsivity of cocaine-dependent patients with antisocial personality disorder to cognitive-behavioral and contingency management interventions. Profiles of Cognitive Dysfunction in Chronic Amphetamine and Heroin Abusers Neuropsychological correlates of opioid dependence and withdrawal. Dissociable Deficits in the Decision-Making Cognition of Chronic Amphetamine Abusers, Opiate Abusers, Patients with Focal Damage to Prefrontal Cortex, and Tryptophan-Depleted Normal Volunteers: Evidence for Monoaminergic Mechanisms Cognitive functioning in opioid-dependent patients treated with buprenorphine, methadone, and other psychoactive medications: stability and correlates Group Psychotherapy for Opiate Addicts in Methadone Maintenance Treatment – A Controlled Trial Cognitive impairment, retention and abstinence among cocaine abusers in cognitive-behavioral treatment. Impaired performance in a test of decision-making by opiate-dependent tobacco smokers. Low-cost contingency management for treating cocaine- and opioid-abusing methadone patients. Cognitive-behavioral therapy plus contingency management for cocaine use: findings during treatment and across 12-month follow-up. Change in neurocognition by housing type and substance abuse among formerly homeless seriously mentally ill persons Computer-assisted delivery of cognitive-behavioral therapy: efficacy and durability of CBT4CBT among cocaine-dependent individuals maintained on methadone. PET imaging of dopamine transporter and drug craving during methadone maintenance treatment and after prolonged abstinence in heroin users. Concurrent alcohol dependence among methadone-maintained cocaine abusers is associated with greater abstinence. Longitudinal Trajectory and Characterization of Cancer-Related Cognitive Impairment in a Nationwide Cohort Study.
Cognitive impairment in drug-dependent patients receiving methadone ( MMP ) maintenance treatment has been reported previously . We assessed cognitive functioning after at least 14 days of stable substitution treatment with buprenorphine ( BUP ) or MMP and after 8 to 10 weeks . We performed a r and omized , nonblinded clinical trial in 59 drug-dependent patients receiving either BUP or MMP maintenance treatment and healthy normal controls ( n = 24 ) matched for sex , age , and educational level . Thirteen patients dropped out of the study before the second testing was performed  ( BUP , n = 22 ; MMP , n = 24 ) . A neuropsychological test battery was used to measure selective attention , verbal memory , motor/cognitive speed , and cognitive flexibility . In addition , subjective perceived stress was assessed with a question naire . Patients in both treatment groups performed equally well in all of the cognitive domains tested . Both BUP and MMP patients showed significantly improved concentration and executive functions after 8 to 10 weeks of stable substitution treatment . The control group achieved better results than the BUP and MMP groups in most cognitive domains , indicating cognitive impairment in the patients . Perceived stress did not show any significant change after 8 to 10 weeks of treatment , and no major differences were detected between the 3 groups . No effects of perceived stress on cognitive function were found . Our results indicate a cognitive impairment in patients receiving maintenance treatment with BUP  or  MMP  compared with healthy controls . Selective attention improved in both patient groups during treatment . We propose that the improvement of attention may facilitate rehabilitation of drug-dependent patients AIM Contingency management ( CM ) is efficacious in reducing drug use . This study examined whether CM also reduces human immunodeficiency virus ( HIV ) risk behaviors and if these effects are mediated by longest duration of abstinence achieved during treatment . DESIGN Data were analyzed from a subset of participants in a combined data set of three published r and omized controlled trials of CM treatments . SETTING A community-based methadone maintenance clinic . PARTICIPANTS One-hundred and sixty-five cocaine-abusing methadone maintenance patients . INTERVENTION Participants received either st and ard methadone treatment or st and ard methadone treatment with CM for 3 months . MEASUREMENTS The HIV Risk Behavior Scale ( HRBS ) was administered prior to r and omization to a study condition and 3 months after the study treatments ended . The primary objective indicator of drug use was longest duration of cocaine and opioid abstinence achieved during treatment . FINDINGS Relative to those assigned to st and ard care , participants receiving CM significantly decreased overall HIV risk behaviors and injection drug use risk behaviors .  CM participants also achieved longer duration s of consecutive cocaine and opioid abstinence during treatment . Duration of abstinence achieved mediated the relationship between treatment condition and HRBS difference scores . CONCLUSIONS These results suggest that CM treatment reduces HIV drug use risk behaviors in cocaine-abusing methadone maintenance patients This study compared the efficacy of 2 approaches for the treatment of cocaine dependence among methadone-maintained patients with and without antisocial personality disorder ( ASPD ) . Patients were r and omly assigned to 4 study conditions : cognitive-behavioral treatment ( CBT ) , contingency management ( CM ) , CBT with CM , or methadone maintenance . The Structural Clinical Interview for Mental Disorders-IV was administered to 108 patients to assess ASPD . A 2-way analysis of variance showed that patients with ASPD were more likely to abstain from cocaine use during treatment than patients without ASPD . The strong treatment effect for ASPD patients was primarily due to the CM condition . Regression analyses showed that ASPD remained significantly related to  CM treatment responsivity while controlling for other factors Groups of subjects whose primary drug of abuse was amphetamine or heroin were compared , together with age- and IQ-matched control subjects . The study consisted of a neuropsychological test battery which included both conventional tests and also computerised tests of recognition memory , spatial working memory , planning , sequence generation , visual discrimination learning , and attentional set-shifting . Many of these tests have previously been shown to be sensitive to cortical damage ( including selective lesions of the temporal or frontal lobes ) and to cognitive deficits in dementia , basal ganglia disease , and neuropsychiatric disorder . Qualitative differences , as well as some commonalities , were found in the profile of cognitive impairment between the two groups . The chronic amphetamine abusers were significantly impaired in performance on the extra-dimensional shift task ( a core component of the Wisconsin Card Sort Test ) whereas in contrast , the heroin abusers were impaired in learning the normally easier intra-dimensional shift component . Both groups were impaired in some of tests of spatial working memory . However , the amphetamine group , unlike the heroin group , were not deficient in an index of strategic performance on this test . The heroin group failed to show significant improvement between two blocks of a sequence generation task after training and additionally exhibited more perseverative behavior on this task . The two groups were profoundly , but equivalently impaired on a test of pattern recognition memory sensitive to temporal lobe dysfunction . These results indicate that chronic drug use may lead to distinct patterns of cognitive impairment that may be associated with dysfunction of different components of cortico-striatal circuitry Severity of opioid dependence , and performance on two successive runs of the  Wisconsin Card Sorting Test ( WCST ) , were assessed in 39 right-h and ed male and female methadone patients who had been r and omly assigned to either a recently dosed ( n=21 ) or 24 hr abstinent ( n=18 ) condition . Results indicated that severity of opioid dependence was positively correlated with perseverative responses and errors on the second run of the WCST , p<.05 . Further , controlling for the effect of dependence severity , patients in early methadone withdrawal made selectively more perseverative responses and errors than did recently dosed patients , p<.05 , with no difference on nonperseverative errors . Findings were consistent with the hypothesis that opioid dependence , like alcoholism and cocaine addiction , is associated with disruption of executive cognitive functions mediated by the prefrontal cortex We used a novel computerized decision-making task to compare the decision-making behavior of chronic amphetamine abusers , chronic opiate abusers , and patients with focal lesions of orbital prefrontal cortex ( PFC ) or dorsolateral/medial PFC . We also assessed the effects of reducing central 5-hydroxytryptamine ( 5-HT ) activity using a tryptophan-depleting amino acid drink in normal volunteers . Chronic amphetamine abusers showed sub-optimal decisions ( correlated with years of abuse ) , and deliberated for significantly longer before making their choices . The opiate abusers exhibited only the second of these behavioral changes . Importantly , both sub-optimal choices and increased deliberation times were evident in the patients with damage to orbitofrontal PFC but not other sectors of PFC . Qualitatively , the performance of the subjects with lowered plasma tryptophan was similar to that associated with amphetamine abuse , consistent with recent reports of depleted 5-HT in the orbital regions of PFC of methamphetamine abusers . Overall , these data suggest that chronic amphetamine abusers show similar decision-making deficits to those seen after focal damage to orbitofrontal PFC . These deficits may reflect altered neuromodulation of the orbitofrontal PFC and interconnected limbic-striatal systems by both the ascending 5-HT and mesocortical dopamine ( DA ) projections Background In many but not in all neuropsychological studies  buprenorphine-treated opioid-dependent patients have shown fewer cognitive deficits than patients treated with methadone .  In order to examine if hypothesized cognitive advantage of buprenorphine in relation to methadone is seen in clinical patients we did a neuropsychological follow-up study in unselected sample of  buprenorphine- vs. methadone-treated patients . Methods In part I of the study fourteen buprenorphine-treated and 12 methadone-treated patients were tested by  cognitive tests  within two months ( T1 ) , 6 - 9 months ( T2 ) , and 12 - 17 months ( T3 ) from the start of  opioid substitution treatment . Fourteen healthy controls were examined at similar intervals . Benzodiazepine and other psychoactive comedications were common among the patients . Test results were analyzed with repeated measures analysis of variance and planned contrasts . In part II of the study the patient sample was extended to include 36 patients at T2 and T3 . Correlations between cognitive functioning and medication , substance abuse , or demographic variables were then analyzed . Results In part I methadone patients were inferior to healthy controls tests in all tests measuring attention , working memory , or verbal memory .  Buprenorphine patients were inferior to healthy controls in the first working memory task , the Paced Auditory Serial Addition Task and verbal memory . In the second working memory task , the Letter-Number Sequencing , their performance improved between T2 and T3 . In part II only group membership ( buprenorphine vs. methadone ) correlated significantly with attention performance and improvement in the Letter-Number Sequencing . High frequency of substance abuse in the past month was associated with poor performance in the Letter-Number Sequencing . Conclusions The results underline the differences between non-r and omized and r and omized studies comparing cognitive performance in opioid substitution treated patients ( fewer deficits in buprenorphine patients vs. no difference between buprenorphine and methadone patients , respectively ) . Possible reasons for this are discussed A controlled trial was conducted evaluating cognitive-behavioural group psychotherapy as a measure to reduce concomitant drug use in methadone maintenance treatment ( MMT ) . 73 opiate addicts were r and omly assigned to local routine MMT or to routine MMT plus group psychotherapy ( 20 sessions over 20 weeks ) . Psychotherapy was delivered by therapists according to a manual . Drug use ( urine screen ) was compared at onset of psychotherapy , end of intervention period ( 6 months after study onset ) , and 6 months later . Data analysis was done according to intention-to-treat principles . Results indicated that patients in the  psychotherapy group ( n = 41 ) showed less drug use than control subjects ( n = 32 ) . This group difference was statistically significant at 6-month follow-up ( p = 0.02 ) . These findings underscore the usefulness of group psychotherapy in MMT . The delayed effect is comparable to other studies evaluating cognitive-behavioural psychotherapy Cognitive-behavioral therapy ( CBT ) depends on adequate cognitive functioning in patients , but prolonged cocaine use may impair cognitive functioning . Therefore , cognitive impairment may impede the ability of cocaine abusers to benefit from CBT . To begin to address this issue , we investigated the relationship between cognitive impairment and two treatment outcomes , therapy completion and abstention .  Eighteen carefully screened non-depressed cocaine-dependent patients in a psychopharmacological clinical trial were administered the MicroCog computerized battery to assess cognitive performance at treatment entry .  T-tests were used to compare cognitive functioning between completers ( patients remaining in treatment at least 12 weeks ) and dropouts . The results indicated that treatment completers had demonstrated significantly better cognitive performance at baseline than patients who dropped out of treatment . Cognitive domains that significantly distinguished between treatment completers and dropouts were attention , mental reasoning and spatial processing . This study provides preliminary evidence that cognitive impairments may decrease treatment retention and abstinence in CBT of cocaine dependence This study tested whether opiate dependence , tobacco smoking , or their combination accompanied impaired performance on the  gambling task ( GT )  , which tests decision-making .  GT previously detected impairments in patients with lesions of the ventromedial prefrontal cortex and in substance abusers . Four groups were matched on demographic characteristics and intelligence : methadone-maintained smokers ( n = 9 ) and nonsmokers ( n = 9 ) , and control ( i.e. , not opiate-dependent ) smokers ( n = 9 ) and nonsmokers ( n = 10 ) . The  Wisconsin Card Sorting Task ( WCST )  was administered to test whether differences in  GT performance reflected generalized deficits in prefrontal cortical function . While there were no significant group differences on the WCST , groups differed significantly on  GT performance ( F(3,31 ) = 2.95 , P = 0.048 ) , controlling for depressive symptom ratings and childhood attention deficit hyperactivity disorder .  Methadone-maintained smokers ( but not nonsmokers ) performed more poorly than either of the two control groups ( P = 0.007 versus smokers ; P = 0.024 versus nonsmokers ) . In a planned analysis of methadone-maintained subjects , smokers scored more poorly on  GT  than nonsmokers ( F(1,18 ) = 5.64 , P = 0.032 ) and had more treatment failures ( 67 % heroin use during the last 30 days versus 20 % ) . The findings suggest that among opiate-dependent individuals , tobacco smoking may be a marker for a more severe form of substance abuse disorder , reflecting impaired decision-making , as modeled by GT This study evaluated the efficacy of a low-cost contingency management ( CM ) procedure in reducing  concurrent cocaine and opioid use among methadone patients . Forty-two patients were r and omly assigned to 12 weeks of st and ard treatment or st and ard treatment plus CM . CM patients eamed the opportunity to draw from a bowl and win prizes ranging from $ 1 to $ 100 in value for su bmi tting sample s negative for cocaine and opioids . Patients in the CM condition achieved longer duration s of continuous abstinence than patients in the st and ard treatment condition , and these effects were maintained throughout a 6-month follow-up period . On average , patients in the CM condition earned $ 137 of prizes . These data suggest that this prize reinforcement procedure may be suitable for community-based setting Contingency management ( CM ) rapidly reduces cocaine use , but its effects subside after treatment . Cognitive-behavioral therapy ( CBT ) produces reductions months after treatment . Combined , the 2 might be complementary . One hundred ninety-three cocaine-using methadone-maintained out patients were r and omly assigned to 12 weeks of group therapy ( CBT or a control condition ) and voucher availability ( CM contingent on cocaine-negative urine or noncontingent ) . Follow-ups occurred 3 , 6 , and 12 months posttreatment . Primary outcome was cocaine-negative urine ( urinalysis 3 times/week during treatment and once at each follow-up ) . During treatment , initial effects of CM were dampened by CBT . Posttreatment , there were signs of additive benefits , significant in 3- versus 12-month contrasts . Former CBT participants were also more likely to acknowledge cocaine use and its effects and to report employment OBJECTIVE To test the effect of living in group housing rather than independent apartments on executive functioning , verbal memory and sustained attention among formerly homeless persons with serious mental illness and to determine whether substance abuse modifies this effect . METHOD In metropolitan Boston , 112 persons in Department of Mental Health shelters were r and omly assigned to group homes ( " Evolving Consumer Households " , with project facilitator , group meetings , resident decision-making ) or independent apartments . All were case managed . A  neuropsychological test battery  was administered at baseline , at 18 months ( Time 2 ) , with an 81 % follow-up rate , and at 48 months ( Time 3 ) , with a 59 % follow-up rate . Hierarchical Linear Modeling was applied to executive functioning -- assessed with the  Wisconsin Card Sorting Test (Perseverations)-Logical Memory story recall , and an auditory Continuous Performance Test ( CPT ) for sustained attention . Subject characteristics were controlled . RESULTS When moved to group homes , subjects without a lifetime substance abuse history improved on Perseverations , while those who moved to independent apartments deteriorated on Perseverations . Across the two housing conditions , subjects showed no change in Perseverations , but improved on Logical Memory story recall and the CPT . CONCLUSIONS Type of housing placement can influence cognitive functioning ; notably , socially isolating housing is associated with weakened executive functioning . Substance abuse significantly diminishes environmental effects . These are important factors to consider in housing placement and subsequent treatment OBJECTIVE A previous pilot trial evaluating computer-based training for cognitive-behavioral therapy ( CBT4CBT ) in 77 heterogeneous substance users ( alcohol , marijuana , cocaine , and opioids ) demonstrated preliminary support for its efficacy in the context of a community-based outpatient clinic . The authors conducted a more definitive trial in a larger , more homogeneous sample . METHOD In this r and omized clinical trial , 101 cocaine-dependent individuals maintained on methadone were r and omly assigned to st and ard methadone maintenance or methadone maintenance with weekly access to CBT4CBT , with seven modules delivered within an 8-week trial . RESULTS Treatment retention and data availability were high and comparable across the treatment conditions . Participants assigned to the CBT4CBT condition were significantly more likely to attain 3 or more consecutive weeks of abstinence from cocaine ( 36 % compared with 17 % ; p<0.05 , odds ratio=0.36 ) . The group assigned to CBT4CBT also had better outcomes on most dimensions , including urine specimens negative for all drugs , but these reached statistical significance only for individuals completing the 8-week trial ( N=69 ) . Follow-up data collected 6 months after treatment termination were available for 93 % of the r and omized sample ; these data indicate continued improvement for those assigned to the CBT4CBT group , replicating previous findings regarding its durability . CONCLUSIONS This trial replicates earlier findings indicating that CBT4CBT is an effective adjunct to addiction treatment with durable effects .  CBT4CBT is an easily disseminable strategy for broadening the availability of CBT , even in challenging population s such as cocaine-dependent individuals enrolled in methadone maintenance programs It has been documented that methadone maintenance treatment is effective in reducing drug craving and relevant risk behaviors in heroin users . However , it is not understood whether methadone maintenance treatment impairs the dopamine transporter in the striatum . To establish whether chronic opiate use might impair brain dopamine neurons in humans , we assessed dopamine transporter ( DAT ) uptake function in the striatum ( cau date and putamen ) , and analyzed the correlation between DAT in the striatum and heroin craving and subjective anxiety in former heroin users with prolonged abstinence and in patients receiving methadone maintenance treatment .  Binding of [(11)C]-2beta-carbomethoxy-3beta-aryltropane ( [ (11)C ] CFT ) as a brain dopamine transporter lig and was measured with positron emission tomography ( PET ) in eleven former heroin users with prolonged abstinence , ten patients receiving methadone maintenance treatment and ten healthy control subjects .  Heroin craving and subjective anxiety in prolonged abstinence and methadone maintenance treatment groups were assessed and the correlations between DAT of striatum and heroin craving or subjective anxiety were determined . In comparison with healthy control subjects , methadone maintenance treatment subjects had lower DAT uptake function in the bilateral cau date and putamen and prolonged abstinence subjects showed significantly lower DAT uptake function in the bilateral cau date . Moreover , in comparison to the prolonged abstinence subjects , the methadone maintenance treatment subjects showed significant decreases of DAT uptake in the bilateral putamen . DAT uptake function in bilateral striatum was not associated with heroin craving in prolonged abstinence or in methadone maintenance treatment subjects ; however , DAT uptake function in the bilateral cau date was significantly correlated with subjective anxiety in methadone maintenance treatment subjects . Our findings suggest that chronic opioid use induces long-lasting striatum dopamine neuron impairment , and prolonged withdrawal from opioids can benefit the recovery of impaired dopamine neurons in the brain Concurrent alcohol dependence ( AD ) among polysubstance abusers has been associated with negative consequences , although it may not necessarily lead to poor treatment outcomes . One of the most efficacious treatments for cocaine abuse is contingency management ( CM ) , but little research has explored the impact of AD on abstinence outcomes , particularly among patients in methadone maintenance . Using data from three trials of CM for cocaine use , we compared baseline characteristics and posttreatment and follow-up cocaine outcomes between  methadone-maintained , cocaine-dependent patients ( N = 193 ) with and without concurrent AD , r and omized to st and ard care ( SC ) with or without CM . Patients with and without concurrent AD  had similar baseline characteristics , with the exception that AD patients reported more alcohol use . AD patients achieved longer duration s of cocaine abstinence and were more likely to su bmi t a cocaine-negative sample at follow-up than non-AD patients . Patients r and omized to CM achieved better outcomes than those r and omized to SC , but there was no interaction between treatment condition and AD status . These findings suggest that cocaine-using methadone patients  with AD achieve greater cocaine abstinence than their non-AD counterparts and should not necessarily be viewed as more difficult to treat PURPOSE Cancer-related cognitive impairment ( CRCI ) is an important clinical problem in patients with breast cancer receiving chemotherapy . Nationwide longitudinal studies are needed to underst and the trajectory and severity of CRCI in specific cognitive domains . PATIENTS AND METHODS The overall objective of this nationwide , prospect i ve , observational study conducted within the National Cancer Institute Community Clinical Oncology Research Program was to assess trajectories in specific cognitive domains in patients with breast cancer ( stage I-IIIC ) receiving chemotherapy , from pre- ( A1 ) to postchemotherapy ( A2 ) and from prechemotherapy to 6 months postchemotherapy ( A3 ) ; controls were assessed at the same time-equivalent points . The primary aim assessed visual memory using the Cambridge Neuropsychological Test Automated Battery Delayed Match to Sample test by longitudinal mixed models including A1 , A2 , and A3 and adjusting for age , education , race , cognitive reserve score , and baseline anxiety and depressive symptoms . We also assessed trajectories of CRCI in other aspects of memory as well as in attention and executive function with computerized , paper-based , and telephone-based cognitive tests . RESULTS In total , 580 patients with breast cancer ( mean age , 53.4 years ) and 363 controls ( mean age , 52.6 years ) were assessed . On the Delayed Match to Sample test , the longitudinal mixed model results revealed a significant group-by-time effect ( P < .005 ) ; patients declined over time from prechemotherapy ( A1 ) to 6 months postchemotherapy ( A3 ; P = .005 ) , but controls did not change ( P = .426 ) . The group difference between patients and controls was also significant , revealing declines in patients but not controls ( P = .017 ) . Several other models of computerized , st and ard , and telephone tests indicated significantly worse performance by patients compared with controls from pre- to postchemotherapy and from prechemotherapy to 6 months postchemotherapy . CONCLUSION This nationwide study showed CRCI in patients with breast cancer affects multiple cognitive domains for at least 6 months postchemotherapy
HighlightsA broad range of domains of neuropsychological performance are significantly impaired in studies which have compared  methadone population s with the healthy controls .
However low power , poor quality and heterogenous population s limit the interpretation of these results .Short term ( less than 1 year ) abstinent groups , when compared with methadone groups , still exhibited cognitive impairments but results are inconclusive .
It is still not clear what the role of global sedative effects of opioids such as methadone have on cognitive impairment .
Only higher quality longitudinal studies using ecologically valid cognitive tests , in well‐defined population groups can address this question .Methadone population s present with a broad range of neuropsychological impairment when compared with healthy controls .
Results : Data from a total cohort of 1063 CM , 412 AP and 879 HP participants , from 23 independent studies  indicate global impairments in neurocognitive function in CM relative to HP participants .
Conclusion : Method ological issues such as small sample sizes , heterogeneity and poor quality limited the interpretation of the results and does not address whether the observed impairments reflect co‐morbid functioning , methadone‐related sedation and /or other factors .
Introduction : There is a presumption that neurocognition is commonly impaired in chronic methadone exposed individuals ( CM ) when compared with healthy controls ( HP ) .
Additionally , it remains unclear if short term ( < 1 year ) abstinence ( AP ) is associated with an altered cognitive profile when compared with CM .