Memory-Focused Cognitive Therapy for Cocaine Use Disorder: Theory, Procedures and Preliminary Evidence From an External Pilot Randomised Controlled Trial

Abstract

BackgroundCocaine use disorder (CUD) is a debilitating condition with no NICE-recommended medication or specific psychosocial interventions. In the United Kingdom (UK), general counselling (treatment-as-usual; TAU) is widely delivered, but has limited effectiveness. We tested the feasibility, safety and preliminary efficacy of a novel, adjunctive psychosocial intervention for CUD, called ‘memory-focused cognitive therapy’ (MFCT).MethodsWe did a two-arm, external pilot randomised controlled trial at a specialist community National Health Service addictions clinic in London, UK. 30 adults (≥18 years), voluntarily seeking treatment for CUD (enrolled ≥14 days; all with moderate-to-severe DSM5 CUD), were individually randomised (1:1) to a control group (ongoing TAU; 3 × 90 min CUD cognitive conceptualisation assessments; 2 × 30 min cocaine-related cue-induction procedures; and 3 × 30 min research follow-ups); or to an intervention group (ongoing TAU; 3 × 90 min cognitive conceptualisation assessments; 2 × 30 min cocaine-related cue-induction procedures; 5 × 120 min, one-to-one, MFCT sessions [in 1 week]; and 3 × 60 min research follow-ups and MFCT-relapse prevention).The primary outcome was the total percentage score on the frequency version of the Craving Experiences Questionnaire (CEQ-F) at 1-month follow-up after the intensive intervention week (clinical endpoint; recall period past 2 weeks; higher score indicating greater craving). Secondary outcomes at the 1-month follow-up were percentage days abstinent (PDA) from cocaine, and longest period (days) of continuous abstinence (LPA) in the prior 28 days.Outcomes were analysed as an unadjusted group mean difference (with Hedge's g effect size [ES]) and a 95% Confidence Interval [CI] for the primary outcome and a 90% CI for the secondary outcomes. Exploratory, multivariable linear (primary outcome) and Poisson regression models (secondary outcomes), with sex, age, months of regular cocaine use, baseline outcome score, and group estimated the effectiveness of the intervention. The trial is registered with the ISCRTN (ISRCTN16462783).FindingsBetween July 15, 2015, and November 27, 2016, 58 patients were assessed for eligibility and 30 participants were randomised (14 to the control group and 16 to the intervention). With outcome data collected for all participants at the endpoint, the intervention group mean CEQ-F score (14·77; SD 21·47) was lower than the control group mean (51·75; SD 22·72); ES -1·62; 95% CI -2·45 to −0·80.MFCT was associated with more cocaine abstinence in the intervention group (PDA 85·94; SD 18·96) than the control group (PDA 54·59; SD 30·29); ES 1·19; 90% CI 0·54 to 1·84. There was also greater maximum abstinence in the intervention group (LPA 15·69; SD 10·10) than the control group (6·00; SD 7·36); ES 1·06; 90% CI 0·41 to 1·70. Exploratory, confounder-adjusted regression models for this preliminary effect supported the treatment association for reduced craving experiences (CEQ-F Coef. -28·25; 95% CI -45·15 to −11·35); more abstinence (PDA Inciden...

Change in alcohol and other drug use during five years of continuous opioid substitution treatment

“…If there is an unsatisfactory response to flexible dosing, it may be appropriate to suggest a change in medication (e.g. switching from methadone to buprenorphine), reinstate supervised administration (Clinical Guidelines on Drug Misuse and Dependence Update 2017 Independent Expert Working Group, 2017), or offer a targeted psychosocial intervention for opioids , alcohol (Nolan et al, 2016) or cocaine (Marsden et al, 2018) from the service if there are resources or by referral. Although it may be discouraging that some patients continue to alcohol and other drugs, treatment may still offer provide important harm reduction benefits by reducing the risk of opioid poisoning (Cornish et al, 2010;White et al, 2015) and, taking a wider societal perspective, there is an overall economic benefit-cost ratio from investing in OST (Zarkin et al, 2005).…”

Drug-Induced Glucocorticoids and Memory for Substance Use

“…Accordingly, theories describing the contributions of different memory systems to addiction describe both parallel and interactive effects (Table 1). These theories have been extremely influential, inspiring research programs and the development of addiction treatments (recent examples in [11, 12]). With recent evidence that memory for even a single experience can influence later decision-making [13, 14], understanding how memories for drug-related experiences are formed is a critical and timely question.…”

Does craving for cocaine mediate cocaine use? Analysis of a randomized controlled pilot trial of memory-focused cognitive therapy

“…Prior to the analysis of the developmental study (Marsden et al, 2018), the statistical analysis plan for the primary and secondary outcome measures was registered (Centre for Open Science; https://www. osf.io/3kfzj/).…”

“…Prior to the analysis of the developmental study (Marsden et al, 2018), the statistical analysis plan for the primary and secondary outcome measures was registered (Centre for Open Science; https://www.osf.io/3kfzj/). The results showed that compared to an assessment-only control, the intervention was associated with lower levels of craving (bias corrected Hedge’s g = −1.62; 95% confidence interval (CI) −2.45 to –0.80; the primary outcome measure) and more abstinent days ( g = 1.19; 90% CI 0.54 to 1.84; the drug use secondary outcome measure).…”

“…Against this background-and encouraged by the potential for a CBT intervention to be effective when offered alongside ongoing general counseling and support-we developed a novel cognitive therapy intervention with the goal of helping people to better recognize, modify, and control cocaine cravingrelated thoughts, emotions, and behavior. Our memory-focused cognitive therapy (MFCT) is a 15-week, outpatient, individual psychotherapy (Marsden et al, 2017). In addition to a formulation-driven assessment and with use of, cognitive restructuring and behavioural experiments, MFCT adapts to CUD the fear memory reliving, imagery rescripting, and memory reconsolidation paradigm successfully used for the treatment of posttraumatic stress disorder (PTSD) (Brewin, Gregory, Lipton, & Burgess, 2010;Grey, Young, & Holmes, 2002;Holmes & Mathews, 2010).…”