The Feasibility of Goal Management Training to Address Cognitive Impairment in an Outpatient Alcohol Treatment Population: Findings from a Novel Case Series

Abstract

People with alcohol use disorder (AUD) exhibit high rates of comorbidity with cognitive deficits, particularly for executive function (EF). Cognitive impairment has been related to poorer outcomes in substance use treatment. Goal management training (GMT), a structured, therapist-led manualised intervention targeting EF, has demonstrated positive preliminary results in substance use disorder (SUD) treatment programs.. However, these studies have had strict exclusion criteria (e.g. excluding clients with mental health disorders), and the feasibility of running such a program in a broader SUD outpatient setting is unclear. The primary aim of this study was to determine the outcomes and feasibility of a cognitive remediation intervention at an outpatient alcohol treatment service in Sydney, Australia. Clients were referred to the study based on risk of cognitive deficits (as indicated by objective cognitive impairment on a screening tool or relevant collateral clinical information). Eligibility criteria included diagnosis of a current alcohol use disorder and abstinence for 2 or more weeks. The intervention consisted of 9 weekly GMT sessions. Out of 34 clients referred, 11 were eligible to participate, and of these, five were allocated to the intervention group and two to a waitlist control group. Due to poor recruitment, statistical analyses between groups were not possible; instead, this study presents a case series of the five clients recruited to the 9-week group intervention using GMT. Clients engaged in the intervention presented with a range of deficits in their cognitive functioning at baseline. Despite positive comments from participants regarding the intervention, there was a high level of attrition; while four clients (80%) completed at least four sessions, only one participant remained until the end of the nine-session program. In its current form, this program is not suitable for this cohort in the outpatient setting. Suggestions are made for tailoring GMT and other approaches to increase engagement and retention in future interventions.