Randomized clinical trial of Cognitive Remediation Therapy with Work Therapy in the early phase of substance use disorder recovery for older Veterans: 12-Month follow-up

Objective: In a previous report on a randomized clinical trial of a 3-month program of Cognitive Remediation Therapy (CRT) augmented by Work Therapy (WT) compared with WT alone for older veterans with substance use disorder (SUD), we reported significantly greater improvements at six-month follow-up on neurocognitive outcomes of working memory and executive functions for the CRT + WT condition. However, no difference was found between conditions on SUD outcomes, with both groups showing unusually high levels of abstinence. In this study, we extended follow-up to 12 months to test whether there was an SUD outcome "sleeper effect" from CRT + WT. To better understand the effects of WT, we added a treatment-as-usual (TAU) comparison sample. Method: Forty-eight veterans with SUD receiving standard outpatient VA care were randomized into CRT + WT or WT. Clinical Global Impression (CGI) ratings were performed on 43/48 participants with up-to-date medical records. A TAU comparison group (n = 44) with similar demographic and illness characteristics was added to the analysis. Results: Treatment groups did not differ significantly at 12 months on CGI (p = 0.27), with 77% receiving CRT + WT showing favorable SUD outcomes compared to 62% in WT. Both groups had better CGI outcomes (p < 0.01) compared to the TAU comparison group (27%). Hours of WT participation (r = -0.49, p = 0.001) and hours of CRT (r = -0.45, p = 0.048) were associated with better CGI scores. Conclusion: While no sleeper effect was found for CRT, a robust effect was strongly supported for WT on SUD outcomes.