Addiction, cognitive decline and therapy: seeking ways to escape a vicious cycle

Any type of behavioral change is an effortful process. Thus, the process of behavioral therapy, where clients seek to change maladaptive behavioral patterns, requires high-level cognitive engagement. It is unfortunate, then, that cognitive impairment is a feature of substance use disorders (SUDs), and especially because the domains that tend to be impaired are the very ones involved in the process of therapeutic behavioral change. In this review, we compare the cognitive profile that is frequently observed with chronic SUD with the skills that are required to initiate and sustain behavioral change during rehabilitation. Furthermore, we look to new therapeutic developments that seek to improve cognitive function. We propose that the use of these cognitive enhancing agents as adjuncts to behavioral therapy should help to overcome some of the cognitive barriers imposed by the disorder itself, and hence reduce the chance of relapse. This review examines the literature looking at cognitive impairment in substance use disorder (SUD) and how this impacts therapy. We found that many of the cognitive domains that are likely to be engaged during behavioral therapy for substance use are particularly impacted by chronic exposure to drugs of abuse. Thus, the symptoms of the disorder become a hurdle for recovery. We also found an increasing trend for research into cognitive enhancing agents for use in treatment of SUD.