Can Cognitive Flexibility Training Delivered During Early Abstinence Prevent Relapse in Opioid Use Disorder?
BACKGROUND: High relapse rates in opioid use disorder (OUD) have been attributed to poor executive functioning. One key executive functioning deficit impeding recovery is poor cognitive flexibility, or inability to change. We hypothesize that an intervention designed to improve cognitive flexibility would support OUD recovery. This study determined if an intervention combining cognitive flexibility training and transcranial direct current stimulation (tDCS) delivered during early abstinence had an effect on cognitive flexibility and on subsequent relapse rates in OUD.
METHODS: Twenty participants (Age: M=28.57, SD=7.871) with OUD (n=7, 1 woman; 1-2 weeks abstinent) were recruited from a 28-day residential addiction treatment program. All participants were randomly assigned to 5 days of either active tDCS (20 minutes of 2mA; symmetrical montage dorsolateral prefrontal cortex - anode on left, cathode on right) or sham (randomized assignment) concurrent with cognitive flexibility training (intra-extra dimensional set shifting task practice). Participants completed a one-month follow up interview after discharge from residential treatment to inquire relapse status (abstinent: n=5; relapsed: n=2).
RESULTS: Preliminary findings showed a different pattern of performance change for OUD depending on future relapse status. There was a significant group x time interaction (p=0.025), where OUD that remained abstinent over the 1-month follow-up period showed cognitive flexibility improvement during training, a pattern not observed in the relapse group. It should be noted the recruitment is still ongoing and tDCS assignment is still blinded.
DISCUSSION: In our sample, cognitive flexibility improvement (outside of tDCS assignment) measured during early abstinence seems to be relevant to future relapse status for OUD. While these findings need to be confirmed in larger sample sizes, preliminary evidence suggests that interventions targeting cognitive flexibility may be beneficial for OUD recovery.