Cognitive training and remediation interventions for substance use disorders: A Delphi consensus study

Antonio Verdejo‐Garcia, Tara Rezapour, Emily Giddens, Arash Khojasteh Zonoozi, Parnian Rafei, Jamie Berry, Alfonso Caracuel, Marc L. Copersino, Matt Field, Eric L. Garland, Valentina Lorenzetti, Leandro Malloy‐Diniz, Victoria Manning, Ely M. Marceau, David L. Pennington, Justin C. Strickland, Reinout Wiers, Rahia Fairhead, Alexandra Anderson, Morris BellWouter J. Boendermaker, Samantha Brooks, Raimondo Bruno, Salvatore Campanella, Janna Cousijn, Miles Cox, Andrew C. Dean, Karen D. Ersche, Ingmar Franken, Brett Froeliger, Pedro Gamito, Thomas E. Gladwin, Priscila D. Goncalves, Katrijn Houben, Joanna Jacobus, Andrew Jones, Anne M. Kaag, Johannes Lindenmeyer, Elly McGrath, Talia Nardo, Jorge Oliveira, Charlotte R. Pennington, Kelsey Perrykkad, Hugh Piercy, Claudia I. Rupp, Mieke H. J. Schulte, Lindsay M. Squeglia, Petra Staiger, Dan J. Stein, Jeff Stein, Maria Stein, William W. Stoops, Mary Sweeney, Katie Witkiewitz, Steven P. Woods, Richard Yi, Min Zhao, Hamed Ekhtiari

Research output: Contribution to journalArticlepeer-review


Aims: Substance use disorders (SUD) are associated with cognitive deficits that are not always addressed in current treatments, and this hampers recovery. Cognitive training and remediation interventions are well suited to fill the gap for managing cognitive deficits in SUD. We aimed to reach consensus on recommendations for developing and applying these interventions. Design, Setting and Participants: We used a Delphi approach with two sequential phases: survey development and iterative surveying of experts. This was an on-line study. During survey development, we engaged a group of 15 experts from a working group of the International Society of Addiction Medicine (Steering Committee). During the surveying process, we engaged a larger pool of experts (n = 54) identified via recommendations from the Steering Committee and a systematic review. Measurements: Survey with 67 items covering four key areas of intervention development: targets, intervention approaches, active ingredients and modes of delivery. Findings: Across two iterative rounds (98% retention rate), the experts reached a consensus on 50 items including: (i) implicit biases, positive affect, arousal, executive functions and social processing as key targets of interventions; (ii) cognitive bias modification, contingency management, emotion regulation training and cognitive remediation as preferred approaches; (iii) practice, feedback, difficulty-titration, bias modification, goal-setting, strategy learning and meta-awareness as active ingredients; and (iv) both addiction treatment work-force and specialized neuropsychologists facilitating delivery, together with novel digital-based delivery modalities. Conclusions: Expert recommendations on cognitive training and remediation for substance use disorders highlight the relevance of targeting implicit biases, reward, emotion regulation and higher-order cognitive skills via well-validated intervention approaches qualified with mechanistic techniques and flexible delivery options.

Original languageEnglish
Early online date12 Dec 2022
Publication statusE-pub ahead of print - 12 Dec 2022

Bibliographical note

Copyright © 2022, The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. Funding Information: This study was funded by grants MRF1141214 from the Australian Medical Research Future Fund and GNT2009464 from the National Health and Medical Research Council to Antonio Verdejo‐Garcia. Open access publishing facilitated by Monash University, as part of the Wiley ‐ Monash University agreement via the Council of Australian University Librarians.


  • Cognitive remediation
  • Delphi method
  • cognitive training
  • interventions
  • neuroscience
  • treatment


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