New Tools and Strategies to Bolster Behavioral Therapy

Through skillfully administered behavioral therapy, recovering drug abusers can learn to resist cravings and avoid situations that trigger relapse. Many long-term abusers, however, experience memory and cognition impairments that impede their progress in this life-saving educational process. To remedy this problem, NIDA-funded scientists are investigating whether certain medications might strengthen patients' understanding and memory retention. They are also studying the potential of computers and other technologies to extend the reach of therapy and improve followup care.

The principle of using medication to enhance behavioral therapy has already shown promise in several nondrug contexts, including, for example, the treatment of patients with a morbid fear of heights. In a preliminary trial, 60 percent of patients who received D-cycloserine (DCS) prior to two behavioral therapy sessions reported that they were "much improved" when fear of heights was assessed 1 week and 3 months after treatment; only 20 percent of patients given a placebo reported such progress. DCS has also shown positive results in people with social anxiety and obsessive-compulsive disorder.

NIDA-supported investigators are initially focusing on cognitive enhancers to help people quit methamphetamine and other stimulants, drugs that cause some of the most debilitating cognitive impairments during early abstinence. One medication currently under study is modafinil, a mild stimulant that appears to have positive effects on executive function—planning, setting goals, regulating behavior—and impulsivity. The study will measure whether modafinil helps patients progress in cognitive-behavioral therapy (CBT). Researchers suggest that cognition-enhancing medications might permit clinicians to reduce the number of CBT sessions required to counter addiction and thereby reach more people in need of therapy.

Technology—computer software, Web sites, even telephones—may enhance the potency, reach, and cost-effectiveness of behavioral treatment. Patients who cannot or will not attend live therapy sessions may benefit from computer software designed to teach relapse-avoidance skills. Similarly, booster sessions delivered via telephone or the Web might reinforce abstinence. Some providers may offer in-person treatment sessions early in a patient's therapy and then shift to telephone or computer delivery of treatment. These technologies should be particularly beneficial for patients who live in remote areas or have limited mobility.

Cognitive enhancers and computers have great potential to augment patients' acquisition of behavioral therapy's skills and lessons. Technology also promises to provide therapists with new, cost-effective tools to help their patients maintain behavioral changes they achieve during treatment. NIDA is committed to ushering these innovative approaches smoothly and efficiently through the stages of discovery and into the Nation's clinics.