Neuropsychologie des Addictions en Communautés Thérapeutiques (NeuroAddiCT)

Context

Alcohol consumption and substance use disorder (SUD) are a major public health issue. Although therapeutic strategies in addiction have evolved, the relapse rate is high (70-80%). Among the different care units, the Therapeutic Community (TC) is a residential treatment welcoming during one year or more for people with SUD. SUD has been repeatedly shown to lead to cognitive deficits, hampering the treatment and being an important relapse risk factor. However, these impairments are not considered in TC context yet.

The screening of the neuropsychological impairments is essential for making the appropriate clinical decisions regarding the nature and timing of treatment, including the cognitive remediation. Although studies conducted in schizophrenia or traumatic brain injury have shown that remediation was effective in treatment outcomes, little is known about Alcohol Use Disorder (AUD) and SUD, especially in TC residents. An investigation of neuropsychological impairments and their impact throughout the treatment would be particularly helpful for researchers and clinicians.

Objectives

The NeuroAddiCT project (Neuropsychology of Addictions in Therapeutic Communities) is an interventional research protocol, which aims to (1) qualify the neuropsychological impairments in TCs residents (Ax 1: Assessment); (2) determine the psychometric parameters of the BEARNI (Ritz et al., 2015) in TC context; (3) assess the efficiency of a global neuropsychological approach on social and professional outcomes of the residents and on the relapse risk at 6-month follow-up (Ax 2: Remediation).

Research hypothesis

First, we hypothesize that neuropsychological impairments in TCs residents will be the same as those previously described in inpatient AUD and Drug Use Disorder (DUD) studies but with greater severity. Second, we hypothesize the BEARNI will be sensitive to the neuropsychological impairments of the TCs residents in comparison of an extended neuropsychological battery. Third, we hypothesize that introducing a global neuropsychological approach (i.e. combining screening and remediation) will promote the recovery of the neuropsychological impairments, reduce the relapse rate and be beneficial in terms of social and professional outcomes.

Methods

This project associates one research unit in Caen (the Laboratoire de Psychologie Caen Normandie; LPCN, EA 7452), the Addiction Federation and three TCs (la Sauvegarde du Nord, Le Cateau-Cambrésis – 59); le Fleuve (Barsac – 33) and Aubervilliers (93). The implementation and coordination of this project has already started in collaboration with these three TCs, the Addiction Federation, which supports the NeuroAddiCT project and takes part to the steering committee.

Two groups of participants will be included in the NeuroAddiCT project: the control group of TCs residents will be included before the implementation of the experimental design and the experimental group will undergo the entire protocol.

Our experimental design will be organized in three testing periods: an initial session (Time 1; Ax 1 and Ax 2) that will include clinical, psychological and socio-professional evaluations, the BEARNI and a neuropsychological assessment (Ax 1) as well as the cognitive remediation (Ax 2). The follow-up session (Time 2, at the sorting of the TC) will include the same protocol as in the Time 1/Ax 1; the second follow-up session (Time 3) will consist to phone-call the resident six months after the exit of the TC to record self-report clinical and social measures of the Ax 1.

Perspectives

This project promotes the partnership between clinicians and researchers. Thus, clinical practices evolution through NeuroAddiCT and strong scientific findings are expected. For the first time, NeuroAddiCT will enable to describe extensively the neuropsychological semiology of people in TCs that could enable clinicians to adapt the treatment of TCs residents. Another expectation is the harmonization of clinical practices between the three TCs, regarding both the measures to qualify residents’ outcomes (i.e. addictive, social and professional) and clinical practices related to the assessment and remediation of the neuropsychological impairments. In response to our long-term mains, our ambition is to spread this harmonization of clinical practices to every French TCs, and to conceive dedicated trainings to the addiction neuropsychology in TCs.

Public health impact

This research project will contribute to a better understanding of the harmful consequences of the use of psychoactive substances on the brain and healthy devices that promote their recovery. This project will thus provide relevant indicators for health impact assessment process that will promote the integration of health into public policy.