Matching Treatments to Cognitive Deficits in Offenders with Substance Use Disorders

Project Summary/Abstract Prior research has identified two subtypes of antisocial offenders, typified by distinct dysfunctional cognitive- emotion interactions undermining self-regulation. One subtype is characterized by an attention-based abnormality, which impairs adaptive processing of contextual information, tangential to one’s primary focus. This abnormality is typified by offenders with high levels of callous/unemotional traits. A second subtype is characterized by hyper-reactions to personally relevant cues, interfering with executive functions that are otherwise needed to regulate behavior. This abnormality is prevalent in those with high externalizing characteristics. Our team has developed cognitive skills training that addresses each of these specific deficits in distinct ways. These distinct interventions are intended to address mechanism-specific cognitive emotional dysfunction, as opposed to treating distinct dysfunctions with a uniform approach. Under an R21, our pilot work has shown evidence of improving outcomes in offenders by matching specific deficits with focused skills training. Here we seek to conduct a well-powered, randomized clinical trial to demonstrate reliability and generalizability of these effects. We expect to verify prior findings of improved outcomes by matching individual deficits with the targeted interventions. We will examine effects of treatment on specific cognitive skills (assessed by laboratory- based tests) and real-world behavioral outcomes including substance use behaviors, institutional adjustment, and recidivism following release from prison. Further, we will examine advanced neuroimaging measures to assess brain changes with treatment. This will aid in specifying potentially different mechanisms of treatment success in each respective group. This project addresses the ongoing need to improve and validate focused interventions that target specific deficits, replacing less-effective one-size-fits-all approaches.