Occupational Therapy-Based Cognitive Rehabilitation of Cocaine Abusers: A Pilot Study

occupational-therapy based cognitive rehabilitation as part of a comprehensive treatment plan
for cocaine abusers

Inclusion Criteria:

1. Age 18-65

2. Primary cocaine use disorder (based on DSM-5 criteria) and in at least 3 months of
remission

3. At least mild cognitive impairment, defined as = or > 1.5 standard deviations
impairment on any 2 performance-based neurocognitive measures

4. Needing to change quality of life, defined as self-identifying at least 2 life areas
as needing to change on the Drug User Quality of Life Scale

5. A Veteran at the San Francisco Veterans Affairs Medical Center

6. Currently receiving weekly drug counseling (individual or group; at least 1 hour/week)
through an outpatient substance use disorder treatment program

Exclusion Criteria:

1. Inability to speak, read, write, and understand English

2. Inadequate hearing or vision

3. Concurrent substance use disorder (except tobacco or caffeine) not in at least 3
months of remission

4. A psychiatric disorder that will interfere with study participation or will make
participation hazardous (e.g., psychosis, suicidal or homicidal ideations, severe
anxiety)

5. A depressive disorder classified as severe, defined as a Beck Depression Inventory-II
score >29

6. Current diagnosis of a bipolar disorder needing acute inpatient psychiatric
hospitalization

7. Currently symptomatic from attention-deficit/hyperactivity disorder (DSM-5 criteria)

8. Any learning disorder, any type of dementia, any type of delirium, or an amnestic
disorder due to any general medical condition

9. Wechsler Test of Adult Reading standard score <70

10. Mini-Mental State Examination score <24

11. Current use of scheduled (i.e., prescribed) regular (i.e., daily) psychotropics or
other medicines with a high likelihood of sedation & cognitive impairment (e.g.,
benzodiazepines, clozapine, anticholinergics)

12. Currently prescribed stimulants (e.g., methylphenidate) or cognitive enhancers (e.g.,
donepezil, memantine)

13. Active medical illnesses - uncontrolled diabetes, uncontrolled hypertension,
uncontrolled thyroid dysfunction, or uncontrolled B12/folate deficiency; central
nervous system illness with potential cognitive aspects (Parkinson's, or Huntington's
dementia); Cirrhosis with complications (e.g., ascites, encephalopathy, jaundice,
gastrointestinal bleeding); Needing acute medical hospitalization from HIV sequelae,
such as HIV-related opportunistic infection

14. Any history of any type of stroke or brain hemorrhage

15. Any history of traumatic brain injury, intracranial pathology (e.g., tumor), or brain
surgery

16. Currently on probation or parole

17. Concurrent participation in another study that medically/administratively interferes
with this study