Improving treatment for people with cognitive impairment and substance misuse issues: Lessons from an inclusive residential treatment program pilot in Australia

Background: Approximately half of the substance dependence treatment population is estimated to have a cognitive impairment, which reduces participation, retention, and post-treatment outcomes. Cognitive behaviour change approaches are less effective for this population and cognitive remediation strategies have been found to improve outcomes. Evidence on modified programs to remove environmental barriers for treatment seekers with disability does not exist. Objective: A modified residential substance misuse treatment program in New South Wales, Australia, was piloted and evaluated to address this knowledge gap. Method: Of 67 residents who received treatment during the evaluation period, 33 were screened as having cognitive impairment. Twelve residents took part in an interview and 10 staff in a focus group to understand their views of the pilot program. Resident characteristics and retention rates and themes about program benefits and challenges are reported. Results: Treatment completion was up to five times higher for residents with cognitive impairment after the new program was implemented. The pilot program provided simplified written and visual materials and concrete examples and introduced a daily virtues program to embed new learning and support behaviour change. Resources to allow staff to engage more intensively with residents and provision of ongoing staff training were viewed as essential for program success. Conclusions: Environmental adaptations, including a combination of conventional treatment modalities with accessible design and person-centred principles, removed barriers to treatment for residents with cognitive impairment. Creating a climate where respect, tolerance and peer support were normalised was likely to have been particularly beneficial for these residents.