Cognitive training and remediation interventions for substance use disorders: a Delphi consensus study


Antonio Verdejo-Garcia, Faculty of Medicine, Nursing and Health Sciences
Tara Rezapour, Institute for Cognitive Science Studies
Emily Giddens, Faculty of Medicine, Nursing and Health Sciences
Arash Khojasteh Zonoozi, Iranian National Center for Addiction Studies
Parnian Rafei, Iranian National Center for Addiction Studies
Jamie Berry, The Faculty of Medicine, Health and Human Sciences
Alfonso Caracuel, Universidad de Granada
Marc L. Copersino, Harvard Medical School
Matt Field, The University of Sheffield
Eric L. Garland, University of Utah Health
Valentina Lorenzetti, Australian Catholic University
Leandro Malloy-Diniz, Universidade Federal de Minas Gerais
Victoria Manning, Faculty of Medicine, Nursing and Health Sciences
Ely M. Marceau, Illawarra Health and Medical Research Institute
David L. Pennington, University of California, San Francisco
Justin C. Strickland, Johns Hopkins School of Medicine
Reinout Wiers, Universiteit van Amsterdam
Rahia Fairhead, Faculty of Medicine, Nursing and Health Sciences
Alexandra Anderson, Faculty of Medicine, Nursing and Health Sciences
Morris Bell, Yale School of Medicine
Wouter J. Boendermaker, Universiteit van Amsterdam
Samantha Brooks, Liverpool John Moores University
Raimondo Bruno, University of Tasmania
Salvatore Campanella, Université Libre de Bruxelles
Janna Cousijn, Erasmus Universiteit Rotterdam
W. Miles Cox, Bangor University
Andrew C. Dean, Jane & Terry Semel Institute for Neuroscience & Human Behavior
Karen D. Ersche, Department of Psychiatry
Ingmar Franken, Erasmus Universiteit Rotterdam

Publication Name



Aims: Substance use disorders (SUD) are associated with cognitive deficits that are not always addressed in current treatments, and this hampers recovery. Cognitive training and remediation interventions are well suited to fill the gap for managing cognitive deficits in SUD. We aimed to reach consensus on recommendations for developing and applying these interventions. Design, Setting and Participants: We used a Delphi approach with two sequential phases: survey development and iterative surveying of experts. This was an on-line study. During survey development, we engaged a group of 15 experts from a working group of the International Society of Addiction Medicine (Steering Committee). During the surveying process, we engaged a larger pool of experts (n = 54) identified via recommendations from the Steering Committee and a systematic review. Measurements: Survey with 67 items covering four key areas of intervention development: targets, intervention approaches, active ingredients and modes of delivery. Findings: Across two iterative rounds (98% retention rate), the experts reached a consensus on 50 items including: (i) implicit biases, positive affect, arousal, executive functions and social processing as key targets of interventions; (ii) cognitive bias modification, contingency management, emotion regulation training and cognitive remediation as preferred approaches; (iii) practice, feedback, difficulty-titration, bias modification, goal-setting, strategy learning and meta-awareness as active ingredients; and (iv) both addiction treatment work-force and specialized neuropsychologists facilitating delivery, together with novel digital-based delivery modalities. Conclusions: Expert recommendations on cognitive training and remediation for substance use disorders highlight the relevance of targeting implicit biases, reward, emotion regulation and higher-order cognitive skills via well-validated intervention approaches qualified with mechanistic techniques and flexible delivery options.

Open Access Status

This publication may be available as open access

Funding Number


Funding Sponsor

National Health and Medical Research Council



Link to publisher version (DOI)