Neuropsychological Interventions for Decision-Making in Addiction: a Systematic Review

Decision-making deficits are strong predictors of poor clinical outcomes in addiction treatment. However, research on interventions that address decision-making deficits among people with addiction is scarce and has not been analyzed. We aimed to systematically review evidence on neuropsychological interventions for decision-making deficits in addiction to identify promising therapies. Eligibility criteria were (1) participants with a diagnosis of substance use or behavioral addictive disorders, (2) interventions consisting of (neuro) psychological treatments that address decision-making, (3) comparators comprising control (sham) interventions, treatment as usual or no-treatment, (4) outcomes including a decision-making task, and (5) studies including RCTs and non-randomized trials. Search terms included addiction (or alcohol/drug/substance use/gambling) AND treatment (or specific interventions) AND decision-making (or specific tasks). The search yielded 728 hits, and two independent assessors agreed on the final selection of 12 articles. Interventions included Contingency Management (3 studies), Working Memory Training (2 studies) Goal Management Training (2 studies), Cognitive Behavioral Therapy (2 studies), Reality Therapy, Motivational Interview and Monetary Management. The main outcome measures were tasks of delay discounting, risk-taking and reward-based decision-making. Results showed that Goal Management Training improves reward-based decision-making, while Contingency Management combined with Cognitive Behavioral Therapy has beneficial effects on delay discounting. The evidence on Working Memory Training and Cognitive Behavioral Therapy as stand-alone treatments was mixed. Motivational Interview and Monetary Management had no significant effects on decision-making. Bias control across studies was moderate. We conclude that Goal Management Training and Contingency Management combined with Cognitive Behavioral Therapy have potential to modify decision-making in people with addiction. RCTs are needed to establish the efficacy of these interventions.