Baseline executive functions and receiving cognitive rehabilitation can predict treatment response in people with opioid use disorder

Tara Rezapour, Javad Hatami, Ali Farhoudian, Alireza Noroozi, Reza Daneshmand, Mehmet Sofuoglu, Alex Baldacchino, Hamed Ekhtiari

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Impaired cognitive functions, particularly executive function, predicts poor treatment success in people with substance use disorders. The current study investigated the effect of receiving adjunct cognitive rehabilitation and baseline executive function (EF) measures on treatment response among people with opioid use disorder (OUD).

The analysis sample consisted of 113 participants with OUD who were discharged from a compulsory court-mandated methadone maintenance treatment (MMT) and followed for 3 months. We used the Backward digit span/Auditory verbal learning, Stroop, and Trail making tests to assess the three measures of EF, including working memory, inhibition, and shifting, respectively. Treatment response was operationalized as (1) treatment retention and (2) the number of positive urine tests for morphine during 3-month follow-up periods. The study used Cox's proportional hazards model and linear mixed model to identify predictive factors.

Lower Stroop interference scores predicted increased length of stay in treatment (χ2 = 33.15, P < 0.001). The linear mixed model showed that scores on auditory verbal learning test and group intervention predicted the number of positive urine tests during a 3-month follow-up.

Working memory and inhibitory control, as well as receiving cognitive rehabilitation, could be potentially considered as predictors of treatment response for newly MMT admitted patients with OUD. Assessment of EF before treatment initiation may inform treatment providers about patient's cognitive deficits that may interfere with therapeutic interventions.
Original languageEnglish
Article number108558
JournalJournal of Substance Abuse Treatment
Early online date7 Jul 2021
Publication statusE-pub ahead of print - 7 Jul 2021


  • Executive function
  • Treatment response
  • Opioid use disorders
  • Cognitive rehabilitation
  • Retention
  • Relapse
  • Methadone maintenance treatment


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