Cognitive boosting interventions for impulsivity in addiction: a systematic review and meta-analysis of cognitive training, remediation and pharmacological enhancement

Aims To evaluate and compare the effects of three cognitive boosting intervention approaches (computerised cognitive training, cognitive remediation and pharmacological cognitive enhancers) on measures of impulsive action and impulsive choice. Design Systematic review and meta-analysis of publications that reported original controlled trials of cognitive boosting interventions. Setting Studies conducted anywhere in the world. No language restrictions were applied. Participants Treatment-seeking adults with substance use disorder or gambling disorder. Measurements Our primary outcome was a reduction in impulsive action or choice on a validated cognitive measure post-intervention. We assessed risk of bias using the Cochrane Collaboration tool and determined pooled estimates from published reports. We performed random-effects analyses for impulsive action and impulsive choice outcomes and planned moderator analyses. Findings Of 2204 unique studies identified, 60 were included in the full-text review. Twenty-three articles were considered eligible for inclusion in the qualitative synthesis and 16 articles were included in our meta-analysis. Articles eligible for pooled analyses included five working memory training (computerised cognitive training) studies with 236 participants, three goal management training (cognitive remediation) studies with 99 participants, four modafinil (cognitive enhancer) studies with 160 participants and four galantamine (cognitive enhancer) studies with 131 participants. Study duration ranged from 5 days to 13 weeks, with immediate follow-up assessments. There were no studies identified that specifically targeted gambling disorder. We only found evidence for a benefit on impulsive choice of goal management training, although only in two studies involving 66 participants (standardised mean difference (SMD) = 0.86; 95% CI = 0.49-1.23; P = 0.02; I-2 = 0%, P = 0.95). Conclusion Cognitive remediation, and specifically goal management training, may be an effective treatment for addressing impulsive choice in addiction. Preliminary evidence does not support the use of computerised cognitive training or pharmacological enhancers to boost impulse control in addiction.