To improve treatment outcomes, cognitive remediation strategies using pharmacotherapy have been proposed, and several psychotropic medications have been identified as potential candidates ( Sofuoglu, 2010 Vocci, 2008). These impairments may interfere with behavioral treatment, leading to poor treatment retention and outcome ( Vocci, 2008). One reason for the limited efficacy of such therapeutic interventions may be the cognitive impairments associated with chronic MA abuse (eg, London et al, 2005 Monterosso et al, 2005 Salo et al, 2005 Scott et al, 2007 Simon et al, 2010). Behavioral treatments, such as cognitive behavioral therapy, are the principal therapeutic strategy used for MA dependence, but they have only achieved modest success ( Lee and Rawson, 2008). Methamphetamine (MA) abuse and dependence are significant public health problems both in the United States ( Gonzales et al, 2010) and worldwide ( Pluddemann et al, 2010 Rawson and Condon, 2007 United Nations Office on Drugs and Crime, 2009 Wechsberg et al, 2010). These results suggest that modafinil may be a suitable pharmacological adjunct for enhancing the efficiency of cognitive-based therapies for MA dependence.
The findings suggest that modafinil improves learning in MA-dependent participants, possibly by enhancing neural function in regions important for learning and cognitive control.
After controlling for performance differences, MA-dependent participants showed a greater effect of modafinil on brain activation in bilateral insula/ventrolateral prefrontal cortex and anterior cingulate cortices than control participants. Modafinil boosted learning in MA-dependent participants, bringing them to the same performance level as control subjects the control group did not show changes in performance with modafinil. Under placebo conditions, MA-dependent participants showed worse learning performance than control participants. Modafinil (200 mg) and placebo were administered orally (one single dose each), in counterbalanced fashion, 2 h before each of two testing sessions. We therefore conducted a randomized, double-blind, placebo-controlled, cross-over study, using functional magnetic resonance imaging, to examine the effects of modafinil on learning and neural activity related to cognitive function in abstinent, MA-dependent, and healthy control participants. Modafinil has been shown to improve cognitive performance in neuropsychiatric patients and healthy volunteers. Therefore, medications that improve cognition in these subjects may improve the success of therapy for their addiction, especially when cognitive behavioral therapies are used. Methamphetamine (MA)-dependent individuals exhibit deficits in cognition and prefrontal cortical function.
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