Piloting of an intervention to reduce problematic alcohol use in early phase psychosis

Substance misuse significantly impacts recovery during early phase psychosis (EPP). However, effective psychotherapeutic interventions for substance misuse in EPP patients are limited. Cognitive remediation offers a novel approach by targeting mechanisms underlying substance use, including cognitive control and emotional regulation. This pilot study aimed to explore the feasibility of using a modified Cognitive Enhancement Therapy (CET) intervention in young adults with EPP, examining its effects on problematic alcohol use. This intervention, which focuses on remediation of neurocognitive and social cognitive deficits, was adapted with a reduced timeframe (6 months) and delivered via a virtual platform with the intent to improve retention. Participants who received CET saw improvements in verbal learning and memory, along with reductions in negative psychotic symptoms. Although the small sample size precluded statistical analyses, a notable reduction (50%) in alcohol use, or cessation, was seen in 6 out of 7 participants with 3 individuals notably reaching abstinence by the trial end. Overall alcohol use was reduced by 35%. Additionally, 3 participants with co-occurring cannabis use had significant reduction in cannabis risk scores (60%) over the course of the trial. Feedback from the participants suggests CET’s focus on emotional regulation, social confidence, and functional recovery contributed to their reduction in alcohol dependence. These promising outcomes highlight the need for further research to explore the potential benefits of cognitive remediation treatments for addressing substance misuse in EPP. This study was registered at clinicaltrials.gov under #NCT05365347. • A modified Cognitive Enhancement Therapy (CET) approach, with a shortened time frame and virtual delivery, is feasible and thus cost effective for services. • The results of the current trial add to the evidence that CET is an effective intervention to reduce problematic alcohol use in patients with a psychotic spectrum disorder. • Psychosocial approaches focusing on improving functional outcomes, emotional regulation, social cognition, and confidence can help individuals with EPP reduce problematic alcohol use.