However, only a handful of studies have evaluated cognitive functioning and CBT outcome. Thus, individuals who have difficulties with attention/concentration and/or inhibiting their behaviors might be expected to have particular problems with CBT. CBT places a high level of emphasis on complex tasks such as learning and retaining new cognitive and social coping skills and strategies, recognizing and challenging problematic cognitions, attending to cues in the environment that might precipitate craving, inhibiting conditioned responses, and substituting new behaviors. Cognitive-behavioral therapy (CBT) may be a particular challenge for substance-using patients with limitations in cognitive functioning. While there is some evidence that cognitive impairment is associated with poorer treatment and outcome overall ( Bates et al., 2004 Bates, Pawlak, Tonigan, & Buckman, 2006 Fals-Stewart et al., 1994 McCrady & Smith, 1986 Passetti, Clark, Mehta, Joyce, & King, 2008) such studies remain rare, and little is known regarding how cognitive functioning may affect response to specific empirically validated therapies. These include functions such as being able to attend to what is discussed in treatment learning, retaining, and implementing new strategies monitoring of one's behavior and controlling impulsive responding ( Ersche & Sahakian, 2007 Fals-Stewart, Schafer, Lucente, Rustine, & Brown, 1994 Garavan & Hester, 2007). It is particularly striking that cognitive functions most commonly found to be impaired among substance users (e.g., cognitive flexibility, inhibition, and control memory, learning, and attention) are precisely those functions that are usually considered to be critical to treatment response. A large literature has highlighted the extent to which significant levels of cognitive impairment are found among chronic substance users ( Bolla, Funderburk, & Cadet, 2000 DiSclafani, Tolou-Shams, Price, & Fein, 2002 Fals-Stewart & Bates, 2003 Goldstein & Volkow, 2002 Gottschalk, Beauvais, Hart, & Kosten, 2001 Tomasi et al., 2007 Tucker et al., 2004). There is now extensive and compelling evidence of the role of cognition (memory, learning, attention, and cognitive control) in the development and maintenance of addiction ( Goldstein & Volkow, 2002). Multiple lines of evidence point to the potential importance of assessing and addressing cognitive functioning in the treatment of substance use disorders.
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