Neurobiological Mechanisms of Chess as an Add-On Treatment Against SUD

Substance Use Disorders Clinical Trial

— Chess_SUD  

Official title:

Investigating Neurobiological Mechanisms of Chess as an Add-On Treatment Against Substance Use Disorder

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04057534
• Other study ID #: Chess_SUD
• Status: Completed
• Phase: N/A
• Start date: April 1, 2020
• Est. completion date: November 17, 2023

Study information

• Verified date: March 2024
• Source: Central Institute of Mental Health, Mannheim
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Neurobiological and neuropsychological approaches to investigate the potential mechanism of action of chess as an add-on therapy (chess based - cognitive remediation treatment, CB-CRT) to reduce cognitive deficits in individuals with alcohol use disorder (AUD) or tobacco use disorder (TUD).

Description:

The study aims to investigate the potential mechanism of action of chess as a "chess based - cognitive remediation treatment, CB-CRT" to reduce cognitive deficits in individuals with substance use disorder (SUD) seeking treatment using neurobiological and neuropsychological approaches. Furthermore, it will be assessed whether this chess intervention has a generalized positive effect on short-term abstinence. Interestingly, the functional domains and associated underlying neuronal networks observed to be affected in individuals with SUD overlap significantly with those that could be strengthened by chess-based cognitive training or formal chess. Specifically, strengthening of cortical control regions (dorsolateral prefrontal cortex, DLPFC) and brain areas relevant for decision-making (orbitofrontal cortex, OFC) could prevent future relapse. Therefore, chess as an add-on therapy to complement other standard treatments of SUD could lead to improved therapeutic outcomes.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 108
• Est. completion date: November 17, 2023
• Est. primary completion date: November 17, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 65 Years

Eligibility

Inclusion Criteria:

• severe alcohol (AUD) or tabacco use disorder (SUD) according to DSM-5
• abstinence from alcohol for at least 72 hours (AUD)
• sufficient ability to communicate with investigators and answer questions in both written and verbal format
• ability to provide fully informed consent and to use self-rating scales
• main diagnosis AUD: inpatient or outpatient treatment in our clinic
• main diagnosis TUD: participation in 6 weeks smoking cessation treatment
• Normal or corrected to normal vision
• Signed consents for data security

Exclusion Criteria:

• severe internal, neurological, and/or psychiatric comorbidities; other Axis I mental disorders other than TUD according to ICD-10 and DSM 5 (except for other substance use disorders - if AUD or TUD is still the main diagnosis -, ADHD, remitted depression, mild or moderate depression, adjustment disorder, generalized anxiety disorder, phobias, panic disorder or other mild or moderate personality disorders) in the last 12 months
• Severe withdrawal symptoms (CIWA-Ar > 7; Sullivan et al. 1989)
• alcohol intoxication (>0‰)
• history of brain injury
• severe cognitive impairments
• common exclusion criteria for MRI (e.g. metal, claustrophobia, pregnancy)
• suicidality or endangerment of others
• positive Covid-19 screening

Related Conditions & MeSH terms

• Substance Use Disorders
• Substance-Related Disorders

Intervention

Behavioral:
• Standard therapy for AUD plus Chess-based cognitive treatment
Behavioral: standard AUD Cognitive Behavioral Therapy (CBT) in Clinical setting. Patients who voluntarily submit to enter a qualified detoxification treatment program will be examined, either in-patient, out-patient, or in a day-clinic setting at the Department of Addictive Behaviour and Addiction Medicine. Additional, the experimental group receives chess based cognitive remediation treatment (CB-CRT) for 1,5 hours three times a week. The tasks of the treatment were created by our cooperation partner, the psychologist Juan Antonio Montero. He is currently successfully applying this battery as an add-on therapy. The training battery is designed to strengthen cognitive functioning in specific domains such as short-term memory, focal attention, selective attention, pattern recognition, visuospatial abilities, metacognition and also inhibition.
• Standard therapy for AUD
Behavioral: standard AUD Cognitive Behavioral Therapy (CBT) in Clinical setting. Patients who voluntarily submit to enter a qualified detoxification treatment program will be examined, either in-patient, out-patient, or in a day-clinic setting at the Department of Addictive Behaviour and Addiction Medicine.
• Standard smoking cessation therapy for TUD plus Chess-based cognitive treatment
Behavioral: standard smoking cessation therapy for TUD in group therapy setting. Patients who voluntarily submit to enter a qualified smoking cessation program will be examined in an out-patient setting at the Department of Addictive Behaviour and Addiction Medicine. They receive a six-week standard therapy (one 1,5 hours group therapy per week). Additional, the experimental group receives chess based cognitive remediation treatment (CB-CRT) for 1,5 hours three times a week. The tasks of the treatment were created by our cooperation partner, the psychologist Juan Antonio Montero. He is currently successfully applying this battery as an add-on therapy. The training battery is designed to strengthen cognitive functioning in specific domains such as short-term memory, focal attention, selective attention, pattern recognition, visuospatial abilities, metacognition and also inhibition.
• Standard therapy for TUD
Behavioral: standard smoking cessation therapy for TUD in group therapy setting. Patients who voluntarily submit to enter a qualified smokind cessation program will be examined in an out-patient setting at the Department of Addictive Behaviour and Addiction Medicine. They receive a six-week standard therapy (one 1,5 hours group therapy per week). Additional, the experimental group receives chess based cognitive remediation treatment (CB-CRT) for 1,5 hours three times a week.

Locations

Country	Name	City	State
Germany	Klinik für Abhängiges Verhalten, Zentralinstitut für Seelische Gesundheit	Mannheim

Sponsors (1)

Lead Sponsor	Collaborator
Central Institute of Mental Health, Mannheim

Country where clinical trial is conducted

Germany, 

References & Publications (12)

Adinoff B. Neurobiologic processes in drug reward and addiction. Harv Rev Psychiatry. 2004 Nov-Dec;12(6):305-20. doi: 10.1080/10673220490910844. — View Citation

Amidzic O, Riehle HJ, Fehr T, Wienbruch C, Elbert T. Pattern of focal gamma-bursts in chess players. Nature. 2001 Aug 9;412(6847):603. doi: 10.1038/35088119. No abstract available. — View Citation

Atherton M, Zhuang J, Bart WM, Hu X, He S. A functional MRI study of high-level cognition. I. The game of chess. Brain Res Cogn Brain Res. 2003 Mar;16(1):26-31. doi: 10.1016/s0926-6410(02)00207-0. — View Citation

Bates ME, Buckman JF, Nguyen TT. A role for cognitive rehabilitation in increasing the effectiveness of treatment for alcohol use disorders. Neuropsychol Rev. 2013 Mar;23(1):27-47. doi: 10.1007/s11065-013-9228-3. Epub 2013 Feb 15. — View Citation

Blasco-Fontecilla H, Gonzalez-Perez M, Garcia-Lopez R, Poza-Cano B, Perez-Moreno MR, de Leon-Martinez V, Otero-Perez J. Efficacy of chess training for the treatment of ADHD: A prospective, open label study. Rev Psiquiatr Salud Ment. 2016 Jan-Mar;9(1):13-2 — View Citation

Demily C, Cavezian C, Desmurget M, Berquand-Merle M, Chambon V, Franck N. The game of chess enhances cognitive abilities in schizophrenia. Schizophr Res. 2009 Jan;107(1):112-3. doi: 10.1016/j.schres.2008.09.024. Epub 2008 Nov 7. No abstract available. — View Citation

Fattahi F, Geshani A, Jafari Z, Jalaie S, Salman Mahini M. Auditory memory function in expert chess players. Med J Islam Repub Iran. 2015 Oct 6;29:275. eCollection 2015. — View Citation

Fauth-Buhler M, de Rover M, Rubia K, Garavan H, Abbott S, Clark L, Vollstadt-Klein S, Mann K, Schumann G, Robbins TW. Brain networks subserving fixed versus performance-adjusted delay stop trials in a stop signal task. Behav Brain Res. 2012 Nov 1;235(1):89-97. doi: 10.1016/j.bbr.2012.07.023. Epub 2012 Jul 20. — View Citation

Goncalves PD, Ometto M, Bechara A, Malbergier A, Amaral R, Nicastri S, Martins PA, Beraldo L, dos Santos B, Fuentes D, Andrade AG, Busatto GF, Cunha PJ. Motivational interviewing combined with chess accelerates improvement in executive functions in cocain — View Citation

Lally N, Huys QJM, Eshel N, Faulkner P, Dayan P, Roiser JP. The Neural Basis of Aversive Pavlovian Guidance during Planning. J Neurosci. 2017 Oct 18;37(42):10215-10229. doi: 10.1523/JNEUROSCI.0085-17.2017. Epub 2017 Sep 18. — View Citation

Onofrj M, Curatola L, Valentini G, Antonelli M, Thomas A, Fulgente T. Non-dominant dorsal-prefrontal activation during chess problem solution evidenced by single photon emission computerized tomography (SPECT). Neurosci Lett. 1995 Oct 6;198(3):169-72. doi — View Citation

Vollstadt-Klein S, Wichert S, Rabinstein J, Buhler M, Klein O, Ende G, Hermann D, Mann K. Initial, habitual and compulsive alcohol use is characterized by a shift of cue processing from ventral to dorsal striatum. Addiction. 2010 Oct;105(10):1741-9. doi: — View Citation

* Note: There are 12 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	change in neural alcohol cue-reactivity	fMRI alcohol cue-reactivity task (Vollstädt-Klein et al. 2010)	2 time points: before and after 6 weeks chess-based cognitive training
Primary	change in neural tobacco cue-reactivity	fMRI tobacco cue-reactivity task (Vollstädt-Klein et al. 2011)	2 time points: before and after 6 weeks chess-based cognitive training
Primary	change in neural correlates of inhibition	fMRI stop-signal task (Whelan et al. 2012)	2 time points: before and after 6 weeks chess-based cognitive training
Primary	substance use (alcohol consumption and tabacco use)	self-report	3 months follow-up after the end of treatment
Primary	change in neural working memory processes	fMRI working memory task "N-back" (Charlet et al. 2014)	2 time points: before and after 6 weeks chess-based cognitive training
Primary	Change in working memory capacity	working memory capacity measured by letter-number sequencing task of the [Wechsler Memory Scale (Kent 2013)]; raw values will be transformed to IQ-like scales (mean 100, SD 15); the higher the value, the higher the working memory capacity	2 time points: before and after 6 weeks SCP
Primary	Change in impulsivity	impulsivity measured with BIS scale [Barratt impulsiveness scale (Patton et al. 1995)];range 15-60; total score will be used; high values represent high impulsivity	3 time points: before and after 6 weeks SCP plus after 3 months
Primary	Change in decision-making	[Iowa Gambling Task (Bechara et al. 1994)]	2 time points: before and after 6 weeks SCP
Primary	Change in mental flexibility	[Dimensional Change Card Sort (Zelazo et al. 2014)]	2 time points: before and after 6 weeks SCP
Primary	Change in attentional capacity	[d2 Test of Attention (Brickenkamp 2002)].	2 time points: before and after 6 weeks SCP
Secondary	change in functional connectivity within the salience network (SN) and executive control network (ECN)	[measured with fMRI]	2 time points: before and after 6 weeks therapy and chess-based cognitive training