Engaging the Patient with Cognitive Impairment in Treatment

While many of the strategies discussed in this section apply to all patients, they may be particularly important for engaging patients with CI. The following strategies may increase the patient’s engagement in treatment: 

• Provide written information to the patient about treatment and talk them through the process – the patient may be more likely to enter treatment if they understand what treatment will involve, the process of treatment, and what they will be required to do. 
• Keep in mind that the discussion of different treatment options with the patient may need to be presented in a way that accounts for their type of CI (e.g., assisting the patient to write down options if learning is impaired). Where the clinician judges that the patient is capable of making a decision, the patient should be involved in deciding which treatment to participate in. 
• Establish a positive relationship with the patient with CI by: 
  • keeping information as simple and structured as needed  
  • adopting an empathetic, non-judgmental, non-authoritarian approach 
  • listening carefully to what the patient has to say 
  • scheduling sufficient time for consultations 
• Maintain contact with patients with cognitive deficits. To increase the likelihood that patients will attend appointments, clinicians should: 
  • telephone and/or send a text message before a consultation to remind the patient they have an appointment 
  • schedule the appointment at the same time on the same day to decrease the likelihood of forgetting 
  • encourage support networks to accompany the patient if appropriate 
  • follow-up by telephone if an appointment has been forgotten and arrange an alternative time 
  • arrange for referral to aftercare before completing treatment to ensure there is no gap in continuing care. It is often this gap that leads to relapse. 

Cognitive deficits can also affect treatment by limiting the patient’s ability to effectively express their thoughts and feelings and to understand communication from the clinician. The clinician should keep all communication as simple as possible, and repeat information several times if necessary. They should use multi-modal presentation of material where possible (e.g. verbally, visually, experientially/‘doing’). The clinician can regularly check that the patient understands what they are saying by asking them to summarise in their own words, rather than merely asking them if they understand. Patients with memory problems should be encouraged to record their thoughts and questions in a diary and be directed to refer to their notes as a way to ensure the memory problem does not affect potential treatment outcomes. Treatment planning should also be undertaken in collaboration with the patient, as well as relevant supports (i.e., family and friends), and relevant health professionals (e.g. GP, addiction medicine specialist).