Comparing the Effectiveness of Cognitive Rehabilitation and Phototherapy on the Risk-Taking of Clients of Drug Addiction Clinics

Aims: Risk-taking is a behavior that endangers a person's health and provides the basis for a person to suffer from physical and psychological diseases. Substance dependence disorder includes cognitive, behavioral, and psychological symptoms along with a pattern of repetition and withdrawal tolerance consequences. The aim of the current research was the effectiveness of cognitive rehabilitation and phototherapy on the risk-taking of people with substance dependence disorder. Materials and Methods: The research method is based on the practical purpose and from the point of view of data collection, it is a part of quantitative and semi-experimental research, with a pre-test, and post-test design with a control group with a ۲-month follow-up. In this research, the statistical population was all clients of Nik, Golrizan and Hami drug abuse treatment clinics in Tehran in ۲۰۲۰. First, the Balloon Analogue Risk Task [۲۳] was performed on the clients who volunteered to participate in the sessions. Then, using available sampling method, among these people, those who scored higher than the others, ۶۳ people were selected as available and randomly assigned in groups (۲۱ people in the cognitive rehabilitation group, ۲۱ people in the phototherapy group and ۲۱ people in the control group). Informed consent to participate in the research, not having specific physical and psychological diseases, at least high school education and an age range of ۱۸ to ۵۰ years were the criteria for entering the research. Absence of more than ۲ sessions in therapy sessions, simultaneous participation in other courses and therapeutic interventions at the same time as the research, failure to answer the post-test questions and failure to participate in the follow-up level were the criteria for exiting the research. The Balloon Analogue Risk Task (BART): This test was first introduced in ۲۰۰۲ by Lejuez [۲۳]. A higher score in this variable indicates a riskier decision [۲۴]. This computer test examines the possibility of checking a person's level of risk-taking in real conditions and measures the performance or bias of the risk-taking strategy [۲۵]. Because there are ۳۰ computerized balloons in this test, it does not have a range of responses and the adjusted score in the main score of the test and the respondent's riskiness index [۲۶]. In the original version, the convergent validity of the survey test and its Pearson correlation with the survey impulsivity test and the coefficient of ۰.۴۳ and significance at the ۰.۰۱ level has been obtained [۲۷]. In Iran, this test has been standardized on young Iranians, and to examine its concurrent validity, the high-risk decision-making test in social situations [۲۳] with the subscales of health riskiness, novelty, ambiguity, and economic riskiness and depression, anxiety, and stress scale with three subscales of depression, anxiety and stress have been used as a general construct [۲۵]. The correlation coefficient with risk-taking in social situations was ۰.۴۵ and significant at the ۰.۰۵ level, and the correlation coefficient with the anxiety/depression/stress test was ۰.۸۱ and significant at the ۰.۰۵ level and also Cronbach's alpha was used to check its reliability and the coefficient was ۰.۷۹ [۲۴]. In the present study, the reliability of the test was calculated and the total coefficient of the questions was calculated as ۰.۷۳ using Cronbach's alpha method. In this test, the indicators of the adjusted score, which is equivalent to the average number of times the balloons inflated that did not burst, the unadjusted score, which is equivalent to the average number of times the balloons are inflated, the number of times the balloons burst and the maximum and a minimum number of times a balloon is inflated are measured [۲۳]. In the cognitive rehabilitation part, which was adapted from previous studies [۱۴, ۱۹], ۱۲ sessions of cognitive rehabilitation were used using Stop Signal Software (Sina Psychology Software Company), and two symbols of a circle and a square were used in each test. The size of the visual stimuli was equal to ۱.۵ cm۲, which remained on the screen for ۱.۲۵۰ milliseconds. Respondents should respond to the stimuli as quickly as possible with the left and right clicks of the computer mouse. In a way that they responded to the circle stimulus by right-clicking and to the square stimulus by left-clicking. In ۲۰% of the tests, an audio stimulus (۷۵۰ Hz-۷۵ ms) was presented shortly after the visual stimulus, and when hearing it, the respondent had to stop responding immediately (stop signal). Also, the phototherapy sessions were adapted from previous studies [۲۸], where ۱۲ sessions of low-power laser treatment were used using a German RJ device, and the subjects were exposed to infrared light (IR) radiation and directly exposed to the skull. Infrared light with a maximum wavelength of ۸۱۰ nm and ۳۲ J/cm۲ was irradiated on the entire frontal and prefrontal with a distance of one centimeter. During this period, ۱۲ sessions were conducted (۲ times a week). Ethical Permissions: This article was taken from the PhD thesis titled "The combined effect of cognitive rehabilitation and phototherapy on drug craving and cognitive performance of clients of drug addiction clinics" with the ethical code of IR.IAU.K.REC.۱۳۹۹.۰۵۴, and all the ethical principles of the research were observed. Statistical Analysis: After checking the defaults of parametric tests, a mixed analysis of variance was used. Also, Bonferroni's post hoc test and SPSS ۲۴ software were used to compare treatment interventions. Findings: The average age of the cognitive rehabilitation group was ۳۴.۱۹±۸.۲۷, the phototherapy group was ۳۲.۷۶±۷.۶۸, and the control group was ۳۳.۳۳±۷.۷۳. The F statistic obtained from the comparison of the frequencies of the ۳ groups in the age variable was equal to ۰.۱۷۴, which was not statistically significant (p=۰.۸۴۱) and indicated that the groups were equal in terms of age. Also, the amount of Chi-Square analysis results from the comparison of ۳ groups in the education variable was equal to Chi-Square= ۲.۳۱۳, which this amount was not statistically significant (p=۰.۶۷۸) and indicated that the three groups were equal in terms of education. The average risk of the rehabilitation group and the phototherapy group decreased in the post-test compared to the pre-test (Table ۱). Considering that the purpose of this article was to investigate the number of balloons bursting before and after the therapeutic intervention and to compare the experimental and control groups; therefore, the examination of the subscales of Barrett's test was omitted and only the criterion of the total number of burst balloons was calculated. To check the significance of the changes obtained in the post-test and follow-up, mixed variance analysis was used and the results of which are included in Tables ۲, ۳ and ۴. The results of mixed analysis of variance showed that cognitive rehabilitation and phototherapy had a significant effect on reducing risk (Table ۲). A two-by-two comparison of the mean adjustment of test levels (pre-test, post-test and follow-up) on risk-taking showed that the difference between the mean of post-test and follow-up (intervention stability effect) was not significant, so cognitive rehabilitation and phototherapy did not have a lasting effect over time (Table ۳). The results of Bonferroni's post hoc risk test to identify more effective treatment showed that the average difference between the phototherapy group and the control group was greater than the average difference between cognitive rehabilitation and the control group, and phototherapy was more effective than cognitive rehabilitation in reducing risk. The difference between the mean risk factors of the cognitive rehabilitation group and the control group was ۲.۱۱۱, which was statistically significant (p=۰.۰۰۱), the mean difference between the risk variable in the phototherapy group and the control group was ۲.۸۵۷, and this difference was also statistically significant (p=۰.۰۰۱). The results showed that this average difference between the phototherapy and control groups was greater than the average difference between the cognitive rehabilitation group and the control group. Conclusion: Based on the findings of this article, the use of low-power laser plays a significant role in helping to improve the harmful effects of addiction and reducing cravings and in a short time, it produces significant results in improving the brain function of people involved in addiction, and it can be used along with drug therapy and psychotherapy. Clinical & Practical Tips in POLICE MEDICINE: Due to the very low side effects of phototherapy and the possibility of its implementation in different conditions, this method can be used as a new method in controlling the high-risk conditions of the military forces. The findings of the present study can be used to formulate new treatment programs and interventions in addiction treatment and counselling centers. Acknowledgements: The researchers sincerely appreciate all the people who helped us in this research and were involved in coordinating and conducting the research. Conflict of Interest: The authors stated that there is no conflict of interest in the present study. Authors' Contribution: First author, presentation of the idea and design of the study; second author, data analysis; third author, data analysis; fourth author, statistical analysis of data; fifth author, data collection; sixth author, data analysis; all the authors participated in the initial writing of the article and its revision, and all accept the responsibility for the accuracy and correctness of the contents of this article with the final approval of this article. Financial Sources: This project was done with the financial support of Karaj Islamic Azad University.    Table ۱) Average vulnerability in experimental and control groups Dependent variable the level M±SD rehabilitation Phototherapy Control Risk taking pre-test ۳۰.۸۶±۰.۸۵۴ ۳۰.۹۰±۰.۹۴۴ ۳۰.۹۵±۰.۹۲ post-test ۲۷.۷۱±۰.۹۵۶ ۲۶.۵۷±۰.۷۴۶ ۳۰.۸۶±۰.۹۶ Follow up ۲۷.۸۱±۰.۹۸۱ ۲۶.۶۷±۰.۹۱۳ ۳۰.۹۰±۰.۹۴ Table ۲) The results of intra-subject and inter-subject mixed variance of risk taking Dependent variable Sources Change F statistic p Impact factor Statistical power Risk taking Time ۳۵۰.۱۵۷ ۰.۰۰۱ ۰.۸۵۴ ۰.۹۹۹ group ۷۷.۸۷۱ ۰.۰۰۱ ۰.۷۲۲۰ ۰.۹۹۹ time×group ۸۹.۲۲۱ ۰.۰۰۱ ۰.۷۴۸ ۰.۹۹۹ Table ۳) The results of Bonferroni's post hoc  risk test to check the validity of the results Dependent variable Level Adjusted mean Differences in steps mean difference p Risk taking pre-test ۳۰.۹۰۵ pre-test post-test ۲.۵۲۱ ۰.۰۰۱ post-test ۲۸.۳۸۱ pre-test Follow up ۲.۴۴۴ ۰.۰۰۱ Follow up ۲۸.۴۶۰ post-test Follow up -۰.۰۷۹ ۰.۰۷۸