Cognitive Function and Cerebral Perfusion During Cocaine Abstinence

Department of Psychiatry, Yale University, New Haven, Connecticut, United States
American Journal of Psychiatry (Impact Factor: 12.3). 05/2001; 158(4):540-5. DOI: 10.1176/appi.ajp.158.4.540
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    • "Data suggest that regional metabolic alterations seen in CDI are associated with changes in brain dopamine activity (2, 9, 10) as well as with neuronal injury in the frontal cortex in both frontal gray and white matter (5, 11–13). There are also several studies showing that chronic cocaine-use is associated with attention, memory, and executive impairments (7, 14–19). "
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    ABSTRACT: Background: Cocaine-dependent individuals (CDI) present executive cognitive function (ECF) deficits, but the impact of psychiatric comorbidities such as Attention-Deficit Hyperactivity Disorder (ADHD) on neuropsychological functioning is still poorly understood. The aim of this study was to investigate if CDI with ADHD (CDI + ADHD) would have a distinct pattern of executive functioning when compared with CDI without ADHD (CDI). Methods: We evaluated 101 adults, including 69 cocaine-dependent subjects (divided in CDI and CDI + ADHD) and 32 controls. ECF domains were assessed with Digits Forward (DF), Digits Backward (DB), Stroop Color Word Test (SCWT), the Wisconsin Card Sorting Test (WCST), and the Frontal Assessment Battery (FAB). DSM-IV criteria for ADHD were used for diagnosis and previous ADHD symptoms (in the childhood) were retrospectively assessed by the Wender-Utah Rating Scale (WURS). Results: There were no significant differences between CDI + ADHD, CDI, and controls in estimated intellectual quotient (IQ), socioeconomic background, education (in years), and pre-morbid IQ (p > 0.05). SCWT and WCST scores did not differ across groups (p > 0.05). Nevertheless, CDI and CDI + ADHD performed more poorly than controls in total score of the FAB (p < 0.05). Also, CDI + ADHD did worse than CDI on DF (F = 4.756, p = 0.011), DB (F = 8.037, p = 0.001), Conceptualization/FAB (F = 4.635, p = 0.012), and Mental flexibility/FAB (F = 3.678, p = 0.029). We did not find correlations between cocaine-use variables and neuropsychological functioning, but previous ADHD symptoms assessed by WURS were negatively associated with DF (p = 0.016) and with the total score of the FAB (p = 0.017). Conclusion: CDI + ADHD presented more pronounced executive alterations than CDI and CDI exhibited poorer cognitive functioning than controls. Pre-existing ADHD symptoms may have a significant negative impact on executive dysfunction in CDI. It remains to be investigated by future studies if symptoms such as impulsivity or a pre-existing ECF dysfunction could represent underlying cognitive endophenotypes that would substantially increase the risk for acquiring addictive disorders.
    Frontiers in Psychiatry 10/2013; 4:126. DOI:10.3389/fpsyt.2013.00126
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    • "Given that the majority of residential substance abuse facilities provide short-term care (approximately 30 days), the ability to integrate a specialized treatment for depression within an ongoing substance abuse treatment program in a short time period is critical. Further, despite the success of CBT for depression more generally, adequate cognitive functioning is necessary for many of the treatment components (Gottschalk et al., 2001). In a recent review, the relationship between CBT treatment outcomes and cognitive deficits were examined in patients with cocaine dependence (Aharonovich et al., 2006). "
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    ABSTRACT: The two most common comorbid conditions with HIV are substance use disorders and depression, and individuals with comorbid HIV, depression, and substance dependence face a more chronic and treatment-resistant course. As an example of how to adapt evidence-based approaches to a complex comorbid population, the current case study examined the integration of a combined depression and HIV medication adherence treatment. The resulting intervention, ACT HEALTHY, combines a brief behavioral activation approach specifically developed to treat depression in individuals receiving residential substance abuse treatment (LETS ACT; Daughters et al., 2008) with a brief cognitive-behavioral approach to improving HIV medication adherence (Life-Steps; Safren et al., 1999; Safren et al., 2009). The current case series demonstrates the use of ACT HEALTHY among 3 depressed HIV-positive, low-income African Americans entering residential substance abuse treatment.
    Cognitive and Behavioral Practice 08/2010; 17(3):309-321. DOI:10.1016/j.cbpra.2009.12.003 · 1.33 Impact Factor
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    • "As we have confirmed previous findings of the existence of cognitive impairment in chronic opiate users, it seems likely that participants in opiate abuse treatment programs will have difficulty with attention and memory, and these deficits may persist for months and years past detoxification. Recent studies have suggested that cognitive status may play a role in treatment efficacy (Miller, 1991;Gottschalk et al., 2001;Aharonovic et al., 2003;Teichner et al., 2002). Thus, the deficits we have demonstrated in both MMT and PA patients suggest that these populations may benefit from more personal effectiveness programs, adult daily living skills, remedial education programs, and concrete treatment planning to improve outcomes (Czuchry and Dansereau, 2004;Zinn et al., 2004). "
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    ABSTRACT: An accumulating body of research suggests that former heroin abusers in methadone maintenance therapy (MMT) exhibit deficits in cognitive function. Whether these deficits are present in former methadone maintained patients following discontinuation of MMT is unknown. This study tests the hypothesis that former heroin users who have detoxified from methadone maintenance therapy and are drug-free have less pronounced cognitive impairment than patients continuing long-term MMT. A series of neuropsychological tests were administered to three groups of subjects: 29 former heroin addicts receiving methadone maintenance treatment, 27 former heroin addicts withdrawn from all opiates, and 29 healthy controls without a history of drug dependence. Testing included Wechsler Adult Intelligence Scale-Revised Vocabulary Test, the Stroop Color-Word Test, the Controlled Oral Word Association Test, the Benton Visual Retention Test, and a Substance Use Inventory. Both methadone-maintained and abstinent subject groups performed worse than controls on tasks that measured verbal function, visual-spatial analysis and memory, and resistance to distractibility. Abstinent subjects performed worse than their methadone maintained counterparts on tests measuring visual memory and construct formation. Cognitive impairment did not correlate with any index of drug use. We confirmed previous findings of neuropsychological impairment in long-term MMT recipients. Both patients receiving MMT and former heroin users in prolonged abstinence exhibited a similar degree of cognitive impairment. Cognitive dysfunction in patients receiving methadone maintenance may not resolve following methadone detoxification.
    Drug and Alcohol Dependence 11/2006; 84(3):240-7. DOI:10.1016/j.drugalcdep.2006.02.006 · 3.42 Impact Factor
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