Cognitive impairment influences drinking outcome by altering therapeutic mechanisms of change

Center of Alcohol Studies, Rutgers University, Piscataway, NJ, USA.
Psychology of Addictive Behaviors (Impact Factor: 2.09). 10/2006; 20(3):241-53. DOI: 10.1037/0893-164X.20.3.241
Source: PubMed

ABSTRACT Serious neuropsychological impairments are seen in a minority of addiction treatment clients, and, theoretically, these impairments should undermine behavioral changes targeted by treatment; however, little evidence supports a direct influence of impairment on treatment response. To address this paradox, the authors used structural equation modeling and Project MATCH data (N=1,726) to examine direct, mediated, and moderated paths between cognitive impairment, therapeutic processes, and treatment outcome. Mediated relations were found, wherein impairment led to less treatment compliance, lower self-efficacy, and greater Alcoholics Anonymous Involvement, which, in turn, more proximally predicted drinking. Impairment further moderated the effect of self-efficacy, making it a poor predictor of drinking outcomes in impaired clients, thereby suggesting that impaired and unimpaired clients traverse different pathways to addiction recovery.

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Available from: Marsha E Bates, Jan 07, 2014
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    • "The importance of the latter foci is supported by evidence that between 50 and 80 percent of people with alcohol disorders or other drug dependencies experience mild to severe executive function impairments (Aharonovich et al. 2006; Bates et al. 2006; Goldman 1990; Gonzalez et al. 2004). Among people in substance abuse treatment, these neuropsychological impairments are related to greater attrition, violations of clinic rules, and poor treatment outcomes (Aharonovich et al. 2003, 2006; Bates et al. 2006; Teichner et al. 2002). "
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    ABSTRACT: Alcohol and other drug dependencies are, in part, character­ ized by deficits in executive functioning, including working memory. Working-memory training is a candidate computer­ ized adjunctive intervention for the treatment of alcoholism and other drug dependencies. This article reviews emerging evidence for computerized working memory training as an efficacious adjunctive treatment for drug dependence and highlights future challenges and opportunities in the field of working-memory training, including duration of training needed, persistence of improvements and utility of booster sessions, and selection of patients based on degree of deficits.
    09/2014; 36(1):123 -126.
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    • "Decreased Glu levels in participants reporting a loss of control over alcohol intake could also indicate glial damage or mitochondrial injury which have been found to be associated with neurodegeneration and cognitive impairment (Gibson et al., 2010; Seifert et al., 2006). It has been suggested that cognitive impairment might play an important role in drinking behavior (Bates et al., 2006) mediated by lower self-efficacy, especially in individuals with executive dysfunction (Morgenstern and Bates, 1999). "
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    ABSTRACT: The development and maintenance of alcohol use disorders (AUD) have been hypothesized to be associated with an imbalance of glutamate (GLU) homeostasis. White matter (WM) loss, especially in anterior brain regions, has been reported in alcohol dependence, which may involve disturbances in both myelin and axonal integrity. Frontal lobe dysfunction plays an important role in addiction, because it is suggested to be associated with the loss of control over substance use. This study investigated magnetic resonance spectroscopy (MRS)-detectable Glu levels in frontal WM of non-treatment-seeking heavy drinkers and its associations with AUD symptoms. Single-voxel MR spectra optimized for Glu assessment (TE 80 ms) were acquired at 3T from a frontal WM voxel in a group of heavy drinking, non-treatment-seeking subjects in comparison with a group of subjects with only light alcohol consumption. The results corroborate previous findings of increased total choline in heavy drinking subjects. A negative association of Glu levels with severity of alcohol dependence and especially loss of control over time and amount of alcohol intake was observed. In contrast to the rather unspecific rise in choline-containing compounds, low Glu in frontal WM may be specific for the shift from nondependent heavy drinking to dependence and does not reflect a simple effect of the amount of alcohol consumption alone.
    Alcoholism Clinical and Experimental Research 06/2013; 37. DOI:10.1111/acer.12149 · 3.31 Impact Factor
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    • "The overall low level of clinical impairment in this 1 - month - abstinent ALC sample was encouraging , as better performance on select domains of functioning during early abstinence was related to better treatment outcome in several studies ( Bates et al . , 2006 ; Cunha and Novaes , 2004 ; Durazzo et al . , 2008a ; Tapert et al . , 2004 ) . Our findings highlight the clinical salience of also providing scores in research reports , when possible , that are based on the appro - priate normative data to determine the participants ' level of ability . The ALC sample overall demonstrated a low fre -"
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    ABSTRACT: BACKGROUND: Increasing age and chronic cigarette smoking are independently associated with adverse effects on multiple aspects of neurocognition in those seeking treatment for alcohol use disorders. However, the potential interactive effects of age and cigarette smoking on neurocognition in early abstinent alcohol-dependent individuals (ALC) have not investigated. METHODS: Cross-sectional performances of never-smoking healthy comparison participants (nvsCOM; n = 39) and 1-month-abstinent, treatment-seeking, never-smoking (nvsALC; n = 30), former-smoking (fsALC; n = 21), and actively smoking (asALC; n = 68) ALC were compared on a comprehensive neurocognitive battery. Domains of functioning evaluated were cognitive efficiency, executive functions, fine motor skills, general intelligence, learning and memory, processing speed, visuospatial functions and working memory. Participants were between 26 and 71 years of age at the time of assessment. RESULTS: asALC showed steeper age-related effects than nvsCOM on the domains of visuospatial learning, auditory-verbal memory, cognitive efficiency, executive functions, processing speed, and fine motor skills. In pairwise comparisons, fsALC and asALC performed more poorly than both nvsCOM and nvsALC on multiple domains; nvsCOM and nvsALC showed no significant differences. Domain scores for the ALC groups generally fell in the low-to-high-average range of functioning. A clinically significant level of impairment was apparent in only 25% of ALC participants on visuospatial learning, visuospatial memory, and fine motor skills domains. Measures of alcohol use or consumption were not significantly related to neurocognition in the ALC cohorts. CONCLUSIONS: The age-related findings suggest that the combination of active chronic smoking and alcohol dependence in this 1-month-abstinent ALC cohort was associated with greater than normal age-related effects in multiple domains. In general, a low level of clinically significant impairment was observed in the alcohol-dependent participants. The findings from this study, in conjunction with previous research, strongly support smoking cessation interventions for those seeking treatment for alcohol and substance use disorders.
    Alcoholism Clinical and Experimental Research 05/2013; 37. DOI:10.1111/acer.12140 · 3.31 Impact Factor
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