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


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 treatment of alcohol dependence includes several types of therapy such as motivational enhancement therapy, 12-step facilitation, or cognitive behavioral therapy, which all require attending to and receiving new information, and being able to integrate and translate it into behavioral changes (Bates et al., 2006). To benefit from these therapies, ALs must implement cognitive functions such as episodic memory, planning, inhibition, and problem-solving abilities, which have been repeatedly found as impaired. "

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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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    • "Wernicke–Korsakoff neuropathology is often undiagnosed during life (Harper, 1983), which may result in deteriorating cognition among alcohol-dependent populations. As many as 50–80% of patients presenting to alcohol treatment services may show signs of cognitive impairment (Bates et al., 2002), which disrupts treatment engagement and prognosis (Bowden et al., 2001; Bates et al., 2006). Modifications to existing addiction treatment programmes have been suggested in order to improve engagement and patient outcomes (Bates et al., 2002). "
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