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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