Neurocognitive Performance Among Alcohol Dependent Men With and Without Physical Violence Toward Their Partners: A Preliminary Report

Executive functioning in antisocial behavior: A multi-level systematic meta-analysis

Neurobiological information - including executive functioning - is increasingly relevant for forensic clinical practice, as well as for the criminal justice system. Previous meta-analyses report that antisocial populations show impaired performance on executive functioning tasks, but these meta-analyses are outdated, have limitations in their methodological approach, and are therefore in need of an update. The current multi-level meta-analysis including 133 studies (2008-2023) confirms impaired performance in executive functioning (d=.42), but studies are heterogeneous. Several moderator analyses showed that neuropsychological test used, type of executive function component, and control group characteristics moderated the overall effect. Specifically, matching psychiatric problems in the non-antisocial control group eliminated any differences in executive functioning between groups. No moderation effects were found for assessment quality, hot or cold executive functions, and various population characteristics. These results could indicate that the assessment of executive functioning in antisocial populations may be less relevant for recidivism risk assessment than thought, although this should first be assessed in prospective longitudinal studies. Executive functioning could potentially be used to identify or screen for individuals with certain treatment needs or be used as a responsivity factor, especially in disorders which are often underdiagnosed in criminal justice settings.

Participants in Court-mandated Intervention Programs for Intimate Partner Violence Perpetrators with Substance Use Problems: A Systematic Review of Specific Risk Factors

Men with alcohol and/or other drug use problems (ADUPs) court-mandated to attend intervention programs for intimate partner violence (IPV) perpetrators have been identified as a high-risk, highly resistant group of IPV perpetrators, as they present lower treatment adherence and higher dropout and recidivism rates. Previous research suggests that IPV perpetrators with ADUPs may require tailored interventions to address their specific risk factors. The present systematic review was conducted using PRISMA guidelines to identify the specific risk factors in men with and without ADUPs on entry to court-mandated perpetrator programs. The following databases were searched from inception to November 2021: Web of Science, PsycINFO, and Scopus. There was a screening of 3,995 records, and 29 quantitative studies were included in the review. Risk factors present in males court-mandated to perpetrator programs were grouped into four categories: sociodemographic risk factors, personality disorders and psychological adjustment, social-relational risk factors, and risk factors related to attitudes towards women. Results indicated that the main risk factors in IPV perpetrators with ADUPs, compared to those without, were higher clinical symptomatology (e.g., anger and impulsivity), personality disorders, poorer executive functions, having experienced more stressful life events, higher exposure to childhood trauma, lower intimate social support, and higher responsibility attributed to the offenders' personal context. These results contribute to a deeper understanding of the complex phenomenon of IPV and ADUPs, and could help to inform key targets for perpetrator programs that may improve the well-being of their (ex)partners and increase the effectiveness of intervention programs for IPV perpetrators.

Neuropsychological Performance, Substance Misuse, and Recidivism in Intimate Partner Violence Perpetrators

Previous research has pointed out the importance of neuropsychological impairments in intimate partner violence (IPV) perpetrators for reoffending/recidivism once treatment ends. However, less is known about whether substance misuse is associated with impairments or deficits, which facilitate recidivism. In this study, we first aimed to assess whether IPV perpetrators with (n = 104) and without (n = 120) substance misuse showed differences in specific neuropsychological variables in comparison with non-violent men (n = 82). Second, we examined whether there were differences in IPV perpetrators' recidivism and whether these differences were explained by neuropsychological performance. Our results revealed that IPV perpetrators with substance misuse showed worse cognitive performance than controls. Furthermore, we also found differences between IPV perpetrators without substance misuse and controls, but only in terms of executive functioning. There were no differences in neuropsychological performance between the two groups of IPV perpetrators, although those with substance misuse presented higher recidivism rates than those without substance misuse. Finally, cognitive flexibility, verbal fluency, and worse attention functioning were related to high recidivism in both groups of IPV perpetrators. This study underlies the importance of performing neuropsychological assessments during the initial stages of intervention programs for IPV perpetrators in order to design coadjutant neuropsychological/cognitive training to address not only the psychological needs (including substance misuse) of IPV perpetrators, but also their neuropsychological needs.

Personality disorders as predictors of intimate partner violence: A meta-analysis

Despite years of research demonstrating a relation between personality pathology and intimate partner violence (IPV), no meta-analysis has been published examining how well, or poorly, all ten personality disorders (PDs) predict IPV perpetration or victimization, nor has any meta-analysis examined these relations across types of IPV. Therefore, the present study was undertaken to synthesize existing research on the effects of all ten PDs, as well as psychopathy and global PD symptoms, on physical, psychological, and sexual IPV perpetration and victimization. An initial search in PsycINFO, PubMed, and Sociological Abstracts yielded 3988 results. After duplicate and irrelevant articles were removed, 163 studies were included in the analysis, representing 189 individual samples. Analysis was conducted in R using the metafor package. Main effects analyses indicate that PDs were significantly and positively related to IPV perpetration. Results were more mixed for IPV victimization. Antisocial and borderline PDs demonstrated the most robust effect sizes across both perpetration and victimization. Moderator analyses suggested that with few exceptions, main effects were consistent across a number of sample and study characteristics. Findings may help to inform prevention and intervention efforts in clinical settings.

Strengthening the Connection Between Acquired Brain Injury (ABI) and Family Violence: The Importance of Ongoing Monitoring, Research and Inclusive Terminology

Family violence (FV) harms communities worldwide so FV prevention strategies and effective responses are urgently needed. This article reports on FV apparent in a study which explored the experiences of people with both ABI and justice system encounters in Victoria, Australia. One hundred interviews and one focus group consulted people with ABI, their families and carers, and various stakeholder groups in the Victorian justice system in Australia. Qualitative content analysis determined dominant themes and sub-themes and the less common themes. Inductive interpretive content analysis identified themes commonly found in previous published research and themes that appeared unique to, or unanticipated in, our data, such as the FV theme upon which this article focuses. Our findings reveal that FV has adversely affected many people with ABI who came into contact with Victoria's justice system. Further, as ABI and FV often co-occur with substance abuse, mental health problems, socio-economic and many other significant disadvantages, for some FV perpetrators with an ABI, their ABI symptoms and characteristic co-morbidities may be a mitigating factor in their offending. The connection between ABI and family violence emerged as a troubling research theme. Indeed, the impact of FV on too many of our participants with an ABI compels us to call for further related research and secondary prevention programs targeted at FV victims, and offenders, living with ABI. An intersectional understanding of family violence and TBI/ABI in social ecological contexts is required to better understand brain injury at both individual and population levels.

Altered neural dynamics in occipital cortices serving visual-spatial processing in heavy alcohol users

BACKGROUND

Visual-spatial processing deficits have been previously linked to heavy alcohol use, but the underlying neurological mechanisms are poorly understood. Neuroimaging studies have shown alcohol-related aberrations in occipital cortices that appear to be associated with these neuropsychological deficits in visual-spatial processing, however the neural dynamics underlying this altered processing remains unknown.

METHODS

Twenty-three adults with high scores on the Alcohol Use Disorders Identification Test - Consumption (male: ⩾5, female: ⩾4) were compared to 30 demographically-matched controls with low Alcohol Use Disorders Identification Test - Consumption scores (⩽2). All participants completed a visual-spatial processing task while undergoing high-density magnetoencephalography. Time-frequency windows of interest were determined using a data-driven method, and spectrally-specific neural activity was imaged using a beamforming approach. Permutation testing of peak voxel time series was then used to statistically compare across groups.

RESULTS

Participants with heavy alcohol use responded slower on the task and their performance was more variable. The magnetoencephalography data indicated strong theta (4-8 Hz), alpha (10-16 Hz), and gamma (62-72 Hz) responses in posterior brain regions across both groups. Following voxel time-series extraction, significant group differences were found in the left and right visual association cortices from about 375-550 ms post-stimulus, such that adults with heavy alcohol use had blunted alpha responses compared to controls.

CONCLUSION

Individuals with heavy alcohol use exhibited aberrant occipital alpha activity during visual-spatial processing. These data are the first to show spectrally-specific differences during visual-spatial processing related to heavy alcohol use, and highlight alcohol's effect on systems-level neural activity.

Lower Prefrontal and Hippocampal Volume and Diffusion Tensor Imaging Differences Reflect Structural and Functional Abnormalities in Abstinent Individuals with Alcohol Use Disorder

BACKGROUND

Alcohol use disorder (AUD) is known to have adverse effects on brain structure and function. Multimodal assessments investigating volumetric, diffusion, and cognitive characteristics may facilitate understanding of the consequences of long-term alcohol use on brain circuitry, their structural impairment patterns, and their impact on cognitive function in AUD.

METHODS

Voxel- and surface-based volumetric estimations, diffusion tensor imaging (DTI), and neuropsychological tests were performed on 60 individuals: 30 abstinent individuals with AUD (DSM-IV) and 30 healthy controls. Group differences in the volumes of cortical and subcortical regions, fractional anisotropy (FA), axial and radial diffusivities (AD and RD, respectively), and performance on neuropsychological tests were analyzed, and the relationship among significantly different measures was assessed using canonical correlation.

RESULTS

AUD participants had significantly smaller volumes in left pars orbitalis, right medial orbitofrontal, right caudal middle frontal, and bilateral hippocampal regions, lower FA in 9 white matter (WM) regions, and higher FA in left thalamus, compared to controls. In AUD, lower FA in 6 of 9 WM regions was due to higher RD and due to lower AD in the left external capsule. AUD participants scored lower on problem-solving ability, visuospatial memory span, and working memory. Positive correlations of prefrontal cortical, left hippocampal volumes, and FA in 4 WM regions with visuospatial memory performance and negative correlation with lower problem-solving ability were observed. Significant positive correlation between age and FA was observed in bilateral putamen.

CONCLUSIONS

Findings showed specific structural brain abnormalities to be associated with visuospatial memory and problem-solving ability-related impairments observed in AUD. Higher RD in 6 WM regions suggests demyelination, and lower AD in left external capsule suggests axonal loss in AUD. The positive correlation between FA and age in bilateral putamen may reflect accumulation of iron depositions with increasing age.

Alcohol, Self-Regulation and Partner Physical Aggression: Actor-Partner Effects Over a Three-Year Time Frame

The question of how individual differences related to self-regulation interact with alcohol use patterns to predict intimate partner aggression (IPA) is examined. We hypothesized that excessive drinking will be related to partner aggression among those who have low self-regulation. In addition, we explored the extent to which differences in self-regulation in one partner may moderate the relationship between alcohol use and partner aggression. A sample of married or cohabitating community couples (N = 280) ages 18–45 was recruited according to their classification into four drinking groups: heavy drinking in both partners (n = 79), husband only (n = 80), wife only (n = 41), by neither (n = 80), and interviewed annually for 3 years. IPA, drinking, and scores on measures of negative affect, self-control, and Executive Cognitive Functioning (ECF) were assessed for both members of the couple. The Actor Partner Interdependence Model (APIM) was used to analyze longitudinal models predicting the occurrence of IPA from baseline alcohol use, negative affect, self-control and ECF. Actor self-control interacted with partner self-control such that IPA was most probable when both were low in self-control. Contrary to prediction, actors high in alcohol use and also high on self-control were more likely to engage in IPA. Partner alcohol use was predictive of actor IPA when the partner was also high in negative affect. Low partner ECF was associated with more actor IPA. These findings suggest that self-regulatory factors within both members of a couple can interact with alcohol use patterns to increase the risk for relationship aggression.

Synergistic Effects of Depression and Poor Impulse Control on Physical Partner Violence; A National Study in United States

Background

Although major depressive disorder (MDD) also increases the risk of Intimate Partner Violence (IPV) perpetration, poor mental health has been mostly conceptualized as a consequence of IPV victimization rather than a risk factor for IPV perpetration. Poor impulse control is another IPV risk factor. Building on a risk / risk framework, this study investigates additive and multiplicative effects of male partners' MDD and poor impulse control on physical IPV victimization reported by female partner.

Methods

This national longitudinal study followed a random sample of 2,500 male and female cohabiting partners for two years in United States. Data came from the Fragile Families and Child Wellbeing Study (FFCWS). Male partner's MDD was the independent variable. Baseline socio-demographic factors (age, relation status, education level, income, and minority status) and Generalized Anxiety Disorder (GAD), and Alcohol Use Disorder (AUD) were covariates. Outcome was female partner's physical IPV victimization measured at baseline and two years later. Male partner's impulse control was the moderator. Model I tested independent effects of MDD and impulse control on physical IPV. Model II used multi-group structural equation model to test the effect of MDD in those with low and poor impulse control. All participants provided written consent and SPSS and AMOS were used for data analysis.

Results

In Model 1 that tested additive effects of SES, GAD, AUD, MDD, and poor impulse control did not show main effects of MDD or impulse control on an increase in perpetration of physical IPV over two years. Model 2 showed that MDD predicts an increase in perpetration of physical IPV of men with poor impulse control, but not men with high impulse control.

Conclusion

Based on the findings, poor impulse control and MDD have synergistic effects on IPV committed by men. Given the synergistic effects of psychological determinants of IPV, there is a need for prevention of IPV in male partners who have multiple risk factors such as MDD and poor impulse control. Self-regulation trainings of depressed men with poor impulse control may reduce IPV risk among men.

Improvements in Empathy and Cognitive Flexibility after Court-Mandated Intervention Program in Intimate Partner Violence Perpetrators: The Role of Alcohol Abuse

Research assessing the effectiveness of intervention programs for intimate partner violence (IPV) perpetrators has increased considerably in recent years. However, most of it has been focused on the analysis of psychological domains, neglecting neuropsychological variables and the effects of alcohol consumption on these variables. This study evaluated potential neuropsychological changes (emotional decoding, perspective taking, emotional empathy and cognitive flexibility) and their relationship with alcohol consumption in a mandatory intervention program for IPV perpetrators, as well as how these variables affect the risk of IPV recidivism. The sample was composed of 116 individuals with high alcohol (n = 55; HA) and low alcohol (n = 61; LA) consumption according to self-report screening measures who received treatment in a IPV perpetrator intervention program developed in Valencia (Spain). IPV perpetrators with HA consumption were less accurate in decoding emotional facial signals and adopting others' perspective, and less cognitively flexible than those with LA consumption before the IPV intervention. Further, the effectiveness of the intervention program was demonstrated, with increases being observed in cognitive empathy (emotional decoding and perspective taking) and in cognitive flexibility. Nevertheless, the HA group showed a smaller improvement in these skills and higher risk of IPV recidivism than the LA group. Moreover, improvement in these skills was related to a lower risk of IPV recidivism. The study provides guidance on the targeting of cognitive domains, which are key factors for reducing IPV recidivism.

Delta, theta, and alpha event-related oscillations in alcoholics during Go/NoGo task: Neurocognitive deficits in execution, inhibition, and attention processing

Higher impulsivity observed in alcoholics is thought to be due to neurocognitive functional deficits involving impaired inhibition in several brain regions and/or neuronal circuits. Event-related oscillations (EROs) offer time-frequency measure of brain rhythms during perceptual and cognitive processing, which provide a detailed view of neuroelectric oscillatory responses to external/internal events. The present study examines evoked power (temporally locked to events) of oscillatory brain signals in alcoholics during an equal probability Go/NoGo task, assessing their functional relevance in execution and inhibition of a motor response. The current study hypothesized that increases in the power of slow frequency bands and their topographical distribution is associated with tasks that have increased cognitive demands, such as the execution and inhibition of a motor response. Therefore, it is hypothesized that alcoholics would show lower spectral power in their topographical densities compared to controls. The sample consisted of 20 right-handed abstinent alcoholic males and 20 age and gender-matched healthy controls. Evoked delta (1.0-3.5Hz; 200-600ms), theta (4.0-7.5Hz; 200-400ms), slow alpha (8.0-9.5Hz; 200-300ms), and fast alpha (10.0-12.5Hz; 100-200ms) ERO power were compared across group and task conditions. Compared to controls, alcoholics had higher impulsiveness scores on the Barrett Impulsiveness Scale (BIS-11) and made more errors on Go trials. Alcoholics showed significantly lower evoked delta, theta, and slow alpha power compared to controls for both Go and NoGo task conditions, and lower evoked fast alpha power compared to controls for only the NoGo condition. The results confirm previous findings and are suggestive of neurocognitive deficits while executing and suppressing a motor response. Based on findings in the alpha frequency ranges, it is further suggested that the inhibitory processing impairments in alcoholics may arise from inadequate early attentional processing with respect to the stimulus related aspects/semantic memory processes, which may be reflected in lower posterio-temporal evoked fast alpha power. It can thus be concluded that alcoholics show neurocognitive deficits in both execution and suppression of a motor response and inadequate early attentional processing with respect to the semantic memory/stimulus related aspects while suppressing a motor response.

Deficits in behavioural inhibition in substance abuse and addiction: a meta-analysis

AIMS

Deficits in behavioural inhibitory control are attracting increasing attention as a factor behind the development and maintenance of substance dependence. However, evidence for such a deficit is varied in the literature. Here, we synthesised published results to determine whether inhibitory ability is reliably impaired in substance users compared to controls.

METHODS

The meta-analysis used fixed-effects models to integrate results from 97 studies that compared groups with heavy substance use or addiction-like behaviours with healthy control participants on two experimental paradigms commonly used to assess response inhibition: the Go/NoGo task, and the Stop-Signal Task (SST). The primary measures of interest were commission errors to NoGo stimuli and stop-signal reaction time in the SST. Additionally, we examined omission errors to Go stimuli, and reaction time in both tasks. Because inhibition is more difficult when inhibition is required infrequently, we considered papers with rare and equiprobable NoGo stimuli separately.

RESULTS

Inhibitory deficits were apparent for heavy use/dependence on cocaine, MDMA, methamphetamine, tobacco, and alcohol (and, to a lesser extent, non-dependent heavy drinkers), and in pathological gamblers. On the other hand, no evidence for an inhibitory deficit was observed for opioids or cannabis, and contradictory evidence was observed for internet addiction.

CONCLUSIONS

The results are generally consistent with the view that substance use disorders and addiction-like behavioural disorders are associated with impairments in inhibitory control. Implications for treatment of substance use are discussed, along with suggestions for future research arising from the limitations of the extant literature.

The contribution of childhood parental rejection and early androgen exposure to impairments in socio-cognitive skills in intimate partner violence perpetrators with high alcohol consumption

Alcohol consumption, a larger history of childhood parental rejection, and high prenatal androgen exposure have been linked with facilitation and high risk of recidivism in intimate partner violence (IPV) perpetrators. Participants were distributed into two groups according to their alcohol consumption scores as high (HA) and low (LA). HA presented a higher history of childhood parental rejection, prenatal masculinization (smaller 2D:4D ratio), and violence-related scores than LA IPV perpetrators. Nonetheless, the former showed poor socio-cognitive skills performance (cognitive flexibility, emotional recognition and cognitive empathy). Particularly in HA IPV perpetrators, the history of childhood parental rejection was associated with high hostile sexism and low cognitive empathy. Moreover, a masculinized 2D:4D ratio was associated with high anger expression and low cognitive empathy. Parental rejection during childhood and early androgen exposure are relevant factors for the development of violence and the lack of adequate empathy in adulthood. Furthermore, alcohol abuse plays a key role in the development of socio-cognitive impairments and in the proneness to violence and its recidivism. These findings contribute to new coadjutant violence intervention programs, focused on the rehabilitation of basic executive functions and emotional decoding processes and on the treatment of alcohol dependence.

Parenting of men with co-occurring intimate partner violence and substance abuse

No studies to date have compared parenting behaviors of men with co-occurring intimate partner violence (IPV) and substance abuse (SA) with community controls. This study was designed to document mediators of differences in parenting behavior of fathers and the emotional-behavioral problems of their children for men with co-occurring SA and IPV. The self-reported parenting (negative, positive and coparenting behaviors) and the child emotional-behavioral problems of 43 fathers with children aged 2 to 6 years with a recent history of SA + IPV were compared to a sample of 43 community control fathers with the same socioeconomic and cultural backgrounds. Fathers completed measures on their parenting behavior with a target child, coparenting behavior with the child's mother, emotion regulation, romantic attachment, psychiatric symptoms, and the behavior of the target child. Men with co-occurring SA + IPV had significantly less positive coparenting and more negative parenting behaviors than community control fathers. Negative parenting and coparenting were mediated by the fathers' avoidant attachment problems. SA + IPV fathers also reported more emotional and behavioral problems in their children. These poor child outcome differences between groups were mediated by the negative parenting behaviors of the fathers. These results suggest areas of potential focus in interventions with fathers who have co-occurring SA + IPV issues. Focus on attachment difficulties with his coparent, which may include affect regulation, coping with emotions, and communication skills training related to coparenting, may yield significant changes in parenting behaviors and ultimately child functioning.

Self-regulation, daily drinking, and partner violence in alcohol treatment-seeking men

This study builds on research identifying deficits in behavioral self-regulation as risk factors for intimate partner violence (IPV). It also builds on alcohol administration research identifying these deficits as moderators of the association between acute alcohol consumption and aggression in laboratory paradigms. Participants analyzed were 97 men seeking residential treatment for alcohol dependence who were involved in a current or recent heterosexual relationship of at least 1 year. Participants completed a self-report measure of impulsivity, neuropsychological tests of executive function, and computerized delay discounting and behavioral inhibition tasks. With the exception of the self-report measure of impulsivity, performance on measures of behavioral self-regulation was not associated with the occurrence or frequency of past year IPV in this sample. Similarly, self-reported impulsivity moderated the association between daily drinking and IPV in multivariate models controlling for daily drug use, but deficits in performance on other measures did not. Performance on a tower task moderated the association between daily drinking and the occurrence of IPV, but contrary to hypotheses, better task performance was associated with greater likelihood of IPV on drinking days. These results suggest that self-perceived impulsivity is a better predictor of IPV in alcohol treatment seeking men than deficits in performance on behavioral measures of delay discounting, behavioral inhibition, and executive function.

Informed Consent: An Ethical Issue in Conducting Research with Male Partner Violent Offenders

Ethical codes help guide the methods of research that involve samples gathered from "at-risk" populations. The current paper reviews general as well as specific ethical principles related to gathering informed consent from partner violent offenders mandated to outpatient treatment, a group that may be at increased risk of unintentional coercion in behavioral sciences research due to court-mandates that require outpatient treatment without the ethical protections imbued upon prison populations. Recommendations are advanced to improve the process of informed consent within this special population and data supporting the utility of the recommendations in a sample 70 partner violent offenders are provided. Data demonstrate that participants were capable of comprehending all essential elements of consent.

The relationship of intimate partner aggression to head injury, executive functioning, and intelligence

Measures of head injury, executive functioning, and intelligence were given to a community sample composed of 102 male perpetrators of intimate partner aggression (IPA) and 62 nonaggressive men. A history of head injury and lower mean score on a measure of verbal intelligence were associated with the frequency of male-perpetrated physical IPA as reported by male perpetrators and their female partners. Lower mean scores on a measure of verbal intelligence also predicted frequency of psychological IPA perpetration. Using the perpetrator subtypes outlined by Holtzworth-Munroe et al. (2000), analyses revealed that compared with other groups, the most severely aggressive subtypes (i.e., borderline-dysphoric and generally violent-antisocial) were the most likely to report a history of head injury and to have significantly lower mean scores on a neuropsychological test of verbal intelligence. The possible role of neuropsychological factors in IPA perpetration and implications for prevention and intervention programs are discussed.

Affective Awareness in Parenting of Fathers with Co-Occurring Substance Abuse and Intimate Partner Violence

PURPOSE

Few studies have examined the parenting of fathers with co-occurring Substance Abuse (SA) and Intimate Partner Violence (IPV) problems. None have specifically interviewed men with these co-occurring issues using qualitative methods about their reflective functioning in relation to their children. This qualitative study was designed to provide evidence of the reflective capacity of fathers with co-occurring SA and IPV.

APPROACH

To assess this, men were asked to describe examples of negative emotions they experienced as parents and how they perceived their children responded to those emotions. Forty fathers with co-occurring SA and IPV were interviewed using the Revised Parent Development Interview. Interviews were coded for reflective functioning and for themes that emerged related to angry and guilty feelings these fathers experienced as parents.

FINDINGS

Overall, fathers in the sample had a very limited capacity to think about the thoughts and feelings of their children. The desire to spend more time with their child and an inability to provide financially were two common themes. Anger toward the child's mother for not providing adequate care and a focus on shielding the child from his anger were also reported frequently. Fathers did not report feelings of guilt related to their substance use or aggression in their relationships.

ORIGINALITY

This paper is one of the first to explore reflective functioning of fathers with co-occurring IPV and SA. These findings are discussed in relation to their implications for intervention with fathers with co-occurring SA and IPV issues.

Widespread and sustained cognitive deficits in alcoholism: a meta-analysis

The cognitive repercussions of alcohol dependence are well documented. However, the literature remains somewhat ambiguous with respect to which distinct cognitive functions are more susceptible to impairment in alcoholism and to how duration of abstinence affects cognitive recovery. Some theories claim alcohol negatively affects specific cognitive functions, while others assert that deficits are more diffuse in nature. This is the first meta-analysis to examine cognition in alcohol abuse/dependence and the duration of abstinence necessary to achieve cognitive recovery. A literature search yielded 62 studies that assessed cognitive dysfunction among alcoholics. Effect size estimates were calculated using the Comprehensive Meta-Analysis V2, for the following 12 cognitive domains: intelligence quotient, verbal fluency/language, speed of processing, working memory, attention, problem solving/executive functions, inhibition/impulsivity, verbal learning, verbal memory, visual learning, visual memory and visuospatial abilities. Within these 12 domains, three effect size estimates were calculated based on abstinence duration. The three groups were partitioned into short- (< 1 month), intermediate- (2 to 12 months) and long- (> 1 year) term abstinence. Findings revealed moderate impairment across 11 cognitive domains during short-term abstinence, with moderate impairment across 10 domains during intermediate term abstinence. Small effect size estimates were found for long-term abstinence. These results suggest significant impairment across multiple cognitive functions remains stable during the first year of abstinence from alcohol. Generally, dysfunction abates by 1 year of sobriety. These findings support the diffuse brain hypothesis and suggest that cognitive dysfunction may linger for up to an average of 1 year post-detoxification from alcohol.

Glutamatergic hyperfunctioning during alcohol withdrawal syndrome: therapeutic perspective with zinc and magnesium

It is known that the glutamatergic pathways are hyperfunctioning during alcohol withdrawal syndrome. It has been demonstrated that hyperfunctioning of this system causes a great damage to the superior cortical activity, the ability to concentrate and the control of impulses. Recent studies show that the cations zinc and magnesium modulate the glutamatergic function, reducing it to non-toxic levels, yet not reducing it to the point of depriving this neurotransmitter of its normal activity. New perspectives of treatment focus on the modulation of this system, having, as a result, reestablishment of impulse control abilities, damage prevention to the hippocampus and the amygdala and prevention of future relapses.

Recent research on impulsivity in individuals with drug use and mental health disorders: implications for alcoholism

Alcohol misuse and dependence, and many of its accompanying psychological problems, are associated with heightened levels of impulsivity that both accelerate the development of clinically significant illness and complicate clinical outcome. This article reviews recent developments in our understanding of impulsivity as they relate to brain circuitry that might underlie these comorbid factors, focusing upon the clinical features of substance use (and dependence), bipolar disorder, and pathological gambling. Individuals who are affected by these disorders exhibit problems in several domains of impulsive behavior including deficient response or "motor" control, and the tolerance of prolonged delays prior to larger rewards at the expense of smaller rewards ("delay-discounting"). These populations, like alcoholic dependents, also exhibit impairments in risky decision-making that may reflect dysfunction of monoamine and catecholamine pathways. However, several areas of uncertainty exist including the specificity of impairments across disorders and the relationship between impulse control problems and altered evaluation of reward outcomes underlying observed impairments in action selection.

Behavioral measures of impulsivity and the law

The General Theory of Crime proposes that crime is explained by the combination of situational opportunity and lack of self-control. Impulsivity is one of the important components of self-control. Because behavioral measures of impulsivity are becoming more commonly utilized to assess forensic populations, this manuscript provides an overview of three current behavioral measures. In doing so, an example of their application is provided using a group of individuals likely to come into contact with the legal system: adolescents with Conduct Disorder. Earlier age of onset of Conduct Disorder symptoms has been shown to be an important predictor of the persistence of poor outcomes into adulthood, including participation in criminal activities. This study found differential behavioral profiles across distinct measures of impulsivity by those with childhood- versus adolescent-onset Conduct Disorder. Legal implications for defining behavioral deficits using behavioral measures of impulsivity and their current limitations are discussed.