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Manning V, Teo HC, Guo S, Wong KE, Li TK. Neurocognitive Functioning and Treatment Outcome Following Detoxification Among Asian Alcohol-Dependent Inpatients. Subst Use Misuse 2016; 51:193-205. [PMID: 26771240 DOI: 10.3109/10826084.2015.1092985] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The prevalence of alcohol use disorders in Asia is increasing and relapse among treated populations remains the norm, not the exception. The extent to which cognitive impairment influences clinical outcome remains unclear, with research dominated by studies of Caucasian populations. OBJECTIVES This study examines behavioral and self-reported cognitive functioning in detoxified alcohol-dependent (AD) patients in Singapore and its association with outcome. METHODS The cognitive performance of 30 recently-detoxified AD inpatients and 30 demographically-matched controls was compared using visuospatial memory, working memory, set-shifting, planning and reflection impulsivity tests of the CANTAB®, and self-reported dysexecutive symptoms and everyday cognitive difficulties. Patients' alcohol use and self-reported cognitive functioning were reassessed 3-months post-discharge. RESULTS Compared to matched controls, AD inpatients exhibited significantly poorer fluid intelligence, visuospatial memory, working memory, set-shifting flexibility and planning/organization, but not reflection impulsivity. In support of Western studies, a significant proportion (three-quarters) were "clinically impaired" on subtests. Significant reductions were observed in alcohol units, frequency and dependency scores at follow-up, though improvements in self-reported cognitive functioning were limited to abstainers. Baseline cognitive performance did not differentiate those who had abstained from alcohol and relapsed at follow-up. CONCLUSIONS/IMPORTANCE Memory and executive functioning impairments were evident among Asian AD patients alongside self-reported cognitive difficulties, thus cognitively demanding psychological interventions may have limited impact during early detoxification. Future studies can build on these findings, with larger samples and measurement of moderating and mediating factors to extend our understanding of how cognitive impairment influences outcome.
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Affiliation(s)
- Victoria Manning
- a Institute of Mental Health, National Addictions Management Service , Singapore , Singapore.,b Turning Point, Eastern Health , Melbourne , Australia.,c Eastern Health Clinical School , Monash University , Melbourne , Australia
| | - Hui Chin Teo
- a Institute of Mental Health, National Addictions Management Service , Singapore , Singapore
| | - Song Guo
- a Institute of Mental Health, National Addictions Management Service , Singapore , Singapore
| | - Kim Eng Wong
- a Institute of Mental Health, National Addictions Management Service , Singapore , Singapore
| | - Ting-Kai Li
- d Department of Psychiatry , Duke University , Durham , North Carolina , USA
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Adamson SJ, Sellman JD, Frampton CMA. Patient predictors of alcohol treatment outcome: a systematic review. J Subst Abuse Treat 2008; 36:75-86. [PMID: 18657940 DOI: 10.1016/j.jsat.2008.05.007] [Citation(s) in RCA: 240] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Revised: 04/16/2008] [Accepted: 05/05/2008] [Indexed: 01/10/2023]
Abstract
Patient characteristics as predictors of alcohol use disorder treatment outcome were examined on three levels, identifying whether or not variables were significant predictors of drinking-related outcome in univariate analysis, in multivariate analysis, and in multivariate analyses limited to studies including several "key predictors." Also, a model was developed to predict total percentage of variance in treatment outcome accounted for in each study using each of the key predictors and a range of methodological factors. The most consistent univariate predictors were baseline alcohol consumption, dependence severity, employment, gender, psychopathology rating, treatment history, neuropsychological functioning, alcohol-related self-efficacy, motivation, socioeconomic status/income, treatment goal, and religion. When these key predictors were combined into multivariate analyses, baseline alcohol consumption and gender showed substantial reductions in predictive consistency whereas the remaining variables were not greatly affected. The most consistent predictors overall were dependence severity, psychopathology ratings, alcohol-related self-efficacy, motivation, and treatment goal. The two predictor variables most associated with greater variance accounted for in predictive models, when controlling for broader methodological variables, were baseline alcohol consumption and dependence severity. Few predictor variables were examined in more than a third of studies reviewed, and few variables were found to be significant predictors in a clear majority of studies. However, a subset of variables was identified, which collectively could be considered to represent a consistent set of predictors. Too few studies controlled for other important predictor variables. Attempts to synthesize findings were often hampered by lack of agreement of the best measure for predictor variables.
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Affiliation(s)
- Simon J Adamson
- National Addiction Centre (Aotearoa New Zealand), University of Otago, Christchurch, New Zealand
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3
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Bates ME, Pawlak AP, Tonigan JS, Buckman JF. Cognitive impairment influences drinking outcome by altering therapeutic mechanisms of change. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2006; 20:241-53. [PMID: 16938062 PMCID: PMC2965453 DOI: 10.1037/0893-164x.20.3.241] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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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Affiliation(s)
- Marsha E Bates
- Center of Alcohol Studies, Rutgers University, Piscataway, NJ, USA.
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4
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Bates ME, Pawlak AP, Tonigan JS, Buckman JF. Cognitive impairment influences drinking outcome by altering therapeutic mechanisms of change. PSYCHOLOGY OF ADDICTIVE BEHAVIORS : JOURNAL OF THE SOCIETY OF PSYCHOLOGISTS IN ADDICTIVE BEHAVIORS 2006. [PMID: 16938062 DOI: 10.1037/0893–164x.20.3.241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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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Affiliation(s)
- Marsha E Bates
- Center of Alcohol Studies, Rutgers University, Piscataway, NJ, USA.
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5
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Zinn S, Bosworth HB, Edwards CL, Logue PE, Swartzwelder HS. Performance of recently detoxified patients with alcoholism on a neuropsychological screening test. Addict Behav 2003; 28:837-49. [PMID: 12788260 DOI: 10.1016/s0306-4603(02)00258-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Early in recovery from alcoholism, cognitive deficits may compromise patients' utilization of rehabilitative information. Cognitive impairment in a sample of newly detoxified inpatients with alcoholism was examined using the Neurobehavioral Cognitive Status Examination (NCSE). METHODS Consecutively admitted psychiatric inpatients (N=233) with an alcohol-related primary diagnosis (63% male, mean age 46.3) were administered the NCSE following medical stabilization. Within-samples differences between age and diagnostic groups were examined and scores were compared to normative samples. RESULTS Inpatients older than 50 demonstrated significant cognitive deficits for all scales except Attention. In comparison with normative samples, patients with alcoholism produced lower scores, with the most pronounced deficits among middle-aged patients. In alcohol-abusing patients with medical comorbidities, language deficits and more severe memory deficits were observed. Abuse severity or comorbid psychiatric disorder produced no differences in NCSE scores. CONCLUSIONS Neuropsychological screening following detoxification in patients diagnosed with an alcohol disorder reflected the effects of increased age and medical comorbidity. Our finding of frequent deficits in abstraction, comprehension, and memory suggests that cognitive-behavioral treatments for inpatients may be less effective if cognitive impairment is not considered.
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Affiliation(s)
- Sandra Zinn
- Health Services Research and Development, Building 16, Room 55, Durham Veterans Affairs Medical Center (152), 508 Fulton Street, Durham, NC 27705, USA.
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Bates ME, Bowden SC, Barry D. Neurocognitive impairment associated with alcohol use disorders: implications for treatment. Exp Clin Psychopharmacol 2002; 10:193-212. [PMID: 12233981 DOI: 10.1037/1064-1297.10.3.193] [Citation(s) in RCA: 215] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Between 50% and 80% of individuals with alcohol use disorders experience mild to severe neurocognitive impairment. There is a strong clinical rationale that neurocognitive impairment is an important source of individual difference affecting many aspects of addiction treatment, but empirical tests of the direct influence of impairment on treatment outcome have yielded weak and inconsistent results. The authors address the schism between applied-theoretical perspectives and research evidence by suggesting alternative conceptual models of the relationship between neurocognitive impairment and addiction treatment outcome. Methods to promote neurocognitive recovery and ways in which addiction treatments may be modified to improve psychosocial adaptation are suggested. Specific suggestions for future research that may help clarify the complex relations between neurocognitive impairment and addiction treatment are outlined.
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Affiliation(s)
- Marsha E Bates
- Center of Alcohol Studies, Rutgers University, Piscataway, New Jersey 08854-8001, USA.
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7
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Wicks S, Hammar J, Heilig M, Wisén O. Factors Affecting the Short-Term Prognosis of Alcohol Dependent Patients Undergoing Inpatient Detoxification. Subst Abus 2001; 22:235-245. [PMID: 12466683 DOI: 10.1080/08897070109511465] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Stable measures of psychological functioning require a considerable period of abstinence. However, the duration of inpatient detoxification programs has decreased dramatically in most health care systems, posing a novel challenge for clinical evaluation of patients. The present study was carried out to examine whether factors predicting short-term prognosis can be identified in alcohol dependent subjects during early stages of inpatient detoxification. Self-reports of mood states were obtained, and executive cognitive functioning was examined. Outcome was studied at 2-3 months. No correlation was found between self-reported symptoms of depression, hopelessness, and anxiety, and percentage of nondrinking days. A significant positive correlation was found between Wisconsin Card Sorting Test (WCST) performance and short-term prognosis measured by this parameter. Thus, in addition to transient withdrawal-related effects, impairments of WCST performance in early stages of alcohol detoxification may reflect more long standing deficits in problem-solving strategies, of possible relevance for matching patients to treatment services.
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Affiliation(s)
- S. Wicks
- Addiction Centre South, Huddinge University Hospital, Huddinge, Sweden.
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Wölwer W, Burtscheidt W, Redner C, Schwarz R, Gaebel W. Out-patient behaviour therapy in alcoholism: impact of personality disorders and cognitive impairments. Acta Psychiatr Scand 2001; 103:30-7. [PMID: 11202126 DOI: 10.1034/j.1600-0447.2001.00149.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We investigated whether alcoholic patients with comorbid personality disorders and those with cognitive impairments would benefit in a different way from different behaviour therapy strategies. METHOD After detoxification, 120 alcoholics were assigned randomly to one of three out-patient treatment programmes comprising 'coping skills training', 'cognitive behaviour therapy' or unspecific supportive control therapy. Personality disorders and cognitive impairments were assessed at the beginning of the 6-month treatment period. RESULTS The impact of concomitant personality disorders or cognitive impairments was generally only moderate and mainly independent from treatment condition. However, alcoholic patients relapsing within 6 months after detoxification showed a higher rate of personality disorders (especially antisocial and borderline) and slightly more cognitive deficits (especially in verbal memory and visuomotor functions) than abstainers even before therapy. CONCLUSION The high amount of early relapses and drop-outs probably hindered larger differentiated treatment effects. Hypotheses will be retested in treatment completers using forthcoming follow-up data.
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Affiliation(s)
- W Wölwer
- Department of Psychiatry, Heinrich Heine University, Duesseldorf, Germany
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9
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Abstract
BACKGROUND P3a amplitude differences between alcoholic and control groups have not been well defined. Because event-related potential (ERP) differences between these groups appear to be influenced by task difficulty, the present study employed a new auditory ERP paradigm, in which target/standard tone discriminability was difficult, with infrequent nontarget stimuli used to elicit the P3a. METHODS A total of n = 27 male alcoholics and n = 25 male controls were assessed using a three-tone discrimination paradigm, in which the discriminability between the target and standard was difficult, with easily discriminable infrequent nontarget tones also presented. A P3a component with a centro-frontal maximum to the rare nontargets and a P3b with a parietal maximum amplitude to the target stimulus were obtained. Current Source Density (CSD) maps were derived from the potential data and employed to assay topographical differences between subject groups. RESULTS Alcoholics produced smaller P3a amplitudes than control subjects to the rare nontargets with no peak latency differences observed. The most prominent current sources are apparent more anteriorly for the nontarget compared to the target stimulus in both groups. There were more sources and sinks in the alcoholics than in the control subjects for P3a. A bootstrap analysis method showed that P3a CSD maps evinced distinct topographic distributions between alcoholics and control subjects in all brain regions. CONCLUSIONS The lower P3a amplitude and weaker sources in alcoholics coupled with less topographic specificity in their CSD maps, suggests disorganized inefficient brain functioning. This global electrophysiological pattern suggests cortical disinhibition perhaps reflecting underlying CNS hyperexcitability in alcoholics.
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Affiliation(s)
- M Hada
- Department of Neuropsychiatry, Nippon Medical School, (MH), Tokyo, Japan
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10
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Wehr A, Bauer LO. Verbal ability predicts abstinence from drugs and alcohol in a residential treatment population. Psychol Rep 1999; 84:1354-60. [PMID: 10477951 DOI: 10.2466/pr0.1999.84.3c.1354] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Measures of cognitive ability, depression, anxiety, antisocial personality, as well as length, type and severity of addiction were obtained from 122 substance abusers enrolled in residential treatment programs. Over a subsequent 6-mo. monitoring period, relapse to substance use was detected in 46 subjects. 17 subjects withdrew from treatment for other reasons and their relapse status was unknown. The remaining 59 maintained abstinence from alcohol or drug use throughout the monitoring period. The only variables to differentiate the groups significantly on outcome were IQ and the Verbal subtest from the Shipley Institute of Living Scale. Stepwise discriminant function analysis indicated that the Verbal component alone correctly identified 64.4% of patients who would successfully remain abstinent.
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Affiliation(s)
- A Wehr
- University of Connecticut School of Medicine, USA
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11
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WEHR ALLISON. VERBAL ABILITY PREDICTS ABSTINENCE FROM DRUGS AND ALCOHOL IN A RESIDENTIAL TREATMENT POPULATION. Psychol Rep 1999. [DOI: 10.2466/pr0.84.3.1354-1360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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12
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Abstract
The current literature suggests that individuals who chronically abuse alcohol exhibit a wide variety of cognitive deficits resulting from cerebral dysfunction that is either directly or indirectly related to their alcohol consumption history. Cognitive deficits have been hypothesized as having implications for standard alcohol treatment efficacy as they may directly affect cognitively impaired individuals' abilities to utilize various treatment modalities. Although evidence is accumulating that suggests this is actually the case, the majority of alcohol treatment programs neither directly consider the impact cognitive deficits have on treatment efficacy nor do they employ cognitive rehabilitation treatment strategies to remediate identified cognitive deficits. Few studies exist that investigate the remediability of neurobehavioral deficits or the efficacy of integrating cognitive rehabilitation strategies into more traditional treatment programs. Empirical investigations conducted to date indicate that some cognitive deficiencies secondary to alcoholism are amenable to cognitive rehabilitation and this remediation is generalizable. Rigorous well-controlled treatment outcome investigations are needed in order to determine the efficacy of cognitive rehabilitation techniques in naturalistic settings using ecological outcome measures. Also, emphasis should be placed on integrating cognitive rehabilitation techniques with proven efficacy into traditional alcoholism treatment programs.
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Affiliation(s)
- D N Allen
- Psychology Service, Highland Drive VA Medical Center, Pittsburgh, Pennsylvania 15206, USA
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Zlotnick C, Fischer PJ, Agnew J. Perceptuomotor function of homeless males in alcohol rehabilitation. JOURNAL OF SUBSTANCE ABUSE 1995; 7:235-44. [PMID: 7580232 DOI: 10.1016/0899-3289(95)90007-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In a sample of 76 alcohol rehabilitation program (ARP) residents, homeless men demonstrated significantly poorer perceptuomotor function than nonhomeless men. This difference persisted despite similarities in several factors associated with neurobehavioral test scores including demographic characteristics; frequency, quantity, and duration of alcohol and other substance use; psychosocial factors, including motivation and social support; health, including history of head trauma; and neurotoxic occupational exposure.
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Affiliation(s)
- C Zlotnick
- Alcohol Research Group, University of California, Berkeley, School of Public Health 94709-2176, USA
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15
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Abstract
Measures of electroencephalographic and autonomic activity were recorded from 17 alcohol-dependent patients (after 7-10 and 14-17 days of abstinence) and 14 age-matched non-drug-dependent controls (after comparable intervals). The alcohol-dependent group was divided into subgroups of abstinence-prone or relapse-prone patients, based on their 3-month posttreatment outcome. Data analyses revealed that relapse-prone patients evidenced more electroencephalographic beta-activity at the vertex lead, and a larger amplitude carotid pulse than abstinence-prone patients and controls. The implications of these preliminary findings for relapse prediction and typological development are discussed.
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Affiliation(s)
- L O Bauer
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington
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Kadden RM, Litt MD, Cooney NL. Matching alcoholics to coping skills or interactional therapies. Role of intervening variables. Ann N Y Acad Sci 1994; 708:218-29. [PMID: 8154683 DOI: 10.1111/j.1749-6632.1994.tb24715.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- R M Kadden
- University of Connecticut School of Medicine, Farmington 06030
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17
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Roberts LA, Bauer LO. Reaction time during cocaine versus alcohol withdrawal: longitudinal measures of visual and auditory suppression. Psychiatry Res 1993; 46:229-37. [PMID: 8388109 DOI: 10.1016/0165-1781(93)90091-t] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Visual and auditory stimulus discrimination tasks, analogous to those used in the Reitan-Klove Sensory Perceptual Examination, were performed by 12 cocaine-dependent and 5 alcohol-dependent patients after 1 week, 3 weeks, and 3 months of verified abstinence. Sixteen control subjects, who were not substance-dependent, performed the same tasks after comparable intervals. During each task, either visual or auditory stimuli were presented in the left, in the right, or in both sensory fields. A simple key press was made to discriminate these conditions. Cocaine-dependent patients responded more slowly than control subjects during both tasks. The reaction-time slowing persisted across all three sessions, spanning a 3-month period of abstinence. There were no significant differences between the cocaine-dependent and control groups in response accuracy. In the context of other findings, these findings are interpreted as reflecting an enduring effect of prior cocaine dependence on motor as opposed to sensory functioning.
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Affiliation(s)
- L A Roberts
- Department of Psychiatry, University of Connecticut Health Center, Farmington
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18
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Glenn SW, Errico AL, Parsons OA, King AC, Nixon SJ. The role of antisocial, affective, and childhood behavioral characteristics in alcoholics' neuropsychological performance. Alcohol Clin Exp Res 1993; 17:162-9. [PMID: 8452198 DOI: 10.1111/j.1530-0277.1993.tb00742.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Chronic alcoholics demonstrate cognitive deficits when compared with nonalcoholics. These deficits are typically attributed to the direct effects of ethanol and its metabolites on the central nervous system (CNS). There are other factors, however, that differentiate alcoholics from controls, such as personality or behavioral characteristics. These factors may affect neuropsychological performance and thus alter the interpretation of alcoholic cognitive deficits as resulting solely from alcohol's toxic effects. To investigate this question, male and female alcoholics and peer nonalcoholic controls were compared on personality, behavioral, and cognitive measures. Alcoholics had greater numbers of antisocial behaviors, childhood behavioral disorder symptoms (CBD), and affective symptomatology, and had poorer neuropsychological performance than controls. The three personality and behavioral factors were positively intercorrelated with each other, and were negatively related to cognitive performance. The CBD factor proved to be the most consistent predictor of neuropsychological performance for both alcoholics and controls, and males and females. While the behavioral factors differentiated alcoholics from controls and predicted performance, significant differences between the groups in cognitive performance still remained when these factors were taken into account.
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Affiliation(s)
- S W Glenn
- Center for Alcohol and Drug Related Studies, University of Oklahoma Health Sciences Center, Oklahoma City 73104
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Abstract
Evidence is reviewed indicating that the extent of alcohol abuse alone cannot account for the neuropsychological deficits observed in alcoholics, and that alcohol abuse and head injury may interact in some patients to influence neuropsychological status. Alcohol abuse both increases the risk for head trauma and potentiates the resulting brain injury, which can lead to negative neuropsychological consequences. Clinicians involved in the treatment of addiction should assess patients for history of head injury, and neuropsychological deficits consequent to both head injury and ethanol. These deficits may limit patient ability to comply with addiction rehabilitation programs. Conversely, clinicians in acute care and rehabilitation of the sequelae of head trauma should routinely assess their patients for substance abuse, because such abuse can have a significant impact on recovery from brain injury.
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Affiliation(s)
- D A Solomon
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
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21
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Smith DE, McCrady BS. Cognitive impairment among alcoholics: impact on drink refusal skill acquisition and treatment outcome. Addict Behav 1991; 16:265-74. [PMID: 1663696 DOI: 10.1016/0306-4603(91)90019-e] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The impact of neuropsychological impairment on drink refusal skill acquisition and treatment outcome was examined in 33 male alcoholic inpatients. Subjects stratified by Abstraction scores on the Shipley Institute of Living Scale (SILS) performed differentially on drink refusal components of the Situational Competency Test (SCT) following a skills-based drink refusal intervention. Higher abstraction subjects tended to respond more rapidly on the SCT at post-training, had significantly higher scores on a quiz about effective drink refusal at baseline, and tended to improve more on the quiz following training than subjects with lower conceptual functioning. Aftercare attendance was significantly greater among the higher neuropsychological functioning group. When subjects were categorized by Brain Age Quotient no differences were found in skill acquisition nor in aftercare attendance. Subjects who showed the most learning on the California Verbal Learning Test demonstrated significantly better performance on the drink refusal quiz at post-training. Implications for alcoholism treatment are discussed.
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Parsons OA, Schaeffer KW, Glenn SW. Does neuropsychological test performance predict resumption of drinking in posttreatment alcoholics? Addict Behav 1990; 15:297-307. [PMID: 2378290 DOI: 10.1016/0306-4603(90)90073-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The prediction of resumption of drinking in posttreatment alcoholics was investigated as a function of five possible confounding variables: depression, anxiety, childhood symptoms of attention deficit and conduct disorders and family history of alcoholism. Male and female detoxified alcoholics (n = 103) in inpatient treatment programs were administered a neuropsychological battery and retested as outpatients 14 months later; peer nonalcoholics (n = 73), given the same battery, had a similar interest interval. Alcoholics who resumed drinking (N = 41) performed significantly poorer on an overall neuropsychological performance index than abstainers (N = 62) who performed significantly poorer than nonalcoholics. Stepwise multiple regression equations using the variables noted above revealed that depressive symptoms, ADD and the performance index were the only variables to enter the prediction (R2 = .26, p less than .001); depression accounted for most of the variance. At retest all three groups improved significantly, but not differentially, and were as significantly different at retest as at initial testing. Implications of these results are discussed.
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Affiliation(s)
- O A Parsons
- University of Oklahoma Health Sciences Center, Oklahoma City
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23
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Lee JA. Neuropsychology of Alcoholism: A Review With Attention to Methodology, Biological Markers, Diagnosis, and Treatment. J Psychoactive Drugs 1990. [DOI: 10.1080/02791072.1990.10472204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Alterman AI, Holahan JM, Baughman TG, Michels S. Predictors of alcoholics' acquisition of treatment-related knowledge. J Subst Abuse Treat 1989; 6:49-53. [PMID: 2709474 DOI: 10.1016/0740-5472(89)90021-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Only modest relationships have been found between cognitive functioning and treatment outcome; there is some indication of better prediction of within-treatment progress. The current study attempted to determine whether either cognitive or sociodemographic/alcohol-related variables were predictive of learning in educational treatment. Eighty-seven male alcoholics were exposed to one hour of instruction on the medical effects of alcohol. Sociodemographic, alcohol-related, and cognitive functioning measures were obtained at the outset of treatment. Knowledge was assessed 24 hours prior to and 24 hours and three weeks after the intervention. Statistically significant increases in knowledge were found both 24 hours and three weeks following the educational intervention; retention of information declined significantly from 24 hours to three weeks post-intervention. Discriminant function analyses using either seven cognitive variables or six alcohol-related/sociodemographic variables significantly discriminated between learners and nonlearners 24 hours after the intervention. The weighted composite of measures in each of the analyses was able to successfully differentiate learners from nonlearners in over 70% of the cases. The findings suggest that the clinician may be able to employ a limited number of variables to differentiate between patients who will and will not be able to acquire knowledge from educational interventions.
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Affiliation(s)
- A I Alterman
- VA Medical Center, Philadelphia, Pennsylvania 19104
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