Clinical Limitations of Neuropsychological Testing in Predicting Treatment Outcome among Alcoholics

The purpose of the present study was to investigate a number of factors that may influence the relationship between neuropsychological impairment and treatment outcome among alcoholics. Cognitive deficit upon admission to treatment was significantly related to the individual's age but independent of the years of problem drinking and the recency of the last drink prior to assessment. Significant improvement was noted on measures of neuropsychological function over the period from treatment admission to 6-month follow-up assessment. On the average, improvement in functioning occurred across time despite drinking relapses during the intervening period. The individual's age, but not years of problem drinking, was associated with recovery of function; neither of these variables interacted with subsequent drinking status to affect differentially the changes in cognitive functioning. Finally, selected measures of neuropsychological function assessed both at admission and 6-month follow-up were reliably related to follow-up employment status but unrelated to the average amount of alcohol consumed per day and to the number of heavy drinking days during the 3-month period between the 6- and 9-month follow-ups. The results are discussed in terms of the need for determining the utility of neuropsychological measures in predicting everyday functioning among alcoholics and for selecting domains of assessment other than cognitive status to predict treatment outcome.     

Neurocognitive ability in adults coping with alcohol and drug relapse temptations

Coping is important for preventing relapse, but may be utilized differently depending on the individual's level of cognitive functioning. Impaired reasoning, attention, and memory are commonly observed in alcohol-dependent individuals. This study describes the prospective relationship between neuropsychological functioning and utilization of coping strategies in predicting outcome one year after discharge from an inpatient alcohol treatment program. Male veterans (n = 43) hospitalized in an alcohol treatment facility were given structured interviews, coping questionnaires, and neuropsychological testing, and were followed three and 12 months after discharge. Neuropsychological ability moderated the relationship between coping and drinking outcomes one year after treatment. This was particularly true for patients with better neurocognitive functioning. Specifically, patients with higher neurocognitive performances and more maladaptive coping responses, such as self-blame, had a greater percentage of drinking days at follow-up. Alcohol-dependent adults with good neuropsychological functioning may be able to benefit more from coping skills training. For those with neuropsychological deficits, coping skills training may need to take cognitive limitations into consideration.     

The process of relapse in severely dependent male problem drinkers

Aims. The aim of the study was to investigate factors hypothesized to influence the relapse process, with a focus on the role of self-efficacy, alcohol dependence and cognitive functioning. Design. The study was conducted in the context of a controlled trial of a relapse prevention programme. Subjects were assessed prior to treatment, at immediate conclusion of treatment and at 6- and 12-month follow-up. Setting. The study was conducted in an Alcohol Treatment Unit (ATU) in Scotland. Participants: Subjects were 60 male problem drinkers who were patients at the ATU. They were heavy drinkers, with corresponding high levels of alcohol dependence and alcohol-related harm. Measurements. The independent variables were posttreatment self-efficacy, alcohol dependence, cognitive functioning, level of depression and alcohol consumption prior to admission to treatment. The dependent variables were post-treatment drinking behaviour and functioning and time to lapse and relapse. Findings. Although the methodology does not allow identification of causality, support was found for the hypothesis that post-treatment self-efficacy was an intervening variable between treatment and outcome. Higher post-treatment self-efficacy predicted better outcome at 6-month follow-up and was associated with a reduced risk of lapse and relapse over the 12-month follow-up. Poorer cognitive functioning was significantly associated with being categorized as a problem drinker at 6-month follow-up and with higher risk of a lapse over the 12-month follow-up. Level of alcohol dependence did not predict outcome. Conclusions. It was concluded that post-treatment self-efficacy rating is a predictor of treatment outcome and time to lapse and relapse and that cognitive functioning is a predictor of treatment outcome and time to lapse.     

Memory enhancement in healthy older adults using a brain plasticity-based training program: a randomized, controlled study

Normal aging is associated with progressive functional losses in perception, cognition, and memory. Although the root causes of age-related cognitive decline are incompletely understood, psychophysical and neuropsychological evidence suggests that a significant contribution stems from poorer signal-to-noise conditions and down-regulated neuromodulatory system function in older brains. Because the brain retains a lifelong capacity for plasticity and adaptive reorganization, dimensions of negative reorganization should be at least partially reversible through the use of an appropriately designed training program. We report here results from such a training program targeting age-related cognitive decline. Data from a randomized, controlled trial using standardized measures of neuropsychological function as outcomes are presented. Significant improvements in assessments directly related to the training tasks and significant generalization of improvements to nonrelated standardized neuropsychological measures of memory (effect size of 0.25) were documented in the group using the training program. Memory enhancement appeared to be sustained after a 3-month no-contact follow-up period. Matched active control and no-contact control groups showed no significant change in memory function after training or at the 3-month follow-up. This study demonstrates that intensive, plasticity-engaging training can result in an enhancement of cognitive function in normal mature adults.     

Outcomes of Co-Morbid Alcoholic Men: A 1-Year Follow-Up

In this prospective, 1-year study, 360 males admitted to an inpatient alcoholism treatment program were administered a DSM-III compatible structured interview and subtyped by co-occurring psychiatric disorder. Forty percent satisfied diagnostic criteria for alcohol dependence while 27% met criteria for alcohol dependence and one additional psychiatric syndrome. The dually diagnosed patients were divided into: alcohol dependence plus drug abuse, alcohol dependence plus antisocial personality and alcohol dependence plus depression. These subtypes were compared on multiple dimensions at intake and at 1-year follow-up. At follow-up, all groups showed significant improvement in drinking and psychosocial functioning. The results suggest that subtyping alcoholics by co-morbid psychiatric disorders may be a good postdictor of clinical history, but a poor predictor of drinking outcome.     

Two-year outcome of an intervention program for university students who have parents with alcohol problems: a randomized controlled trial

BACKGROUND: Only a few intervention studies aiming to change high-risk drinking behavior have involved university students with heredity for alcohol problems. This study evaluated the effects after 2 years on drinking patterns and coping behavior of intervention programs for students with parents with alcohol problems. METHOD: In total, 82 university students (57 women and 25 men, average age 25 years) with at least 1 parent with alcohol problems were included in the study. The students were randomly assigned to 1 of the 3 programs: (i) alcohol intervention program, (ii) coping intervention program, or (iii) combination program. All the 3 intervention programs were manual based and individually implemented during 2 2-hour sessions, 4 weeks apart. Before the participants were randomly assigned, all were subjected to an individual baseline assessment. This assessment contained both a face-to-face interview and 6 self-completion questionnaires: the Alcohol Use Disorders Identification Test, estimated Blood Alcohol Concentration, Short Index of Problems, the Symptom Checklist-90, Coping with Parents' Abuse Questionnaire, and The Interview Schedule for Social Interaction (ISSI). Follow-up interviews were conducted after 1 and 2 years, respectively. The results after 1 year have previously been reported. RESULTS: All participants finished the baseline assessment, accepted and completed the intervention. Ninety-five percent of the students completed the 24-month follow-up assessment. Only the group receiving the combination program continued to improve their drinking pattern significantly (p < 0.05) from the 12-month follow-up to the 24-month follow-up. The improvements in this group were significantly better than in the other 2 groups. The group receiving only alcohol intervention remained at the level of improvement achieved at the 12-month follow-up. The improvements in coping behavior achieved at the 12-month follow-up remained at the 24-month follow-up for all the 3 groups, i.e., regardless of intervention program. CONCLUSION: Positive effects of alcohol intervention between 1 and 2 years were found only in the combined intervention group, contrary to the 1-year results with effects of alcohol intervention with or without a combination with coping intervention.     

Long-Term Abstinence and Quality of Life After a Socioecological Treatment Program: An Italian Experience

This article aims to report the outcomes of a brief residential alcohol treatment based on the socioecological method, as measured in terms of professional evaluation and quality of life. The study covered a one-year period (July 2011–August 2012) by following the experiences of 20 users of alcohol included in a residential treatment program based on the socioecological approach. The treatment outcome was assessed via a quality-of-life (QoL) measure and professional service evaluation on three occasions: upon admission to the hospital, one month after hospital discharge, at the follow-up after 3 to 4 months. Moreover, four club facilitators were interviewed after 7 to 8 months concerning the situation of five patients. Results showed that one out of four people with an alcohol addiction were still sober about one year after discharge and attended the Clubs for Alcoholics in Treatment (CAT) regularly. One month after discharge, QoL data and professional evaluation converged in showing an improvement in 13 participants. Their QoL generally improved, with specific reference to their financial situation, life in general, health condition, and family relations. The brief residential program based on the socioecological model appears to be a feasible path for those seeking alcohol treatment in Italy, as a positive outcome was reported by one half of the patients in terms of better QoL at the 6-month follow-up and by one fourth of patients in terms of sobriety and club attendance at the one-year follow-up.     

Cognitive Functioning, ASP, and Family History of Alcoholism in Young Men at Risk for Alcoholism

Previous research has suggested that individuals with a family history of alcoholism may have cognitive deficits that predate, and possibly predispose, to the onset of alcoholism. However, these deficiencies may result from other factors, e.g., comorbid psychopathology. The current study investigated the neuropsychological functioning of young adult males at high risk for alcohol abuse due to a family history of alcoholism (FH) and/or a personal history of antisocial personality disorder (ASP). A family history of alcoholism (FH+) alone was not associated with neuropsychological impairment. Subjects with ASP, however, exhibited some difficulty with higher level motor control and with verbal concept formation compared with nonASP subjects. No clear pattern of FH x ASP interaction was evident in the measures examined. These findings suggest that previous findings suggesting cognitive deficiencies in FH+ individuals may have been related to a failure to consider co-morbid ASP. The deficits exhibited by the ASP subjects may reflect both reduced inhibitory control and a deficiency in higher level verbal skills. These deficiencies may leave ASP individuals less capable of utilizing higher level language skills to regulate behavior.     

Maritally distressed women with alcohol problems: the impact of a short-term alcohol-focused intervention on drinking behaviour and marital satisfaction

Aim. To evaluate the efficacy of a short-term alcohol-focused intervention for maritally distressed women, and to explore changes in relationship functioning. Design. Participants were assigned randomly to an alcohol-focused treatment or to a waiting-list control group. The waiting-list control group began the intervention at 1-month follow-up. Setting. The intervention took place at a research and training centre offering outpatient psychology services to the community. Participants. A sample of 32 women with alcohol and marital problems were recruited through the media. Participants reported protracted alcohol problems, moderate to severe impact of alcohol on social and occupational functioning, and moderate to severe marital distress. Measurements. Measures of average alcohol consumption, marital distress, relational efficacy and depression were administered at pre- and post-therapy, and at 1, 6 and 12-month follow-up. Intervention. The intervention involved six 1-hour sessions, consisting of clinical assessment, motivational interviewing, cognitive-behavioural strategies and relapse prevention. Results. At 1-month follow-up, the intervention was associated with statistically significant improvements in alcohol consumption, marital satisfaction, relational efficacy and depression, and these effects were sustained at 12-month follow-up. Conclusions. At 1-month follow-up the intervention was associated with decreased alcohol consumption and depression, and increased marital satisfaction and relational efficacy, with evidence of maintained effects at 12-month follow-up. However, it is unlikely that reduced problem drinking and improved confidence in resolving problems were the only factors producing low marital quality in these couples. Further research is needed to identify those individuals who might benefit from marital interventions.     

Neuropsychological Performance of Young Nondrinkers, Social Drinkers, and Long- and Short-Term Sober Alcoholics

Neuropsychological performance of 23-42-year-old males with diverse drinking histories was assessed. Comparisons were made among nondrinkers, social drinkers, short-term sober (less than 30 days) alcoholics and long-term sober (greater than 30 days) alcoholics. Results of these comparisons provided little support for the notion that neurotoxic effects of chronic alcohol consumption are directly related to cognitive impairment. Instead, these results suggested that performance differences among the groups were more closely related to subclinical withdrawal symptoms or native ability than to long-term alcohol consumption. Because none of the dependent measures was related to length of abstinence, and because Wechsler's Adult Intelligence Scale-R Vocabulary differences among groups paralleled neuropsychological test performance differences, it is suggested that differences among groups may reflect differences in native ability. In addition, there were no differences between social drinkers and nondrinkers, nor were there any significant correlations among drinking variables and performance of social drinkers, providing further evidence against a direct relationship between alcohol consumption and cognitive performance.     

Influence of Family Alcoholism History on Alcohol Metabolism, Sensitivity, and Tolerance

As part of the Colorado Alcohol Research on Twins and Adoptees (CARTA), 35 subjects who reported having an alcoholic parent or sibling [family alcoholism history positive (FHP)] were matched with 35 controls [family alcoholism history negative (FHN)]. All subjects were tested three times on a battery of physiological, motor, and cognitive performance tasks before the ingestion of alcohol, then were tested three more times over a 3-hr period during which their blood alcohol concentration (BAC) was brought up to and maintained at about 0.10 g/dl by an initial large dose of ethanol and subsequent topping doses. FHP subjects scored significantly lower than FHN subjects on the Raven's Progressive Matrices and on some of the cognitive tasks before alcohol ingestion. FHP and FHN subjects, however, did not significantly differ in absorption and clearance of alcohol or in sensitivity and acute tolerance scores calculated on the repeated measures. Contrary to expectations, FHP subjects perceived themselves as being more impaired by alcohol than FHN subjects, and there was little evidence to suggest that they were less sensitive to variations in BAC.     

Substance dependence, family history of alcohol dependence and neuropsychological functioning in adolescence

Aims. It was hypothesized that adolescent substance dependence moderates the relationship between family history of alcohol dependence and neuropsychological functioning. Design. This study compared the neuropsychological functioning of nonabusing and alcohol and drug-dependent adolescents with and without a family history of alcohol dependence using hierarchical multiple regressions and general factorial analyses. Setting. Substance-dependent adolescents were recruited and tested in inpatient alcohol and drug abuse treatment programs after 3 weeks of abstinence. A matched sample of non-abusing adolescents was recruited from the same San Diego-area communities. Participants. Substance-dependent adolescents (n = 101) met DSM-III-R criteria for dependence on alcohol and at least one other substance. Non-abusing adolescents (n = 50) had no substance use disorders. Groups were comparable on socio-economic status. Participants were 44% female, ages 13-18, and had no serious head injuries or neurological disorders. Measurements. Information was gathered on demographics, family history, substance involvement, and conduct disorder behaviors and adolescents were administered neuropsychological tests covering language, visuospatial, verbal memory, attention and executive functioning domains. Findings. The hypothesis was supported for language and attention tests. Substance involvement interacted with family history of alcohol dependence to predict language and attention functioning. Family history negative non-abusers performed better than the other adolescents. Conclusions. The pattern of results suggests that family history of alcohol dependence and adolescent substance use are separate risk factors for poorer neuropsychological performance in youth.     

Association of the ADH2*3 Allele With A Negative Family History Of Alcoholism in African American Young Adults

BACKGROUND: Two of the class I alcohol dehydrogenase (ADH) genes (ADH2 and ADH3) encode for multiple isozymes that differ in their kinetic properties. Polymorphisms at both of these gene loci have been linked to alcoholism and/or alcohol-induced disabilities in some populations. At the ADH2 locus, three polymorphisms are present (ADH2*1, ADH2*2, ADH2*3). ADH2*3 allele codes for a high Km and Vmax variant that has been reported to occur exclusively in African Americans and some tribes of Native Americans. In African Americans, the presence of the ADH2*3 allele is associated with protection from alcohol-related birth defects. However, its relationship to risk for alcoholism in African Americans remains relatively unexplored. METHODS: The participants were 97 African American young adults (18-25 years old). A structured interview was used to gather information on demographics, psychiatric diagnoses, personal drinking and drug use history, and familial history of alcohol use disorders. A blood sample was obtained from each participant and leukocyte DNA extracted and genotyped for the presence of ADH2*3 alleles. The specific aim of the study was to investigate the associations between the presence of the ADH2* 3 allele and personal and family history of alcohol use/abuse. RESULTS: Thirty participants (31%) had at least one ADH2*3 allele and two were homozygous for the allele. A significant association between the presence of an ADH2*3 allele and a negative family history of alcoholism was uncovered (p < 0.04). No significant associations of an ADH2*3 allele with personal history of alcohol use disorders or with current drinking were found; however, power to detect associations was limited in this population because half the population did not drink regularly. CONCLUSIONS: Because family history of alcoholism is one of the best predictors of the development of alcohol use disorders, this pilot study suggests that, in this sample of African American young adults, the ADH2*3 allele may be associated with a lowered risk for the development of alcoholism.     

Neuropsychological Deficits in Alcoholics: the relative contributions of gender and drinking history

Alcoholic inpatients at Bexley Hospital Treatment Unit were selected for cognitive assessment on a routine ‘consecutive admission’ basis. The male and female alcoholic groups performed significantly worse on the cognitive tests than matched controls. The ‘consecutive admission’ samples of 72 males and 33 females differed widely on drinking history data; males having significantly severer histories. The females performed worse on tests of immediate recall, and psychomotor speed. This performance difference endured whether the male and female groups were equated for drinking history differences statistically (by co-variance analysis), or by selection criteria (subject matching). The finding is discussed in the context of a greater vulnerability in women to the deleterious effects of alcohol, while noting the methodological complexities which prevent firm conclusions about causality. One possible conclusion is that females are more susceptible than males to the harmful effects of prolonged heavy drinking on cognitive performance. Alternatively, it may be that those females who become alcoholic are ‘at risk’ in some unspecified way which is reflected in the present performance differences.     

Graded Neuropsychological Impairment and Elevated γ-Glutamyl Transferase in Chronic Alcoholic Men

This study hypothesizes that distinct biochemical and metabolic disturbances associated with liver injury may be related to specific cognitive changes in alcoholics. In 132 alcoholic men admitted to an alcohol treatment program, increases in gamma-glutamyl transferase (GGT) values were correlated with impairment in several measures of visuoperceptual and visuoconceptual functioning. The association between plasma levels of GGT and neuropsychological performance was independent of the relative contribution of other laboratory measures of liver injury and of alcohol consumption histories. These observations support the hypothesis that elevated levels of GGT are distinctly associated with neuropsychological deficits and suggest that possible mechanisms beyond severe hepatic dysfunction and alcohol consumption underlie cognitive deficits in alcoholics.     

One-year follow-up of dual diagnosis patients attending a 4-month integrated inpatient treatment

The purpose of this study was to assess a 4-month inpatient treatment program based on integrated models for patients with substance use and psychiatric disorders (dual diagnosis patients). On admission and at the 1-year follow-up, a consecutive sample of 118 dual diagnosis patients who entered the program were assessed by interview. Eighty-four patients (70.6%) completed the 1-year follow-up interview, reporting less frequent substance use, less severe psychiatric symptoms, a lower rehospitalization rate, and better housing conditions than on admission. Patients diagnosed with a comorbid personality disorder had a better improvement in the frequency of drinking and were less likely to be rehospitalized than patients with schizophrenia or depression. The results suggest that the integrated inpatient program may be a promising treatment approach for dual diagnosis patients. The results await replication in controlled studies that need to include an assessment of outpatient treatment following inpatient programs.     

Testosterone in Chronic Alcoholic Men

Reduced testosterone levels in chronic alcoholic men may be associated with the age, alcohol consumption history, severity of liver injury, and nutritional status of these patients. In this study, total testosterone levels were measured in 163 alcoholic men upon admission to an alcohol treatment program (ATP) and at 3 months follow-up. Values of testosterone below the clinical normal range were found in over 17% of the subjects, a finding significantly predicted by age, alcohol consumption and liver injury tests. Follow-up at 3 months further demonstrated that abnormally low testosterone values significantly increased in men who remained abstinent as compared to those who continued to drink.     

Depression and neurocognitive performance in individuals with HIV/AIDS: 2-year follow-up

OBJECTIVES: The aims of this study were to follow a cohort of HIV-infected individuals for 2 years to assess changes in depression and neuropsychological performance over time, to explore the relationship between depression, HIV illness and neuropsychological performance, and to examine the natural history of the effect of highly active antiretroviral therapy (HAART) on depression and neurocognitive performance. METHODS: HIV-seropositive out-patients were assessed at baseline and at 2-year follow-up. At each assessment, patients were assessed for depression [using the Beck Depression Inventory (BDI) and Structured Clinical Interview (SCID-CV)] and completed a battery of neuropsychological tests including the Cambridge Neuropsychological Test Automated Battery (CANTAB) and the Hopkins HIV Dementia Scale (HDS). RESULTS: At baseline, 34.8% scored > or =14 on the BDI [> or =14 suggests depressive symptoms (DS)]. The SCID-CV revealed that 27% of participants met the criteria for current mood disorder. Seven per cent of the participants' scores on the HDS indicated HIV-associated cognitive changes. Eighty participants were re-tested at 2-year follow-up and were split into two groups based on BDI scores at baseline. CANTAB results revealed that the cohort were significantly impaired on nine of 10 measures compared with age-matched normative data. Neurocognitive performance significantly improved for participants with no DS at baseline, whereas participants with DS at baseline did not show as much improvement. Multivariate analysis revealed that 40% of the change in cognitive performance was attributable to the variables age, AIDS and HAART regimen. CONCLUSION: These results suggest a significant decline in depression scores and an improvement in several neurocognitive domains over time, with a relationship between HIV illness, HAART, symptoms of depression and neurocognitive performance.     

Cognitive function in hepatitis C patients with advanced fibrosis enrolled in the HALT-C trial

BACKGROUND/AIMS: Prior studies have demonstrated neuropsychological abnormalities in chronic hepatitis C (CHC) patients even with mild fibrosis. The aim of this study was to determine the frequency, type, and severity of cognitive impairment in a large group of CHC patients with advanced fibrosis. METHODS: Ten validated neuropsychological tests were administered to 201 CHC patients. Standard scores for individual tests were calculated using normative population data that controlled for age, gender, and/or education. Lifetime psychiatric history, alcohol consumption, and mood status were also determined. RESULTS: 33% of patients met criteria for cognitive impairment (i.e. standard score <40 on at least 4 tests). Mild impairment in verbal recall and working memory were noted with other domains remaining intact. Liver disease severity and lifetime psychiatric/substance abuse history did not correlate with group mean cognitive test results or the presence of cognitive impairment. In contrast, IQ and depression scores were significant and independent predictors of cognitive impairment (ROC = 0.84). CONCLUSIONS: 33% of patients entering the HALT-C trial have evidence of a mild, non-focal subcortical processing deficit which was highly correlated with IQ, education, and occupation. Future studies of cognitive function in CHC patients should control for general cognitive ability.     

Neuropsychological Functioning and Outcomes of Treatment for Co-occurring Depression and Substance Use Disorders

Background: We previously published findings from our clinical trial comparing treatment outcomes for substance-dependent veterans with co-occurring depression who received Integrated Cognitive Behavioral Therapy (ICBT) or Twelve-Step Facilitation (TSF) Therapy. Objectives: This study is a secondary analysis that examined whether neuropsychological functioning at baseline moderated substance use and depression outcomes in ICBT relative to TSF. Methods: This study was a randomized clinical trial in which 164 veterans with major depressive disorder and comorbid alcohol, cannabinol, and/or stimulant dependence were randomly assigned to either ICBT or TSF group therapy. A comprehensive neuropsychological test battery was administered at baseline. Results: Contrary to our hypothesis, participants with poor neuropsychological functioning had better substance use outcome in ICBT than in TSF, whereas participants with good neuropsychological functioning had comparable substance use outcomes in TSF and ICBT by 18-month follow-up. Depression outcomes, in contrast, were not moderated by neuropsychological functioning by 18-month follow-up. Conclusions and Scientific Significance: The substance use outcomes may suggest that substance-dependent depressed adults with poorer neuropsychological functioning should be offered ICBT over TSF. These individuals may be less able to develop and use novel coping skills for managing substance use and depressive symptoms on their own without formal structured training in cognitive and behavioral skills provided in ICBT.