Academic journal article Journal of Alcohol & Drug Education

Cognitive Impairment and Substance Abuse: Implications for Treatment Planning

Academic journal article Journal of Alcohol & Drug Education

Cognitive Impairment and Substance Abuse: Implications for Treatment Planning

Article excerpt


The cognitive abilities of 24 males at an in-patient substance abuse facility were assessed using the Neurobehavioral Cognitive Status Examination (Cognistat). Findings suggested that there were significant changes in cognitive .functioning during the 21-day in-patient treatment as measured by the Cognistat. Implications for mental health professionals working with this population are discussed.

Keywords: substance abuse, Cognistat, addictions treatment, cognitive impairment


An extensive body of evidence suggests that cognitive impairment may be a consequence of psychoactive substance abuse (e.g., Atkinson, & Misra, 2002; Fals-Stewart, 1997; Gordis, 1989 ; Morgenstern & Bates, 1999). Numerous studies have examined cognitive deficits in alcoholics (e.g., Atkinson, 2000; Parsons, 1987, Tarter & Edwards, 1987), cocaine abusers (O'Malley, Adamse, Heaton, & Gawin, 1992), and polysubstance abusers (Szalay, Bovasso, Vilov, & Williams, 1992). Although severe cognitive impairment is obvious and easily measurable in the cases of Wernike and Korsakoff Syndromes, deficiencies are more subtle and difficult to pinpoint in the majority of substance abusers (May, 2003; Reed, Grant, & Rourke, 1992).

Williams and Skinner (1990) studied the effects of social alcohol consumption on cognitive functioning in order to determine whether psychological tests could discriminate between high and low alcohol consuming social drinkers. Their limited study did find significant differences. However, they recommend that a battery of tests be used as part of an assessment procedure to identify cognitive deficits in heavy drinkers, including the Wechsler Intelligence Scale for Adults (WAIS), and the Visual Memory Scale (WMS).

Using biological and psychological assessments, May (2003), compared a control group of 14 mental health patients (5 males, 9 females, mean age of 47.5 years) with no substance abuse history to a treatment group of 18 newly abstinent substance abusers (16 males, 2 females, mean age 51 years) on the day of hospital discharge. The hypothesis specified that those who had just regained sobriety would still exhibit elevated enzymes and cognitive impairments that could impair their driving ability, though they were being discharged. Blood tests were utilized to measure the presence aspartate aminotransferase, gamma-glutamyl transferase, and mean corpuscular volume in each participant. Elevated levels of these enzymes often suggest the presence of liver disease, as well as damage to other major organs. The Brief Neuropsychological Cognitive Examination (BNCE), designed to measure cognitive functioning, was also administered. May found that the the BNCE did not detect significant differences in the two groups. However, as might be expected, significant differences were found between the two groups regarding levels of aspartate aminotransferase and mean corpuscular volume, with substance abusers in recovery showing higher levels of each enzyme.

Mann, Gunther, Stettler, and Ackermann (1999) investigated the pattern of cognitive deficits in a group of 49 alcohol-dependent men in an in-patient treatment unit. These individuals had an average of 11.4 years being alcohol dependent. Using a test-retest design with a control group of 49 healthy males, the researchers administered a battery of neuropsychological tests, including an individually-administered measure of verbal intelligence, a test of logical memory, an auditory verbal learning test, and a test for concentration and attention. They found evidence that chronic alcoholism has detrimental effects on cognitive functioning, particularly for memory of verbal material. It was also noted that the alcohol-dependent men scored significantly lower than the controls on five of twelve of the neuropsychological measures.

O'Malley, et al (1992) looked at the effects of cocaine abuse on cognitive abilities. …

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