A Role for Cognitive Rehabilitation in Increasing the Effectiveness of Treatment for Alcohol Use Disorders

Abstract

Neurocognitive impairments are prevalent in persons seeking treatment for alcohol use disorders (AUDs). These impairments and their physical, social, psychological and occupational consequences vary in severity across persons, much like those resulting from traumatic brain injury; however, due to their slower course of onset, alcohol-related cognitive impairments are often overlooked both within and outside of the treatment setting. Evidence suggests that cognitive impairments can impede treatment goals through their effects on treatment processes. Although some recovery of alcohol-related cognitive impairments often occurs after cessation of drinking (time-dependent recovery), the rate and extent of recovery is variable across cognitive domains and individuals. Following a long hiatus in scientific interest, a new generation of research aims to facilitate treatment process and improve AUD treatment outcomes by directly promoting cognitive recovery (experience-dependent recovery). This review updates knowledge about the nature and course of cognitive and brain impairments associated with AUD, including cognitive effects of adolescent AUD. We summarize current evidence for indirect and moderating relationships of cognitive impairment to treatment outcome, and discuss how advances in conceptual frameworks of brain-behavior relationships are fueling the development of novel AUD interventions that include techniques for cognitive remediation. Emerging evidence suggests that such interventions can be effective in promoting cognitive recovery in persons with AUD and other substance use disorders, and potentially increasing the efficacy of AUD treatments. Finally, translational approaches based on cognitive science, neurophysiology, and neuroscience research are considered as promising future directions for effective treatment development that includes cognitive rehabilitation.

Recent Internet Use and Associations with Clinical Outcomes among Patients Entering Addiction Treatment Involved in a Web-Delivered Psychosocial Intervention Study

“…10 Similarly, computer-assisted cognitive rehabilitation interventions have improved treatment outcomes for adults with cognitive dysfunction secondary to alcohol use. 38 Internet access did not differ by primary substance of use, baseline drug abstinence versus non-abstinence, recent days of drug and/or alcohol use, or by psychiatric or medical health measures. Specialty treatment settings are in a unique position to expand capacity by leveraging web-based interventions for patients presenting with a range of substance use and psychiatric disorders.…”

Impulsivity as a vulnerability factor for poor addiction treatment outcomes: A review of neurocognitive findings among individuals with substance use disorders

“…However, whereas previous review articles have focused on the relationship between neurocognitive impairment, cognitive rehabilitation and addiction treatment outcomes (Bates et al, 2013) and on the neurobiology of cognitive control/reward processes and their role in recovery (Garavan & Weierstall, 2012), none of these studies were systematic reviews nor focused specifically on the role of impulsivity.…”

“…Growing recognition of the centrality of neurocognitive impairments related to impulsivity in addiction should bring with it more attempts to examine the effects of these deficits on treatment outcomes, as this may result in an increased emphasis on top-down and bottom-up rehabilitation in treatment (Bates et al, 2013;Garavan & Weierstall, 2012). Whereas the available evidence is rather scarce and methodological differences made it difficult to make direct comparisons between studies, a conceptual integration of the reviewed findings suggests that cognitive (dis)inhibition of drug-related words, delay discounting and impulsive/risky decision-making are clinically relevant and may have prognostic utility in the treatment of alcohol and drug dependent individuals.…”

“…Growing recognition of the centrality of neurocognitive impairments related to impulsivity in addiction should bring with it more attempts to examine the effects of these deficits on treatment outcomes, as this may result in an increased emphasis on top-down and bottom-up rehabilitation (Bates, Buckman, & Nguyen, 2013;Garavan & Weierstall, 2012). Indeed, different from the chronicity of memory loss in Alzheimer or motor dysfunction in Parkinson disease, aspects of impulsive action and impulsive choice are amenable to treatment and may -at least partially -recover by targeting top-down and bottom-up processes (Alfonso, Caracuel, Delgado-Pastor, & Verdejo-García, 2011;Bickel, Yi, Landes, Hill, & Baxter, 2011).…”

Daño cerebral relacionado con el alcohol. Situación actual y llamada a la acción

“…They emerge from a complex net of variables that often interact in a modulation/ moderation way (Bates, Buckman & Nguyen, 2013). Therefore, their alterations might not fit into categorical taxonomies.…”