The Montreal Cognitive Assessment as a predictor of dropout from residential substance use disorder treatment

Abstract

Background Cognitive function is a challenge for many SUD patients, and residential SUD treatment is cognitively demanding. Treatment retention is a predictor for success in SUD treatment, and the literature links low cognitive function to increased dropout rates. In our study we investigate cognitive function and dropout in a residential SUD treatment setting, also accounting for psychological distress. Methods We screened a cohort (N = 142) of inpatients for cognitive function (MoCA®) and psychological distress (SCL-10) and calculated the relative risk for dropping out if over versus under the respective cut-off values (<26 and >1.85), and sex, and age-group (<23 years). We also employed a logistic regression with dropout as outcome and MoCA- and SCL-10 scores, and age and days before testing as input. Results Dropout risk was higher (RR = 1.70) if scoring below MoCA cut-off, and for those younger than 23 years (RR = 2.36). The other variables did not influence dropout risk. MoCA raw scores, age, and SCL-10 were associated with dropout (p < .05); with lower symptoms of psychological distress predicting increased dropout. The interaction between MoCA and SCL-10 scores was not significant (p = .26). Conclusions SUD patients should routinely be screened for cognitive impairment, as it predicts dropout. Screenings should be ensued by appropriate adaptations to treatment and further assessment. The MoCA is a useful screening tool for this, independent of psychological distress. Future studies should replicate our findings, investigate specific interventions, and establish SUD population norms for the MoCA.

Prevalence and Characteristics of Borderline Intellectual Functioning in a Cohort of Patients With Polysubstance Use Disorder

“…Individuals with BIF may not only be severely impaired; they are also less likely to receive adequate treatment for mental health issues, less likely to receive psychotherapy, and more likely to be treated with psychotropic medication than individuals with mental health problems in the general population ( 10 , 22 ). This is obviously the case in individuals with co-occurring BIF and SUD; they tend to show adverse rehabilitation outcomes when offered mainstream SUD treatment, because of factors such as reduced disposition to change and desire for help ( 23 , 24 ), lower treatment compliance ( 25 ), high drop-out rate ( 26 – 28 ), relapse during treatment ( 29 ), and negative treatment experiences ( 30 ). Therefore, it is alarming to realize that impaired intellectual functioning is often overlooked in treatment programs for patients with SUD, even though it can be a key clinical factor in predicting treatment needs and prognosis ( 24 , 29 , 31 – 34 ).…”

Cognitive Screening of Pakistani Substance-Dependent Male Patients using Montreal Cognitive Assessment Score (MoCA)

“…Apart from conventional cognitive impairment screening, MoCA has also been validated in criterion related measures such as predicting treatment attendance [16] and drop-out rates [17]. Both, the studies supported the validity of MoCA in predicting a clinically relevant behavior.…”

A Comprehensive Approach to Understanding Substance Use Disorder and Recovery: Former Patients’ Experiences and Reflections on the Recovery Process Four Years After Discharge from SUD Treatment

“…Norwegian health authorities refer to and pay for the treatment. In the Tyrili cohort 2016 study, quantitative methods were used to examine quality of life, cognitive functioning, psychological distress and experiences of trauma among 138 patients [5,40]. Most of these patients consented to participate in further sub-studies.…”