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.

The internal consistency and convergent and discriminant validity of the d2 Test, a cancellation test of attention and concentration, was examined in a sample of 364 U.S. adults. Test-taking strategy, new process scores for assessing performance constancy, and relations to gender and education were explored. Results suggested that the d2 Test is an internally consistent and valid measure of visual scanning accuracy and speed. Overall performance scores were related to a proxy measure of test-taking strategy in the expected direction, and new acceleration and deterioration measures exhibited convergent validity. Suggested directions for future research include discrimination of attentional processes that support immediate and sustained visual scanning accuracy and speed, further examination of the impact of test-taking strategies on overall performance measures, and additional construct validity examinations for the new process measures.

Context: Neurocognitive mechanisms have long been hypothesized to influence developmental trajectories of antisocial behavior. However, studies examining this association tend to aggregate a variety of problem behaviors that may be differently affected by neurocognitive deficits.Objective: To describe the developmental trajectories of physical violence and theft from adolescence to adulthood, their associations, and the neurocognitive characteristics of individuals following different patterns of trajectory association.Design: Accelerated cohort-sequential, longitudinal design.Setting: Rutgers Health and Human Development Project.Participants: Six hundred ninety-eight men.Main Outcome Measures: Self-reports of physical violence (ages 12-24 years) and theft (ages 12-31 years) were collected across 5 waves. Neurocognitive performance was assessed with executive function and verbal IQ tests between late adolescence and early adulthood. Results:The majority (55%) of subjects showed an increased frequency of theft during the study period, while only a minority (13%) evinced an increasing frequency of physical violence. Executive function and verbal IQ performance were negatively related to high frequency of physical violence but positively related to high frequency of theft.Conclusions: Developmental trajectories of physical violence and theft during adolescence and early adulthood are different and differently related to neurocognitive functioning. Global indexes of antisocial behavior mask the development of antisocial behavior subtypes and putative causal mechanisms.

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.

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.

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Background-Impulsive behavior in humans predicts the onset of drinking during adolescence and alcohol use disorders (AUDs) in adulthood. It is also possible, however, that heavy drinking may increase impulsive behavior by affecting the development of brain areas that support behavioral control or through other associated mechanisms. This study examined whether drinking heavily during adolescence is related to changes in impulsive behavior with a specific focus on how the association differs across individuals, contingent on the developmental course of their impulsiveness.

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