Differential spontaneous recovery across cognitive abilities during detoxification period in alcohol-dependence

Abstract

ObjectiveThere is a lack of consensus regarding the extent to which cognitive dysfunctions may recover upon cessation of alcohol intake by alcohol-dependents (AD), and the divergent findings are most likely due to methodological differences between the various studies. The present study was aimed at conducting a very strict longitudinal study of cognitive recovery in terms of assessment points, the duration of abstinence, control of age and duration of the addiction, and by use of individual analyses in addition to mean group comparisons. Our study further focused on the 2–3 week phase of alcohol detoxification that is already known to positively affect many biological, emotional, motivational, as well as neural variables, followed by longer-term therapies for which good cognitive functioning is needed.Methods41 AD inpatients undergoing a detoxification program, and 41 matched controls, were evaluated twice in terms of five cognitive functions (i.e., short-term memory, working memory, inhibition, cognitive flexibility, and verbal fluency) within a three-week interval [on the first day (T1) and the 18th day (T2) of abstinence for AD patients]. Emotional (positive and negative affectivity and depression) and motivational (craving) variables were also measured at both evaluation times.ResultsAlthough verbal fluency, short-term memory, and cognitive flexibility did not appear to be affected, the patients exhibited impaired inhibition and working memory at T1. While no recovery of inhibition was found to occur, the average working memory performance of the patients was comparable to that of the controls at T2. Improvements in emotional and motivational dimensions were also observed, although they did not correlate with the ones in working memory. Individual analysis showed that not all participants were impaired or recover the same functions.ConclusionsWhile inhibition deficits appear to persist after 18 days of detoxification, deficits in working memory, which is a central component of cognition, are greatly reduced after alcohol detoxification. Individual differences in the trajectory of recovery do arise however, and it might be worth implementing individual assessments of impaired functions at the end of the detoxification phase in order to maximize the chances of success in longer-term treatments and abstinence.

Ergebnisqualität bei alkohol- und substanzbezogenen Störungen: eine Auswertung stationär behandelter Patienten aus 10 psychiatrischen Kliniken

“…In den häufigen Behandlungsfällen der Intoxikation und des Entzuges findet zu Beginn der Behandlung in den ersten Stunden und Tagen oftmals eine erhebliche klinische Besserung statt, allerdings ohne durchgreifende Verbesserung der Grunderkrankung (Abhängigkeit) [16]. Somit bieten CGI und GAF die Möglichkeit, diese Besserung abzubilden, allerdings nicht die Remission von Eigenschaften der Abhängigkeitserkrankung, wie die verminderte Kontrolle über den Substanzkonsum oder das Auftreten von Suchtdruck (Craving).…”

“…Wird die durchschnittliche Besserung beider Instrumente gegen die Aufenthaltsdauer aufgetragen, zeigen sich optimale Änderungen erst nach 3-4 Wochen stationärer Behandlung. Dies stützt die Hypothese, dass es sich bei ASUD um mutmaßlich schwer und komorbid kranke und beeinträchtigte Personen handelt, die einen längeren stationären Aufenthalt auch in der Akutbehandlung benötigen, um eine ausreichende Besserung für die ambulante oder rehabilitative Postakutbehandlung zu erreichen, möglicherweise weil die Personen sich hinsichtlich ihrer kognitiven Eigenschaften noch nicht ausreichend von den toxischen Effekten der jeweiligen Substanz und deren Entzug erholt haben [15,16]. Welchen Einfluss komorbide psychische und somatische Erkrankungen auf die Besserung und die Dauer des stationären Aufenthalts haben, kann möglicherweise in den Vitos-QI-Datensätzen der Folgejahre besser analysiert und beurteilt werden.…”

Brain Structure and Function in Recovery

“… 31 Longitudinal studies also found substantive differences in change trajectories across domains, supporting the general conclusions derived from cross-sectional comparisons of subgroups of people with AUD who differed in abstinence length. 4 Petit and colleagues 32 recently investigated the effects of abstinence on alcohol-related working memory and inhibitory control deficits. By the third week of abstinence, working memory function was indistinguishable between the AUD and control groups, whereas inhibitory control deficits remained.…”

Cognitive remediation therapy of working memory in addictive disorders: An individualized, tailored, and recovery-oriented approach

“…For instance, in alcohol use disorder, some patients fully recover from their cognitive impairments after alcohol detoxification, others still present neurocognitive impairments after 1 year of abstinence, and others may have permanent impairments [10]. In particular, one study stressed that after 2-3 weeks of alcohol detoxification, only half of the patients who exhibited impairments in working memory at the beginning of detoxification spontaneously recovered [20]. Cognitive remediation therapy studies have, however, largely ignored these interindividual differences.…”