Self‐reported cognitive scales in a US National Survey: reliability, validity, and preliminary evidence for associations with alcohol and drug use

Abstract

Aims To evaluate relationships between measures of cognitive functioning and alcohol or drug use among adults (≥18 years) in the U.S. general population. Design Two cognitive scales were created based on dimensionality and reliability of self-reported Executive Function Index items. Relationships between the two scales and validators were evaluated. Associations between the cognitive scales and past-year frequency of alcohol or drug use were estimated with adjusted odds ratios (aOR). Setting USA, using the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III, a nationally representative adult sample selected by multistage probability sampling. Participants 36,085 respondents. Measurements Past-year substance use outcome variables categorized binge drinking, marijuana, cocaine, opioid, sedative/tranquilizer, and stimulant use as frequent (at least weekly to daily), infrequent (any to 2–3 times/month), or no use, assessed by the Alcohol Use Disorder and Associated Disabilities Interview Schedule-V. Key predictors were the two cognitive scales. Construct validators included education and functional impairment. Covariates included age, gender, income, and race/ethnicity. Findings Nine cognitive items fit a two-factor model (Comparative Fit Index=.973): attention (5 items) and executive functioning (4 items). Both scales were positively associated with higher education (ps<.001) and negatively associated with functional impairment (ps<.001), demonstrating construct validity. Poorer attention was associated with frequent and infrequent binge drinking and use of drugs (aOR range=1.07 [binge drinking] to 1.72 [stimulants], ps≤0.01). Poorer executive functioning was associated with frequent binge drinking and use of drugs (aOR range=1.22 [binge drinking] to 2.03 [cocaine], ps<0.001), and infrequent use of all drugs (aOR range=1.19 [marijuana] to 1.63 [cocaine], ps<0.001). Conclusions Impairments in attention and executive functioning are positively correlated with substance use in the U.S. general population.

Cross-domain correlates of cannabis use disorder severity among young adults

“…Finally, self-reported metacognitive deficits that interfere with daily functioning were associated with CUD severity, as has been found with other substances (Aharonovich et al, 2017;Riggs et al, 2012). Data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) found poorer self-reported attention and executive functioning to be associated with more frequent past-year binge drinking and drug use, with every unit decrease in executive functioning associated with two times increased odds of substance use (Aharonovich et al, 2017). Surprisingly, the current study did not find an association between performance-based cognitive deficits and CUD severity, as demonstrated previously (Crane et al, 2013;Hanson et al, 2010;Lisdahl et al, 2014;Meier et al, 2012).…”

Cognitive functioning and treatment outcomes in a randomized controlled trial of internet‐delivered drug and alcohol treatment

“…Individuals with substance use disorders have significantly lower scores on cognitive testing when compared to the general population . Further, cognitive impairment is associated with poorer outcomes suggesting that interventions which are compatible with a broad range of neuropsychological function are necessary …”

Age Differences in Daily and Nondaily Cannabis Use in the United States, 2002–2014

“…Cannabis use, particularly chronic or frequent use, is associated with a variety of adverse correlates and consequences (Hall & Degenhardt, 2014;Hasin, 2018;Vo lkow et al, 2014Vo lkow et al, , 2016. These include cannabis or other substance use disorders (Blanco et al, 2016;Hall, 2009;Hall & Degenhardt, 2009;Hasin et al, 2015, cognitive impairments (Aharonovich et al, 2017;Auer et al, 2016;Meier et al, 2012), psychiatric symptoms (Davis et al, 2013;Di Forti et al, 2015), driving impairments, and motor vehicle crash injuries (Brady & Li, 2014;Hartman & Huestis, 2013;Hartman et al, 2015Hartman et al, , 2016. Differentiating between frequent and infrequent use is clinically meaningful because some people can use cannabis without harm (Fergusson et al, 2015), whereas those who use cannabis frequently (Hall & Degenhardt, 2014) are reported to be more vulnerable to adverse consequences (Hall, 2015;Hall & Degenhardt, 2009;Vo lkow et al, 2014Vo lkow et al, , 2016.…”