Neuropsychological predictors of the attainment of treatment objectives in substance abuse patients.

This study examined the contribution of neuropsychological functioning to the attainment of treatment objectives in substance abuse patients. Subjects were 85 patients enrolled in comprehensive, inpatient and outpatient substance abuse treatment at a VA Medical Center. Most subjects were diagnosed with Alcohol Dependence or Abuse, and nearly half were seeking treatment for Cocaine Dependence or Abuse. After acute detoxification, but before beginning individualized treatment, subjects were administered a neuropsychological screening battery to assess cognitive functioning and affective status. They then attended a variety of daily group therapies. Each therapy group had its own set of specific treatment objectives; on each treatment day, group therapists rated each patient's attainment of the specific objectives for their group. Groups included Assertiveness Training (Levels I and II), Stress Management (Levels I and II), Social Skills Training, Job Skills, Relapse Prevention (Levels I and II), Leisure Planning, Leisure Skills, Occupational Therapy, and 12-Step Study. Stepwise multiple regression indicated that the best predictors of overall objective attainment were better attention (WMS-R Digits Backwards) and less depressive symptomatology (Beck Depression Inventory). These results suggest that attention and mood have a modest yet significant impact on the success of treatment interventions for substance abuse patients. Thus, evaluation of cognitive as well as affective factors in substance abuse patients might be helpful in designing and implementing specialized interventions to maximize the likelihood of treatment success.

Satisfaction of parents with their conduct-disordered and substance-abusing youth.

This study examined parental satisfaction (using the Parent Satisfaction With Youth Scale) in 132 parents of adolescents who were dually diagnosed with conduct disorder/oppositional defiant disorder and drug abuse/dependence. Results indicated parental satisfaction did not vary as a function of age, ethnic minority status, or gender. Parents of younger youth were generally more dissatisfied than parents of older adolescents although younger youth were no more delinquent than older youth. These results suggest that parents of delinquent youth become tolerant of their children's behavior problems with time. As expected, parents were most dissatisfied with their youth's use of drugs, illicit behavior, school performance, and response to discipline. Parents who endorsed lower levels of satisfaction reported their youth engaged in more pronounced levels of problem behavior and more drug use than did parents who were relatively more satisfied with their youth. Study implications and future directions are discussed.

Satisfaction of conduct-disordered and substance-abusing youth with their parents.

Conduct-disordered and substance-abusing adolescents (N = 132) completed the Youth Happiness With Parent Scale (YHPS). The YHPS measures youth happiness with parental behaviors across 11 domains (e.g., communication, chores, and discipline) as well as a single item reflecting overall happiness. Results indicated that youth satisfaction did not vary as a function of parents' or youths' age, ethnic minority status, or gender. Although youth were relatively dissatisfied with their parents across behavioral domains (particularly illegal behaviors, drug use, school conduct, and alcohol use), they were fairly satisfied with their parents overall. Youth happiness with parental behaviors was negatively related to externalizing but not internalizing behavioral problems of the youth. Study implications and future directions are discussed in light of the results.

Assessment of cognitive functioning in men who batter.

The present investigation examined neuropsychological functioning in 50 male batterers court-ordered into treatment and 23 nonpatient controls. Subjects were administered a neuropsychological screening battery consisting of the Screening Test for the Luria-Nebraska Neuropsychological Battery, the Stroop Color and Word Test, two memory subtests from the Luria-Nebraska Neuropsychological Battery-III (Figural Memory and Delayed Figural Memory), and two subtests from the Halstead-Reitan Neuropsychological Battery (Trails A & B). Subjects were categorized as having neuropsychological dysfunction if their scores exceeded the statistical cut offs on two or more subtests. Results indicated that 24 (48%) of the male batterers exhibited cognitive dysfunction, as compared to only 1 (4.3%) of the nonpatient controls. Inspection of individual neuropsychological measures indicated poorer performance across all subtests for impaired male batterers as compared to both nonimpaired batterers and normal controls. In contrast, no significant differences on any of these measures emerged between nonimpaired male batterers and normal controls. Implications for the appropriate screening and treatment of male batterers are discussed.

Prevalence and treatment of substance abuse in the mentally retarded population: an empirical review.

This article presents the first comprehensive review of studies of alcohol and illicit substance use in mentally retarded individuals, including prevalence, and recommendations for assessment and treatment. Mentally retarded persons appear to use/abuse alcohol at about the same rate as their noncognitively-impaired counterparts, and illicit drugs at moderately lower rates. However, little is known regarding which assessments and interventions are most effective in this population, given the absence of published treatment outcome studies and case examples. This is particularly disconcerting as detrimental consequences resulting from substance use have been identified in mentally retarded samples. Anecdotal data suggests that treatment for these individuals require modifications of existing empirically-derived substance abuse interventions to accommodate their unique needs.

The relationship of neuropsychological functioning to measures of substance use in an adolescent drug abusing sample.

The purpose of this research was to investigate the relationship between recent and long term substance use on adolescents' neuropsychological functioning. Subjects were 77 adolescents who were referred for outpatient treatment for drug and conduct problems. Subjects were administered the Luria-Nebraska Neuropsychological Battery-III, structured interviews to assess substance use, and urine tests. Subjects were divided into neuropsychologically impaired and nonimpaired groups. Results indicated no significant group differences for: self-reports of lifetime use of alcohol, cannabis, and hard drugs; self or collateral reports of recent (past 30 days) use of alcohol, cannabis, and hard drugs; or urinalysis detection of alcohol, cannabis, and hard drugs. Correlations between these dependent measures of substance use and neuropsychological functioning were also nonsignificant (all ps > .05). Although neuropsychological impairment was observed for some subjects in this sample, it was unrelated to their cannabis, hard drug, or alcohol use. These results are consistent with those found in the adult literature, given the relatively short period of time that these youth have used such substances. However, given the severity of their absolute levels of substance usage, they may be at greater risk for developing future neuropsychological problems, related directly to the ingestion of alcohol and illicit drugs, and to their secondary effects (e.g., head traumas, malnutrition).

Concurrent validity and analysis of learning curves on the memory scales of the Luria-Nebraska Neuropsychological Battery-Third Edition.

The purpose of this investigation was to evaluate the concurrent validity of the Luria-Nebraska Neuropsychological Battery-Third Edition (LNNB-III) memory scales with the WSM-R (study 1), as well as to investigate performance differences between brain-injured and nonbrain injured subjects on the LNNB-III memory indices, first trial learning, and learning curves of each scale (study 2). Study 1 had 90 subjects (46 males and 44 females). Study 2 had 228 subjects (109 normals and 119 brain-injured). Significant correlations were found between the LNNB-III memory scales and the WSM-R index scores. Findings also revealed poorer overall performance and initial learning of brain-injured subjects across all LNNB-III memory scales. Brain-injured subjects also demonstrated significantly reduced learning curves across repeated trials on two of the three scales. The clinical implications of these findings are discussed.

Identification of neuropsychological subtypes in a sample of delinquent adolescents.

Although research has long recognized a relationship between neurological dysfunction and delinquency, the nature of this relationship is unclear. Based on the theory that there may be clusters of delinquents with different types of neurological dysfunction which contribute to the delinquency in different ways, the present research attempted to identify these subtypes using neuropsychological testing. Seventy-seven such adolescents were administered the full Luria-Nebraska Neuropsychological Battery-III (LNNB-III) and a battery of assessments measuring behavioral functioning and substance use. A Hierarchical Cluster Analysis yielded four identifiable neuropsychological clusters: Verbal/Left-Hemispheric Deficits, Subcortical-Frontal Deficits, Mild-Verbal Deficits, and Normals. The distinctiveness of these subtypes was confirmed by univariate analyses. Results further indicated that the number of LNNB scales that were in the abnormal range differed per subtype, with each subtype differing significantly from one another. These neuropsychological subtypes were found to be associated with specific psychological and behavioral problems.

Prediction of WAIS-R indices based on performance on the Luria Nebraska Neuropsychological Battery-III.

The purpose of this research was to examine the clinical utility of the Luria-Nebraska Neuropsychological Battery-Third Edition (LNNB-III) in estimating intellectual functioning as measured by the WAIS-R. Ninety-one subjects were administered the WAIS-R and the LNNB-III. Multiple regression were calculated to examine the ability of the LNNB-III clinical scales to predict FSIQ, VIQ, and PIQ indices. The LNNB-III General Intelligence Scale (GI) predicted FSIQ within 10 points 79% of the time, and within 15 points 97% of the time. Similarly, GI predicted VIQ and PIQ indices with 67% accuracy within 10 points and with 91% and 87% accuracy, respectively, within 15 points. A combination of LNNB clinical scales fared no better than GI alone when predicting the FSIQ index. However, a combination of LNNB-III scales predicted VIQ with 80% accuracy within 10 points and with 94% accuracy within 15 points. In contrast, a combination of LNNB-III clinical scales predicted the PIQ index 76% of the time within 10 points and 90% of the time within 15 points. GI appears to be a good alternative when an estimate of intellectual functioning is desired given its less than 10 minute administration time. When greater specificity regarding VIQ and PIQ estimates are desired, a combination of specific LNNB-III scales appear preferable.

Internal consistency and discriminant validity of the Luria Nebraska Neuropsychological Battery-III.

This research presents data pertaining to the development of the recently revised Luria Nebraska Neuropsychological Battery-III. The final version of this test battery consists of 31 clinical scales yielding 35 scores. The battery was given to 109 non brain-injured controls and 119 brain-injured subjects. High internal consistency was demonstrated for each clinical scale. Results further indicated that the test battery was very effective at discriminating between normal and brain-injured subjects, as significant between-group differences on 33 of 35 scores were observed. Significant between-group differences were also observed on 25 of the 35 scores when age and education were covaried out of the analyses; those scales not displaying significant between-group differences generally measured very basic over-learned skills.

A multimodal approach to treatment of aggression in a severely brain-injured adolescent.

This case study presents a multimodal treatment approach to the rehabilitation of a severely brain-injured adolescent exhibiting significant aggressive and noncompliant behaviors. All treatments were mass-rehearsed in an overly concrete manner, given her cognitive deficits. Specific interventions included contingency management, stimulus control, problem solving, social skills training, relaxation training, anger management, and parent training. Results indicated a significant reduction in delinquent and aggressive behaviors and in social and attention problems. This success was maintained at an 8-month follow-up. These findings may assist nurses, rehabilitation specialists, and families to better manage aggressive and noncompliant behaviors that frequently follow a traumatic brain injury.

Evaluation of an instructional program for improving medication compliance for chronically mentally ill outpatients.

Outpatient medication adherence is a major problem, especially for patients repeatedly hospitalized for psychiatric disorders. This study included 39 such patients who were receiving case management services from a community mental health center. Patients were matched and randomly assigned to receive in a single session either (1) information regarding medication and its benefits, (2) guidelines for assuring adherence which encompassed all phases related to pill-taking including filling prescriptions, use of a pill container, transportation, self-reminders, doctor's appointments and so forth, or (3) the same guidelines as (2) above but given in the presence of a family member who was enlisted in support. The results showed that adherence increased to about 94% after the guidelines were given for both the individual and family guideline procedure, whereas adherence remained unchanged at 73% after the medication information procedure. These results suggest a practical means for assuring a high level of medication adherence for patients with psychiatric disorders.