Performance on Cognitive Screening Tests and Long-Term Substance Use Outcomes in Patients with Polysubstance Use Disorder.

INTRODUCTION: Cognitive impairments among patients with substance use disorders are prevalent and associated with adverse treatment outcomes. However, knowledge of the predictive value of broad cognitive screening instruments on long-term treatment outcomes is limited. The present study aimed to examine the predictive value of measures from the Montreal Cognitive Assessment® (MoCA®), Wechsler Abbreviated Scale of Intelligence (WASI), and the Behaviour Rating Inventory of Executive Function - Adult version (BRIEF-A) on self-reported long-term substance use and abstinence in patients with polysubstance use disorders (pSUD). METHODS: A cohort (N = 164) of patients with pSUD who started a new treatment sequence in the Stavanger University Hospital catchment area were recruited and followed prospectively for 5 years. Participants completed neurocognitive testing with the MoCA®, WASI, and BRIEF-A at inclusion and were categorized as cognitively impaired or non-impaired according to recommended cut-off values. The sum score of the items from the Drug Use Disorders Identification Test Consumption scale (DUDIT-C) was used as a measure of substance use outcome 1 and 5 years after inclusion. We defined substance abstinence (DUDIT-C = 0) and heavy substance use (DUDIT-C ≥7) to determine whether cognitive impairments measured by the respective instruments were associated with and could predict abstinence and heavy substance use 1 and 5 years after baseline. RESULTS: At the 1-year follow-up, 54% of the total sample reported total abstinence from substances. Conversely, 31% presented heavy substance use. At 5 years, 64% of the total sample reported abstinence from substances, while 25% presented heavy substance use. The results showed a statistically significant association between cognitive impairment defined from MoCA® and higher continuous scores on DUDIT-C at 1-year follow-up. There were no differences in substance abstinence or heavy substance use between patients with and without cognitive impairment at the 1- and 5-year follow-ups. Furthermore, cognitive impairment did not explain substance abstinence or heavy substance use at the 1- and 5-year follow-ups. CONCLUSION: Generally, individuals with pSUD may be burdened and lack psychosocial resources to such an extent that cognitive functioning plays a subordinate role in long-term recovery. The present study suggests that results on screening tools assessing broad cognitive domains at treatment initiation have limited clinical value in predicting long-term substance use outcomes. There is a need to establish clinically viable instruments to assess cognitive functions with well-established clinical and ecological validity in the SUD population.

Personality and substance use disorder: Characteristics as measured by NEO-personality inventory-revised.

The present study investigates the personality characteristics of a cohort of patients with Substance Use Disorders. The included participants (n = 123) were recruited from specialized treatment for addictions in Norway. The personality scores in the current sample were compared to the Norwegian norm sample with t-tests. Age and gender differences in personality scores were assessed by bivariate correlation analyses and t-tests, respectively. The sample had higher scores on Neuroticism and lower scores on Conscientiousness, Agreeableness, Extraversion, and Openness compared to the norm sample (p < 0.01). The effect sizes of the differences between the current sample and the Norwegian norm sample were large for Neuroticism and Conscientiousness. Older participants scored higher on Agreeableness and its facets A1: Trust and A2: Straightforwardness and lower on the facet E5: Excitement-Seeking (p < 0.01). No significant (p < 0.01) gender differences in NEO-PI-R scores were found. In conclusion, the current results support previous findings regarding personality traits associated with SUD. The clinical relevance of the findings is discussed.

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

Objective: To determine the prevalence and associated demographic and clinical features of borderline intellectual functioning (BIF) among individuals with polysubstance use disorder (pSUD). Methods: We applied a cross-sectional analytical design to data from the Norwegian STAYER study (n = 162), a cohort study of patients with a pSUD from the Stavanger University hospital catchment area. We used Wechsler Abbreviated Scale of Intelligence Full Scale IQ (FSIQ) to define BIF (FSIQ = 70-85) and non-BIF (FSIQ = >85) and collected demographic and clinical data using semi-structured interviews and self-reports on the Symptom Checklist 90-Revised (SCL-90-R) and the Satisfaction With Life Scale (SWLS). Results: The prevalence of BIF was 18% in the present study. The presence of BIF was associated with higher SCL-90-R GSI scores than in the non-BIF group. There were no significant differences between the BIF and non-BIF groups regarding age, gender, participation in meaningful daily activity, years of work experience, years of education, satisfaction with life, level of care, treatment attempts, age at substance-use onset, years of substance use, history of injecting drugs, or age of onset of injecting drugs. Conclusion: The present study confirmed a higher prevalence of BIF among patients with pSUD than expected from the distribution of IQ scores in a general population. Elevated SCL-90-R GSI scores suggested that BIF is associated with increased psychological distress in patients receiving treatment for pSUD. Further studies on this association, and its effect on treatment procedure and outcomes are strongly warranted.

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

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.

Measuring cognitive impairment in young adults with polysubstance use disorder with MoCA or BRIEF-A - The significance of psychiatric symptoms.

INTRODUCTION: Chronic polysubstance use disorder (PSUD) is associated with cognitive impairments. These impairments affect the quality of life, occupational functioning, and the ability to benefit from therapy. Psychological distress also affects neurocognitive status, and impaired neurocognition characterizes several psychiatric conditions. Neurocognitive assessment is thus of importance but faces several interpretive challenges. One is disentangling the link between psychological distress and cognitive impairment. This paper investigates the associations between psychological distress and two cognitive screening tools, the Montreal Cognitive Assessment (MoCA) and the Behavior Rating Inventory of Executive Function - Adult Version (BRIEF-A) in young adults with PSUD. MATERIAL AND METHODS: This study included 104 patients with PSUD recruited from the Norwegian Stayer study. Participants completed the MoCA, a self-report measure of executive functioning (EF), the BRIEF-A, and the Symptom Checklist 90 Revised, a measure of psychiatric symptoms (SCL-90-R). Cognitive impairment was diagnosed in accordance with previously published cutoff scores for the MoCA and BRIEF-A. Correlation analysis and multiple logistic regression were used to evaluate the association between cognitive impairment identified with the MoCA or BRIEF-A and psychological distress. RESULTS: More than a third (34.6%) of patients scored below the threshold for cognitive impairment on the MoCA. On the BRIEF-A, 63.2% of participants reported executive problems that exceeded what was expected based on previously published norms. SCL-90-R scores were, as expected, elevated when compared with normative scores. Logistic regression analysis demonstrated a significant association between cognitive impairment identified by the BRIEF-A and scores on the SCL-90-R Global Severity Index (OR = 17.3, 95% CI: 4.4-68.8, p < 0.001) and age (OR = 0.7, 95% CI: 0.6-0.9, p = 0.003). Cognitive impairment identified by the MoCA was not significantly associated with demographic variables or SCL-90-R GSI score in multiple regression analysis. CONCLUSIONS: Our study indicated that the MoCA is a measure of cognitive impairment that is independent of psychological distress, as measured with the SCL-90-R, whereas the BRIEF-A Global Executive Composite is strongly associated with distress. This suggests the need to interpret BRIEF-A results within a broad differential diagnostic context, where the assessment of psychological distress is included. The findings support that performance-based assessment such as the MoCA could reduce the impact of psychological distress in cognitive screening.

One-year sobriety improves satisfaction with life, executive functions and psychological distress among patients with polysubstance use disorder.

INTRODUCTION: Polysubstance use disorder is prevalent in treatment-seeking patients with substance use disorder (SUD), with a higher risk of developing comorbid psychiatric symptoms, more pervasive deficits in cognitive functions, and inferior treatment results. The present study investigates if individuals with polysubstance use disorder who achieve at least one year of abstinence show greater improvements in satisfaction with life, executive functions, and psychological distress, compared to relapsers and controls. The prospective recovery from polysubstance use disorder assessed with broad output indicators remains understudied. A better understanding of the pattern of recovery of the chosen output indicators could shed light on the recovery process for this group of patients. MATERIAL AND METHODS: We investigated changes in satisfaction with life, executive functions and psychological distress over a period of 12months in patients who remained abstinent and in those who relapsed. Subjects with polysubstance use disorder (N=115) were recruited from outpatient and residential treatment facilities; healthy controls (N=34) were recruited by posters exhibited at social welfare and GP offices. Executive functions were assessed by the Behaviour Rating Inventory of Executive Function-Adult self-report version (BRIEF-A), psychological distress by the Symptom Checklist-90-R (SCL-90-R), and satisfaction with life by the Satisfaction With Life Scale (SWLS). Substance use was assessed by self-reports on the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT). Participants were categorized as "relapsers" if they had AUDIT score ≥8, or DUDIT score ≥2 for women and ≥6 for men. RESULTS: Results indicated that the abstinent group had the greatest improvement on all the indicators compared with relapsers and controls. Participants who successfully quit substance use for one year showed improved satisfaction with life, executive functions, and psychological distress compared to participants who relapsed and controls. CONCLUSIONS: Our study provides support for the view that there is a clinically and statistically significant recovery of satisfaction with life, executive functions, and psychological distress for SUD patients following one-year of abstinence. This knowledge highlights the importance of time and continued abstinence. Our findings suggest that a gradual and careful step-up of learning requirement should be adopted, and SUD treatment should initially focus on stabilizing the patient and achieving abstinence, while interventions for co-morbid problems and more cognitively demanding treatment components are more likely to succeed later in the treatment sequence.

One-year abstinence improves ADHD symptoms among patients with polysubstance use disorder.

INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) is a common comorbid disorder in patients suffering from substance use disorder (SUD). Individuals with co-occurring SUD and ADHD are more likely than SUD patients without ADHD to have developed SUD at a younger age, be polysubstance users, and need inpatient treatment more often. The present study investigates whether individuals with polysubstance use disorder who remain abstinent for a year after entering treatment have a more substantial reduction in ADHD symptoms than those who relapsed and controls. MATERIAL AND METHODS: Subjects were SUD patients (N = 115) and healthy controls (N = 34). ADHD symptoms were assessed using the adult ADHD Self-Report Scale (ASRS). Substance use was assessed by self-reports on the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT). Participants were defined as having relapsed if they had an AUDIT score ≥ 8 or a DUDIT score ≥ 2 for women and ≥ 6 for men. RESULTS: Patients who remained abstinent for one year reported a substantial reduction of ADHD symptoms compared to patients who relapsed and controls. CONCLUSIONS: Abstinence alleviates ADHD symptoms among patients with polysubstance use disorder. We suggest that confirmation of an ADHD diagnosis should follow a period of abstinence to avoid identification of false-positive cases.

Assessment of Executive Function in Patients With Substance Use Disorder: A Comparison of Inventory- and Performance-Based Assessment.

INTRODUCTION: Chronic polysubstance abuse (SUD) is associated with neurophysiological and neuroanatomical changes. Neurocognitive impairment tends to affect quality of life, occupational functioning, and the ability to benefit from therapy. Neurocognitive assessment is thus of importance, but costly and not widely available. Therefore, in a busy clinical setting, procedures that include readily available measures targeting core cognitive deficits would be beneficial. This paper investigates the utility of psychometric tests and a questionnaire-based inventory to assess "hot" and "cold" neurocognitive measures of executive functions (EF) in adults with a substance use disorder. Hot decision-making processes are associated with emotional, affective, and visceral responses, while cold executive functions are associated with rational decision-making. MATERIAL AND METHODS: Subjects with polysubstance abuse (n=126) and healthy controls (n=32) were compared on hot (Iowa Gambling Task) and cold (Stroop and the Trail Making Test) measures of EF, in addition to a questionnaire assessing everyday EF related problems (BRIEF-A; Behavior Rating Inventory of Executive Function - Adult, self-report version). Information about the substance abuse and social adjustment were assessed by self-report. Logistic regression analyses were applied to assess independent correlates of SUD status and social adjustment. A multiple linear regression was performed to predict the number of previous treatment attempts. RESULTS: The psychometric test of hot EF (the Iowa Gambling Task) did not differentiate the patients with polysubstance abuse from controls, and was not associated with social adjustment. The psychometric tests of cold EF distinguished somewhat between the groups and were associated with one indicator of social adjustment. The BRIEF-A differentiated between groups on all the clinical scales and was associated with three out of five social adjustment indicators ("criminal lifestyle," "conflict with caregiver," and "stable housing."). CONCLUSIONS: The BRIEF-A inventory was the most sensitive measure of executive function in patients with substance use disorder, followed by measures of cold executive function. BRIEF-A should therefore be considered as an integral part of the clinical routine when assessing patients with SUD.