A Role for Cognitive Rehabilitation in Increasing the Effectiveness of Treatment for Alcohol Use Disorders
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REVIEW
A Role for Cognitive Rehabilitation in Increasing the Effectiveness of Treatment for Alcohol Use Disorders Marsha E. Bates & Jennifer F. Buckman & Tam T. Nguyen
Received: 19 December 2012 / Accepted: 31 January 2013 / Published online: 15 February 2013 # Springer Science+Business Media New York 2013
Abstract 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 M. E. Bates (*) : J. F. Buckman : T. T. Nguyen Center of Alcohol Studies, Rutgers, The State University of New Jersey, 607 Allison Road, Piscataway, NJ 08854-8001, USA e-mail: [email protected]
research are considered as promising future directions for effective treatment development that includes cognitive rehabilitation. Keywords Alcoholism . Cognitive impairment . Brain damage . Cognitive recovery . Cognitive enhancement . Cognitive training
Introduction In 1987, a prescient overview of research on alcoholassociated impairment of the central nervous system and its potential significance to the efficacy of treatment for alcoholism appeared in Parsons, Butters and Nathan’s edited volume, Neuropsychology of Alcoholism: Implications for diagnosis and treatment (Parsons et al. 1987). Studies using computed tomography scans and electroencephalography had documented altered brain structure and function in chronic, heavy drinkers. In parallel, neuropsychological tes
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