Remediation therapy in patients with alcohol use disorders and neurocognitive disorders: A Pilot Study

Authors

  • Cindy Frías-Torres Unidad de Conductas Adictivas, Hospital Clínico, Barcelona
  • José Moreno-España Unidad de Conductas Adictivas, Hospital Clínico, Barcelona
  • Lluisa Ortega Unidad de Conductas Adictivas, Hospital Clínico, Barcelona
  • Pablo Barrio Unidad de Conductas Adictivas, Hospital Clínico, Barcelona
  • Antoni Gual Unidad de Conductas Adictivas, Hospital Clínico, Barcelona
  • Lídia Teixidor López Unidad de Conductas Adictivas, Hospital Clínico, Barcelona

DOI:

https://doi.org/10.20882/adicciones.757

Keywords:

Alcohol dependence, Cognitive impairment, Cognitive remediation, Alcohol-related brain damage

Abstract

Many alcohol-dependent patients suffer from cognitive impairment of variable severity, manifested by alterations in retrograde and anterograde memory, visuospatial processing, cognitive abilities and attention, some of which are reversible. In this context, cognitive remediation therapies could significantly improve patients’ performance; therefore, these are considered a valuable alternative. The aim of this study was to implement cognitive remediation therapy in patients with alcohol dependence and cognitive impairment and evaluate its viability and effectiveness. The participants were sixteen abstinent, alcohol-dependent patients (mean age of 59 years, 63% males) from the Addictive Behaviours Unit of a tertiary hospital. Over 6 months, a nurse led 1-hour weekly sessions (24 sessions in total) during which exercises for improving functional, social and cognitive performance were completed. Patients were assessed at baseline, at the end of the study and 6 months later, using the Mini-Mental State Examination (MMSE) and the Memory Alteration Test (M@T). Their respective scores were 26.4 (SD 3.16), 29 (SD 1.67) and 27 (SD 3.1) for the MMSE and 38.7 (SD 6.81), 45.7 (SD 5.6) and 41.1 (SD 7.86) for the M@T. Changes were assessed with both Friedman and Wilcoxon signed-rank tests, with mostly statistically significant differences (p < 0.05). Assistance and satisfaction were high. Therefore, the therapy was viable, widely accepted and effective.

References

Alfonso, J. P., Caracuel, A., Delgado-Pastor, L. C., y Verdejo-García, A. (2011). Combined Goal Management Training and Mindfulness meditation improve executive functions and decision-making performance in abstinent polysubstance abusers. Drug and Alcohol Dependence, 117, 78–81. doi:10.1016/j.drugalcdep.2010.12.025

Allen, D. N., Goldstein, G., y Seaton, B. E. (1997). Cognitive rehabilitation of chronic alcohol abusers. Neuropsychology Review, 7, 21–39. 

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed). Washington, DC. 

Bates, M., y Buckam, J. (2013.). Integrating body and brain ssytems in addiction neuroscience. In P. Miller (Ed.), Encyclopedia of Addictive Behaviors. Elsevier.

Bates, M. E., Bowden, S. C., y Barry, D. (2002). Neurocognitive impairment associated with alcohol use disorders: implications for treatment. Experimental and Clinical Psychopharmacology, 10, 193–212. 

Bates, M. E., Buckman, J. F., y Nguyen, T. T. (2013). A role for cognitive rehabilitation in increasing the effectiveness of treatment for alcohol use disorders. Neuropsychology Review, 23, 27–47. doi:10.1007/s11065-013-9228-3

Bernardin, F., Maheut-Bosser, A., y Paille, F. (2014). Cognitive impairments in alcohol-dependent subjects. Frontiers in Psychiatry, 5, 78. doi:10.3389/fpsyt.2014.00078

Bickel, W. K., Yi, R., Landes, R. D., Hill, P. F., y Baxter, C. (2011). Remember the future: working memory training decreases delay discounting among stimulant addicts. Biological Psychiatry, 69, 260–265. doi:10.1016/j.biopsych.2010.08.017

Brown, R. A., Abrantes, A. M., Minami, H., Read, J. P., Marcus, B. H., Jakicic, J. M., … Stuart, G. L. (2014). A preliminary, randomized trial of aerobic exercise for alcohol dependence. Journal of Substance Abuse Treatment, 47, 1–9. doi:10.1016/j.jsat.2014.02.004

Chiesa, A., Calati, R., y Serretti, A. (2011). Does mindfulness training improve cognitive abilities? A systematic review of neuropsychological findings. Clinical Psychology Review, 31, 449–464. doi:10.1016/j.cpr.2010.11.003

Crum, R. M., Anthony, J. C., Bassett, S. S., y Folstein, M. F. (1993). Population-based norms for the Mini-Mental State Examination by age and educational level. JAMA, 269, 2386–2391. 

Glass, J. M., Buu, A., Adams, K. M., Nigg, J. T., Puttler, L. I., Jester, J. M., y Zucker, R. A. (2009). Effects of alcoholism severity and smoking on executive neurocognitive function. Addiction, 104, 38–48. doi:10.1111/j.1360-0443.2008.02415.x

Goldman, M. S. (1990). Experience-dependent neuropsychological recovery and the treatment of chronic alcoholism. Neuropsychology Review, 1, 75–101. 

Gongvatana, A., Morgan, E. E., Iudicello, J. E., Letendre, S. L., Grant, I., y Woods, S. P. (2014). A history of alcohol dependence augments HIV-associated neurocognitive deficits in persons aged 60 and older. Journal of Neurovirology, 20, 505–513. doi:10.1007/s13365-014-0277-z

Houben, K., Havermans, R. C., Nederkoorn, C., y Jansen, A. (2012). Beer à no-go: learning to stop responding to alcohol cues reduces alcohol intake via reduced affective associations rather than increased response inhibition. Addiction, 107, 1280–1287. doi:10.1111/j.1360-0443.2012.03827.x

Houben, K., y Wiers, R. W. (2009). Response inhibition moderates the relationship between implicit associations and drinking behavior. Alcoholism, Clinical and Experimental Research, 33, 626–633. doi:10.1111/j.1530-0277.2008.00877.x

Houben, K., Wiers, R. W., y Jansen, A. (2011). Getting a grip on drinking behavior: training working memory to reduce alcohol abuse. Psychological Science, 22, 968–975. doi:10.1177/0956797611412392

Huebner, R. B., y Kantor, L. W. (2010). Advances in alcoholism treatment. Alcohol Research and Health, 33, 295-299.

Lawrence, A. J., Luty, J., Bogdan, N. A., Sahakian, B. J., y Clark, L. (2009). Problem gamblers share deficits in impulsive decision-making with alcohol-dependent individuals. Addiction, 104, 1006–1015. doi:10.1111/j.1360-0443.2009.02533.x

Levine, B., Schweizer, T. A., O’Connor, C., Turner, G., Gillingham, S., Stuss, D. T., … Robertson, I. H. (2011). Rehabilitation of executive functioning in patients with frontal lobe brain damage with goal management training. Frontiers in Human Neuroscience, 5, 9. doi:10.3389/fnhum.2011.00009

Miller, P., Plant, M. L., Plant, M. A., Ozenturk, T., Doyle, D., Fong, J., y Mylchreest, K. (2008). Gender, alcohol, drugs, and health: A comparison of the Isle of Man and the UK. Journal of Substance Use, 13, 389–403. doi:10.1080/14659890802211762

Pedrero-Perez, E. J., Rojo-Mota, G., Ruiz-Sanchez de Leon, J. M., Llanero-Luque, M., y Puerta-Garcia, C. (2011). Cognitive remediation in addictions treatment. Revista de Neurologia, 52, 163–172. 

Rami, L., Bosch, B., Valls-Pedret, C., Caprile, C., Sánchez-Valle Díaz, R., y Molinuevo, J. L. (2009). Discriminatory validity and association of the mini-mental test (MMSE) and the memory alteration test (M@T) with a neuropsychological battery in patients with amnestic mild cognitive impairment and Alzheimer’s disease. Revista de Neurologia, 49, 169–174. 

Rami, L., Molinuevo, J. L., Sanchez-Valle, R., Bosch, B., y Villar, A. (2007). Screening for amnestic mild cognitive impairment and early Alzheimer’s disease with M@T (Memory Alteration Test) in the primary care population. International Journal of Geriatric Psychiatry, 22, 294–304. doi:10.1002/gps.1672

Rojo Mota, G., Pedrero Pérez, E. J., Ruiz Sánchez de León, J. M., Llanero Luque, M., Olivar Arroyo, Á., y Puerta García, C. (2009). Terapia Ocupacional en la rehabilitación de la disfunción ejecutiva en adictos a sustancias. Trastornos Adictivos, 11, 96–105. doi:10.1016/S1575-0973(09)72057-4

Rosón Hernández, B. (2008). Consumo de riesgo y perjudicial de aclohol. Prevalencia y metodos de deteccion en la práctica clínica. Galicia Clínica, 69, 29–44.

Rupp, C. I., Fleischhacker, W. W., Drexler, A., Hausmann, A., Hinterhuber, H., y Kurz, M. (2006). Executive function and memory in relation to olfactory deficits in alcohol-dependent patients. Alcoholism, Clinical and Experimental Research, 30, 1355–1362. doi:10.1111/j.1530-0277.2006.00162.x

Rupp, C. I., Kemmler, G., Kurz, M., Hinterhuber, H., y Fleischhacker, W. W. (2012). Cognitive remediation therapy during treatment for alcohol dependence. Journal of Studies on Alcohol and Drugs, 73, 625–634. 

Ryan, T., y Rothwell, V. (2010). Residential alcohol detoxification: new role for mental health nurses. British Journal of Nursing, 6, 280–284. doi:10.12968/bjon.1997.6.5.280

Schuckit, M. A. (2009). Alcohol-use disorders. Lancet, 373, 492–501. doi:10.1016/S0140-6736(09)60009-X

Soler González, C., Balcells Oliveró, M., y Gual Solé, A. (2014). Alcohol related brain damage. State of the art and a call for action. Adicciones, 26, 199–207. 

Surkan, P. J., Fielding-Miller, R., y Melchior, M. (2012). Parental relationship satisfaction in French young adults associated with alcohol abuse and dependence. Addictive Behaviors, 33, 313–317. doi:10.1016/j.addbeh.2011.10.008

Varela-Rey, M., Woodhoo, A., Martinez-Chantar, M.-L., Mato, J. M., y Lu, S. C. (2013). Alcohol, DNA methylation, and cancer. Alcohol Research: Current Reviews, 35, 25–35. 

Wiers, R. W., Eberl, C., Rinck, M., Becker, E. S., y Lindenmeyer, J. (2011). Retraining automatic action tendencies changes alcoholic patients’ approach bias for alcohol and improves treatment outcome. Psychological Science, 22), 490–497. doi:10.1177/0956797611400615

Yeh, P.-H., Gazdzinski, S., Durazzo, T. C., Sjöstrand, K., y Meyerhoff, D. J. (2007). Hierarchical linear modeling (HLM) of longitudinal brain structural and cognitive changes in alcohol-dependent individuals during sobriety. Drug and Alcohol Dependence, 91, 195–204. doi:10.1016/j.drugalcdep.2007.05.027

Published

2018-04-15

Issue

Section

Originals