Introduction: Retaining clients in residential alcohol and other drug (AOD) treatment is difficul... more Introduction: Retaining clients in residential alcohol and other drug (AOD) treatment is difficult and cognitive impairment has been identified as a significant predictor of treatment dropout. The application of extensive screening for cognitive impairment is cost-prohibitive for most AOD treatment services. The current study aimed to explore cognitive functioning and impairment-associated factors in a typical sample of residential AOD clients using a free brief screening tool that could be utilised by front-line AOD services. Methods: Residents of an AOD therapeutic community (n = 128) and a non-substance using control group (n = 37) were administered a brief cognitive screening measure, the Montreal Cognitive Assessment (MoCA). MoCA total and domain scores were compared between these groups and within the AOD group examined in association with primary substance of misuse, severity of dependence, gender, psychological distress, and history of head injury. Results: Almost half (43.8%) of the AOD sample were identified as cognitively impaired, compared to 16.2% of the control group. Furthermore, 67.2% of the AOD sample had sustained head injuries and 50% of the sample required hospitalization for head injury. History of head injury was a significant determinant of cognitive impairment, and associated with greater levels of psychological distress. Conclusions: There are high rates of interrelated cognitive impairment, head injuries, and psychological distress among clients in residential AOD treatment. Routine screening of clients at intake for cognitive impairment by means of a brief screening measure such as the MoCA, in combination with the assessment of history of head injuries and comorbid psychological disorders, could inform treatment modifications or adjunct interventions to increase retention and improve long-term outcomes.
AimsSubstance use disorders (SUD) are associated with cognitive deficits that are not always addr... more AimsSubstance use disorders (SUD) are associated with cognitive deficits that are not always addressed in current treatments, and this hampers recovery. Cognitive training and remediation interventions are well suited to fill the gap for managing cognitive deficits in SUD. We aimed to reach consensus on recommendations for developing and applying these interventions.Design, Setting and ParticipantsWe used a Delphi approach with two sequential phases: survey development and iterative surveying of experts. This was an on‐line study. During survey development, we engaged a group of 15 experts from a working group of the International Society of Addiction Medicine (Steering Committee). During the surveying process, we engaged a larger pool of experts (n = 54) identified via recommendations from the Steering Committee and a systematic review.MeasurementsSurvey with 67 items covering four key areas of intervention development: targets, intervention approaches, active ingredients and modes of delivery.FindingsAcross two iterative rounds (98% retention rate), the experts reached a consensus on 50 items including: (i) implicit biases, positive affect, arousal, executive functions and social processing as key targets of interventions; (ii) cognitive bias modification, contingency management, emotion regulation training and cognitive remediation as preferred approaches; (iii) practice, feedback, difficulty‐titration, bias modification, goal‐setting, strategy learning and meta‐awareness as active ingredients; and (iv) both addiction treatment work‐force and specialized neuropsychologists facilitating delivery, together with novel digital‐based delivery modalities.ConclusionsExpert recommendations on cognitive training and remediation for substance use disorders highlight the relevance of targeting implicit biases, reward, emotion regulation and higher‐order cognitive skills via well‐validated intervention approaches qualified with mechanistic techniques and flexible delivery options.
Cognitive remediation improves executive functions, self-regulation and quality of life in reside... more Cognitive remediation improves executive functions, self-regulation and quality of life in residents of a substance use disorder therapeutic community
At least one in four patients with substance use disorder (SUD) meet criteria for personality dis... more At least one in four patients with substance use disorder (SUD) meet criteria for personality disorder and overlapping neurocognitive deficits may reflect shared neurobiological mechanisms. We studied neurocognition in females attending residential SUD treatment by comparing SUD with (n = 20) or without (n = 30) comorbid personality disorder. Neuropsychological testing included working memory, inhibition, shifting, verbal fluency, design fluency, psychomotor speed, immediate and delayed verbal memory, processing speed, premorbid functioning, cognitive screening, and self-reported executive function. As expected, whole-sample deficits included working memory (d = -.91), self-reported executive function (d = -.87), processing speed (d = -.40), delayed verbal memory recall (d = -.39), premorbid functioning (d = -.51), and cognitive screening performance (d = -.61). Importantly, the comorbid personality disorder group showed greater self-reported executive dysfunction (d = -.67) and poorer shifting performance (d = -.65). However, they also evidenced better working memory (d = .84), immediate (d = .95) and delayed (d = .83) verbal memory, premorbid functioning (d = .90), and cognitive screening performance (d = .77). Overall executive dysfunction deficits were concordant with those observed in previous SUD studies. Surprisingly, comorbid personality disorder was associated with a pattern indicating poorer subjective (self-report) but better objective performance on a number of tasks, apart from shifting deficits that may relate to emotion dysregulation. Subjective emotional dysfunction may influence the cognitive deficits observed in the personality disorder group.
Given Australia's rapidly ageing population, demand for neuropsychological assessment to assist w... more Given Australia's rapidly ageing population, demand for neuropsychological assessment to assist with the diagnosis and treatment/ management of dementia and stroke will increase. Accurate and reliable neuropsychological assessment is dependent on the availability of appropriate normative data. Although more than a quarter of the Australian population comprises culturally and linguistically diverse (CALD) individuals, there have been no CALD-specific normative studies published in Australia to date. The primary purpose of the current study was to collect norms on Australia's largest and one of its fastest growing CALD groups, Chinese Australians. Other aims included delineation of the influence of demographic factors and assessment of reliability coefficients of neuropsychological test scores for Chinese Australians. Method: A battery of neuropsychological tests was administered to N = 145 community dwelling Chinese Australians aged 55-87 years with the assistance of Chinese-speaking interpreters. Results: Multivariate analysis of variance revealed a significant influence of demographic factors across most test scores and norms were provided by the relevant stratifications. The Rey Auditory Verbal Learning Test (RAVLT) and Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) Digit Symbol Coding (DSC) emerged as the most reliable tests for use with Chinese Australians. Conclusion: The influence of demographic variables and reliability coefficients of neuropsychological tests developed for dominant western cultural groups cannot be assumed to be the same across CALD groups. Use of CALD-specific norms is recommended to increase the reliability and validity of neuropsychological testing.
The objective of this study was to determine the test-retest reliability; construct and criterion... more The objective of this study was to determine the test-retest reliability; construct and criterion validity; and test operating characteristics of a newly developed cognitive impairment risk factor screening instrument, the Alcohol and Drug Cognitive Enhancement (ACE) Screening Tool. Participants in the validation study were 129 adults with substance use disorder (SUD) enrolled in residential SUD treatment services and 209 normal controls. Test and retest data were available for 36 participants with SUD and 40 normal control individuals on the ACE Screening Tool. Test-retest reliability was excellent (ICC = 0.97). The ACE Screening Tool was significantly correlated with the Montreal Cognitive Assessment (MoCA), Behavior Rating Inventory of Executive Functioning-Adult Version (BRIEF-A), Test of Premorbid Functioning (TOPF) and Five Point Test, establishing construct validity. Criterion validity was established using a ternary severity variable constructed using results obtained on the MoCA and BRIEF-A. Test operating characteristics analysis showed 93% sensitivity, 46% specificity, 33% positive predictive power, and 96% negative predictive power using a cut-score of >3. Those high levels of sensitivity and negative predictive power indicated that the tool would likely detect cognitive impairment when present and should therefore be considered suitable as an initial screening tool for cognitive impairment in individuals attending SUD services.
Background and Aims: Substance use disorders (SUD) are associated with cognitive deficits that ar... more Background and Aims: Substance use disorders (SUD) are associated with cognitive deficits that are not always addressed in current treatments, and this hampers recovery. Cognitive training and remediation interventions are well suited to fill the gap for managing cognitive deficits in SUD. We aimed to reach consensus on recommendations for developing and applying these interventions. Design: Delphi approach with two sequential phases: survey development and iterative surveying of experts. Setting: Online study. Participants: During survey development, we engaged a group of 15 experts from a working group of the International Society of Addiction Medicine (Steering Committee). During the surveying process, we engaged a larger pool of experts (n=53) identified via recommendations from the Steering Committee and a systematic review. Measurements: Survey with 67 items covering four key areas of intervention development, i.e., targets, intervention approaches, active ingredients, and mod...
At least one in four patients with substance use disorder (SUD) meet criteria for personality dis... more At least one in four patients with substance use disorder (SUD) meet criteria for personality disorder and overlapping neurocognitive deficits may reflect shared neurobiological mechanisms. We studied neurocognition in females attending residential SUD treatment by comparing SUD with (n = 20) or without (n = 30) comorbid personality disorder. Neuropsychological testing included working memory, inhibition, shifting, verbal fluency, design fluency, psychomotor speed, immediate and delayed verbal memory, processing speed, premorbid functioning, cognitive screening, and self-reported executive function. As expected, whole-sample deficits included working memory (d = -.91), self-reported executive function (d = -.87), processing speed (d = -.40), delayed verbal memory recall (d = -.39), premorbid functioning (d = -.51), and cognitive screening performance (d = -.61). Importantly, the comorbid personality disorder group showed greater self-reported executive dysfunction (d = -.67) and poorer shifting performance (d = -.65). However, they also evidenced better working memory (d = .84), immediate (d = .95) and delayed (d = .83) verbal memory, premorbid functioning (d = .90), and cognitive screening performance (d = .77). Overall executive dysfunction deficits were concordant with those observed in previous SUD studies. Surprisingly, comorbid personality disorder was associated with a pattern indicating poorer subjective (self-report) but better objective performance on a number of tasks, apart from shifting deficits that may relate to emotion dysregulation. Subjective emotional dysfunction may influence the cognitive deficits observed in the personality disorder group.
Substance use disorders are associated with diverse neuropsychological impairments, with deficits... more Substance use disorders are associated with diverse neuropsychological impairments, with deficits in memory and executive functioning commonly observed. Cognitive remediation has been shown to be effective in other populations with cognitive impairments in these domains, including those with psychiatric disorders and acquired brain injuries, and it has been hypothesised to be similarly effective for those in treatment for substance use disorders. We aimed to systematically review the evidence for cognitive remediation interventions administered as an adjunct treatment to substance use rehabilitation. Studies were included if participants were receiving substance use treatment, if improving cognitive functioning was the main focus of the intervention and if they used an experimental design with a control condition receiving treatment-as-usual or an active control intervention. Two independent reviewers agreed on the final selection of 32 studies, encompassing cognitive remediation for working memory, memory, executive functioning and general cognition. Significant differences between intervention and control groups for cognitive test results and treatment outcomes were extracted and compared across treatment approaches. The review found considerable heterogeneity across studies, including in the types of interventions, the nature of participants and the outcome measures used. Further, a lack of quality studies with sufficient power meant that limited conclusions could be drawn, highlighting a need for further replication and research. However, findings indicate that cognitive remediation remains a promising potential avenue for improving cognition and treatment outcomes for those in treatment for substance use disorders. Protocol submitted prospectively to PROSPERO 30.09.2019, CRD42020150978.
Accurate screening for cognitive impairment in alcohol and other drug (AOD) services would help t... more Accurate screening for cognitive impairment in alcohol and other drug (AOD) services would help to identify individuals who may need supports to obtain the greatest benefit from substance use disorder (SUD) treatment. At present there is no screening measure that has been developed specifically to detect cognitive impairment in a SUD population. This study examines the psychometric properties of the Brief Executive-function Assessment Tool (BEAT), which was specifically designed for this purpose. This study involving 501 individuals with SUD and 145 normal control participants established internal consistency (n = 646; 0.734), interrater (n = 60; 0.994), and test-retest reliability (n = 177; 0.845), and construct (all correlations p ≤ 0.05), and criterion (n = 467; ANCOVA p < 0.001) validity. Test operating characteristics (n = 500; 87% sensitivity, 71% specificity, 21% PPP, and 99% NPP) were also established relative to an independent criterion variable made up of three established performance-based neuropsychological tests. Findings support the reliability and validity of the BEAT as a screening measure of executive function impairment with high sensitivity and a low rate of false negatives.
Given Australia's rapidly ageing population, demand for neuropsychological assessment to assist w... more Given Australia's rapidly ageing population, demand for neuropsychological assessment to assist with the diagnosis and treatment/ management of dementia and stroke will increase. Accurate and reliable neuropsychological assessment is dependent on the availability of appropriate normative data. Although more than a quarter of the Australian population comprises culturally and linguistically diverse (CALD) individuals, there have been no CALD-specific normative studies published in Australia to date. The primary purpose of the current study was to collect norms on Australia's largest and one of its fastest growing CALD groups, Chinese Australians. Other aims included delineation of the influence of demographic factors and assessment of reliability coefficients of neuropsychological test scores for Chinese Australians. Method: A battery of neuropsychological tests was administered to N = 145 community dwelling Chinese Australians aged 55-87 years with the assistance of Chinese-speaking interpreters. Results: Multivariate analysis of variance revealed a significant influence of demographic factors across most test scores and norms were provided by the relevant stratifications. The Rey Auditory Verbal Learning Test (RAVLT) and Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) Digit Symbol Coding (DSC) emerged as the most reliable tests for use with Chinese Australians. Conclusion: The influence of demographic variables and reliability coefficients of neuropsychological tests developed for dominant western cultural groups cannot be assumed to be the same across CALD groups. Use of CALD-specific norms is recommended to increase the reliability and validity of neuropsychological testing.
Retaining clients in residential alcohol and other drug (AOD) treatment is difficult and cognitiv... more Retaining clients in residential alcohol and other drug (AOD) treatment is difficult and cognitive impairment has been identified as a significant predictor of treatment dropout. The application of extensive screening for cognitive impairment is cost-prohibitive for most AOD treatment services. The current study aimed to explore cognitive functioning and impairment-associated factors in a typical sample of residential AOD clients using a free brief screening tool that could be utilised by front-line AOD services. Residents of an AOD therapeutic community (n=128) and a non-substance using control group (n=37) were administered a brief cognitive screening measure, the Montreal Cognitive Assessment (MoCA). MoCA total and domain scores were compared between these groups and within the AOD group examined in association with primary substance of misuse, severity of dependence, gender, psychological distress, and history of head injury. Almost half (43.8%) of the AOD sample were identified...
Self-regulation is an important prerequisite for successful academic achievement, particularly fo... more Self-regulation is an important prerequisite for successful academic achievement, particularly for children who are at risk for Attention Deficit Hyperactivity Disorder (ADHD). We taught Mental Contrasting with Implementation Intentions (MCII), a technique that is known to facilitate the self-regulation of goal pursuit, to schoolchildren (sixth-and seventh-graders) both at risk and not at risk for ADHD. Parents rated their children's level of selfregulation 2 weeks after the intervention. Children at risk and not at risk benefited from MCII more than from a learning style intervention only and the benefits of MCII were particularly strong for children at risk for ADHD. The results have implications with respect to supporting children's self-regulation in their everyday school lives. Keywords Self-regulation Á Mental contrasting Á Implementation intentions Á Children at risk for ADHD Self-regulation of goal pursuit: Interventions Research outside the field of education suggests that interventions have the potential to improve the self-regulation
Individuals with substance use disorder (SUD) often present with cognitive impairments, which may... more Individuals with substance use disorder (SUD) often present with cognitive impairments, which may impede their ability to make decisions for themselves, including treatment-related decisions. It is therefore important to assess whether individuals with SUD have adequate decision-making capacity. Indeed, there have not been any capacity assessment tools tailored for use with SUD populations that demonstrate adequate psychometric properties or that have the strong ethical foundation that is required of capacity assessment tools. The Compulsory Assessment and Treatment–Capacity Assessment Tool (CAT–CAT) was designed to fill this gap in the literature. Therefore, the aim of this study was to establish the interrater and test–retest reliability, and discriminative validity of the CAT–CAT. The first of this two-part study recruited healthcare professionals in New Zealand and asked them to conduct a capacity assessment on two hypothetical clients. Generally, excellent interrater reliabilit...
Introduction: Retaining clients in residential alcohol and other drug (AOD) treatment is difficul... more Introduction: Retaining clients in residential alcohol and other drug (AOD) treatment is difficult and cognitive impairment has been identified as a significant predictor of treatment dropout. The application of extensive screening for cognitive impairment is cost-prohibitive for most AOD treatment services. The current study aimed to explore cognitive functioning and impairment-associated factors in a typical sample of residential AOD clients using a free brief screening tool that could be utilised by front-line AOD services. Methods: Residents of an AOD therapeutic community (n = 128) and a non-substance using control group (n = 37) were administered a brief cognitive screening measure, the Montreal Cognitive Assessment (MoCA). MoCA total and domain scores were compared between these groups and within the AOD group examined in association with primary substance of misuse, severity of dependence, gender, psychological distress, and history of head injury. Results: Almost half (43.8%) of the AOD sample were identified as cognitively impaired, compared to 16.2% of the control group. Furthermore, 67.2% of the AOD sample had sustained head injuries and 50% of the sample required hospitalization for head injury. History of head injury was a significant determinant of cognitive impairment, and associated with greater levels of psychological distress. Conclusions: There are high rates of interrelated cognitive impairment, head injuries, and psychological distress among clients in residential AOD treatment. Routine screening of clients at intake for cognitive impairment by means of a brief screening measure such as the MoCA, in combination with the assessment of history of head injuries and comorbid psychological disorders, could inform treatment modifications or adjunct interventions to increase retention and improve long-term outcomes.
AimsSubstance use disorders (SUD) are associated with cognitive deficits that are not always addr... more AimsSubstance use disorders (SUD) are associated with cognitive deficits that are not always addressed in current treatments, and this hampers recovery. Cognitive training and remediation interventions are well suited to fill the gap for managing cognitive deficits in SUD. We aimed to reach consensus on recommendations for developing and applying these interventions.Design, Setting and ParticipantsWe used a Delphi approach with two sequential phases: survey development and iterative surveying of experts. This was an on‐line study. During survey development, we engaged a group of 15 experts from a working group of the International Society of Addiction Medicine (Steering Committee). During the surveying process, we engaged a larger pool of experts (n = 54) identified via recommendations from the Steering Committee and a systematic review.MeasurementsSurvey with 67 items covering four key areas of intervention development: targets, intervention approaches, active ingredients and modes of delivery.FindingsAcross two iterative rounds (98% retention rate), the experts reached a consensus on 50 items including: (i) implicit biases, positive affect, arousal, executive functions and social processing as key targets of interventions; (ii) cognitive bias modification, contingency management, emotion regulation training and cognitive remediation as preferred approaches; (iii) practice, feedback, difficulty‐titration, bias modification, goal‐setting, strategy learning and meta‐awareness as active ingredients; and (iv) both addiction treatment work‐force and specialized neuropsychologists facilitating delivery, together with novel digital‐based delivery modalities.ConclusionsExpert recommendations on cognitive training and remediation for substance use disorders highlight the relevance of targeting implicit biases, reward, emotion regulation and higher‐order cognitive skills via well‐validated intervention approaches qualified with mechanistic techniques and flexible delivery options.
Cognitive remediation improves executive functions, self-regulation and quality of life in reside... more Cognitive remediation improves executive functions, self-regulation and quality of life in residents of a substance use disorder therapeutic community
At least one in four patients with substance use disorder (SUD) meet criteria for personality dis... more At least one in four patients with substance use disorder (SUD) meet criteria for personality disorder and overlapping neurocognitive deficits may reflect shared neurobiological mechanisms. We studied neurocognition in females attending residential SUD treatment by comparing SUD with (n = 20) or without (n = 30) comorbid personality disorder. Neuropsychological testing included working memory, inhibition, shifting, verbal fluency, design fluency, psychomotor speed, immediate and delayed verbal memory, processing speed, premorbid functioning, cognitive screening, and self-reported executive function. As expected, whole-sample deficits included working memory (d = -.91), self-reported executive function (d = -.87), processing speed (d = -.40), delayed verbal memory recall (d = -.39), premorbid functioning (d = -.51), and cognitive screening performance (d = -.61). Importantly, the comorbid personality disorder group showed greater self-reported executive dysfunction (d = -.67) and poorer shifting performance (d = -.65). However, they also evidenced better working memory (d = .84), immediate (d = .95) and delayed (d = .83) verbal memory, premorbid functioning (d = .90), and cognitive screening performance (d = .77). Overall executive dysfunction deficits were concordant with those observed in previous SUD studies. Surprisingly, comorbid personality disorder was associated with a pattern indicating poorer subjective (self-report) but better objective performance on a number of tasks, apart from shifting deficits that may relate to emotion dysregulation. Subjective emotional dysfunction may influence the cognitive deficits observed in the personality disorder group.
Given Australia's rapidly ageing population, demand for neuropsychological assessment to assist w... more Given Australia's rapidly ageing population, demand for neuropsychological assessment to assist with the diagnosis and treatment/ management of dementia and stroke will increase. Accurate and reliable neuropsychological assessment is dependent on the availability of appropriate normative data. Although more than a quarter of the Australian population comprises culturally and linguistically diverse (CALD) individuals, there have been no CALD-specific normative studies published in Australia to date. The primary purpose of the current study was to collect norms on Australia's largest and one of its fastest growing CALD groups, Chinese Australians. Other aims included delineation of the influence of demographic factors and assessment of reliability coefficients of neuropsychological test scores for Chinese Australians. Method: A battery of neuropsychological tests was administered to N = 145 community dwelling Chinese Australians aged 55-87 years with the assistance of Chinese-speaking interpreters. Results: Multivariate analysis of variance revealed a significant influence of demographic factors across most test scores and norms were provided by the relevant stratifications. The Rey Auditory Verbal Learning Test (RAVLT) and Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) Digit Symbol Coding (DSC) emerged as the most reliable tests for use with Chinese Australians. Conclusion: The influence of demographic variables and reliability coefficients of neuropsychological tests developed for dominant western cultural groups cannot be assumed to be the same across CALD groups. Use of CALD-specific norms is recommended to increase the reliability and validity of neuropsychological testing.
The objective of this study was to determine the test-retest reliability; construct and criterion... more The objective of this study was to determine the test-retest reliability; construct and criterion validity; and test operating characteristics of a newly developed cognitive impairment risk factor screening instrument, the Alcohol and Drug Cognitive Enhancement (ACE) Screening Tool. Participants in the validation study were 129 adults with substance use disorder (SUD) enrolled in residential SUD treatment services and 209 normal controls. Test and retest data were available for 36 participants with SUD and 40 normal control individuals on the ACE Screening Tool. Test-retest reliability was excellent (ICC = 0.97). The ACE Screening Tool was significantly correlated with the Montreal Cognitive Assessment (MoCA), Behavior Rating Inventory of Executive Functioning-Adult Version (BRIEF-A), Test of Premorbid Functioning (TOPF) and Five Point Test, establishing construct validity. Criterion validity was established using a ternary severity variable constructed using results obtained on the MoCA and BRIEF-A. Test operating characteristics analysis showed 93% sensitivity, 46% specificity, 33% positive predictive power, and 96% negative predictive power using a cut-score of >3. Those high levels of sensitivity and negative predictive power indicated that the tool would likely detect cognitive impairment when present and should therefore be considered suitable as an initial screening tool for cognitive impairment in individuals attending SUD services.
Background and Aims: Substance use disorders (SUD) are associated with cognitive deficits that ar... more Background and Aims: Substance use disorders (SUD) are associated with cognitive deficits that are not always addressed in current treatments, and this hampers recovery. Cognitive training and remediation interventions are well suited to fill the gap for managing cognitive deficits in SUD. We aimed to reach consensus on recommendations for developing and applying these interventions. Design: Delphi approach with two sequential phases: survey development and iterative surveying of experts. Setting: Online study. Participants: During survey development, we engaged a group of 15 experts from a working group of the International Society of Addiction Medicine (Steering Committee). During the surveying process, we engaged a larger pool of experts (n=53) identified via recommendations from the Steering Committee and a systematic review. Measurements: Survey with 67 items covering four key areas of intervention development, i.e., targets, intervention approaches, active ingredients, and mod...
At least one in four patients with substance use disorder (SUD) meet criteria for personality dis... more At least one in four patients with substance use disorder (SUD) meet criteria for personality disorder and overlapping neurocognitive deficits may reflect shared neurobiological mechanisms. We studied neurocognition in females attending residential SUD treatment by comparing SUD with (n = 20) or without (n = 30) comorbid personality disorder. Neuropsychological testing included working memory, inhibition, shifting, verbal fluency, design fluency, psychomotor speed, immediate and delayed verbal memory, processing speed, premorbid functioning, cognitive screening, and self-reported executive function. As expected, whole-sample deficits included working memory (d = -.91), self-reported executive function (d = -.87), processing speed (d = -.40), delayed verbal memory recall (d = -.39), premorbid functioning (d = -.51), and cognitive screening performance (d = -.61). Importantly, the comorbid personality disorder group showed greater self-reported executive dysfunction (d = -.67) and poorer shifting performance (d = -.65). However, they also evidenced better working memory (d = .84), immediate (d = .95) and delayed (d = .83) verbal memory, premorbid functioning (d = .90), and cognitive screening performance (d = .77). Overall executive dysfunction deficits were concordant with those observed in previous SUD studies. Surprisingly, comorbid personality disorder was associated with a pattern indicating poorer subjective (self-report) but better objective performance on a number of tasks, apart from shifting deficits that may relate to emotion dysregulation. Subjective emotional dysfunction may influence the cognitive deficits observed in the personality disorder group.
Substance use disorders are associated with diverse neuropsychological impairments, with deficits... more Substance use disorders are associated with diverse neuropsychological impairments, with deficits in memory and executive functioning commonly observed. Cognitive remediation has been shown to be effective in other populations with cognitive impairments in these domains, including those with psychiatric disorders and acquired brain injuries, and it has been hypothesised to be similarly effective for those in treatment for substance use disorders. We aimed to systematically review the evidence for cognitive remediation interventions administered as an adjunct treatment to substance use rehabilitation. Studies were included if participants were receiving substance use treatment, if improving cognitive functioning was the main focus of the intervention and if they used an experimental design with a control condition receiving treatment-as-usual or an active control intervention. Two independent reviewers agreed on the final selection of 32 studies, encompassing cognitive remediation for working memory, memory, executive functioning and general cognition. Significant differences between intervention and control groups for cognitive test results and treatment outcomes were extracted and compared across treatment approaches. The review found considerable heterogeneity across studies, including in the types of interventions, the nature of participants and the outcome measures used. Further, a lack of quality studies with sufficient power meant that limited conclusions could be drawn, highlighting a need for further replication and research. However, findings indicate that cognitive remediation remains a promising potential avenue for improving cognition and treatment outcomes for those in treatment for substance use disorders. Protocol submitted prospectively to PROSPERO 30.09.2019, CRD42020150978.
Accurate screening for cognitive impairment in alcohol and other drug (AOD) services would help t... more Accurate screening for cognitive impairment in alcohol and other drug (AOD) services would help to identify individuals who may need supports to obtain the greatest benefit from substance use disorder (SUD) treatment. At present there is no screening measure that has been developed specifically to detect cognitive impairment in a SUD population. This study examines the psychometric properties of the Brief Executive-function Assessment Tool (BEAT), which was specifically designed for this purpose. This study involving 501 individuals with SUD and 145 normal control participants established internal consistency (n = 646; 0.734), interrater (n = 60; 0.994), and test-retest reliability (n = 177; 0.845), and construct (all correlations p ≤ 0.05), and criterion (n = 467; ANCOVA p < 0.001) validity. Test operating characteristics (n = 500; 87% sensitivity, 71% specificity, 21% PPP, and 99% NPP) were also established relative to an independent criterion variable made up of three established performance-based neuropsychological tests. Findings support the reliability and validity of the BEAT as a screening measure of executive function impairment with high sensitivity and a low rate of false negatives.
Given Australia's rapidly ageing population, demand for neuropsychological assessment to assist w... more Given Australia's rapidly ageing population, demand for neuropsychological assessment to assist with the diagnosis and treatment/ management of dementia and stroke will increase. Accurate and reliable neuropsychological assessment is dependent on the availability of appropriate normative data. Although more than a quarter of the Australian population comprises culturally and linguistically diverse (CALD) individuals, there have been no CALD-specific normative studies published in Australia to date. The primary purpose of the current study was to collect norms on Australia's largest and one of its fastest growing CALD groups, Chinese Australians. Other aims included delineation of the influence of demographic factors and assessment of reliability coefficients of neuropsychological test scores for Chinese Australians. Method: A battery of neuropsychological tests was administered to N = 145 community dwelling Chinese Australians aged 55-87 years with the assistance of Chinese-speaking interpreters. Results: Multivariate analysis of variance revealed a significant influence of demographic factors across most test scores and norms were provided by the relevant stratifications. The Rey Auditory Verbal Learning Test (RAVLT) and Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) Digit Symbol Coding (DSC) emerged as the most reliable tests for use with Chinese Australians. Conclusion: The influence of demographic variables and reliability coefficients of neuropsychological tests developed for dominant western cultural groups cannot be assumed to be the same across CALD groups. Use of CALD-specific norms is recommended to increase the reliability and validity of neuropsychological testing.
Retaining clients in residential alcohol and other drug (AOD) treatment is difficult and cognitiv... more Retaining clients in residential alcohol and other drug (AOD) treatment is difficult and cognitive impairment has been identified as a significant predictor of treatment dropout. The application of extensive screening for cognitive impairment is cost-prohibitive for most AOD treatment services. The current study aimed to explore cognitive functioning and impairment-associated factors in a typical sample of residential AOD clients using a free brief screening tool that could be utilised by front-line AOD services. Residents of an AOD therapeutic community (n=128) and a non-substance using control group (n=37) were administered a brief cognitive screening measure, the Montreal Cognitive Assessment (MoCA). MoCA total and domain scores were compared between these groups and within the AOD group examined in association with primary substance of misuse, severity of dependence, gender, psychological distress, and history of head injury. Almost half (43.8%) of the AOD sample were identified...
Self-regulation is an important prerequisite for successful academic achievement, particularly fo... more Self-regulation is an important prerequisite for successful academic achievement, particularly for children who are at risk for Attention Deficit Hyperactivity Disorder (ADHD). We taught Mental Contrasting with Implementation Intentions (MCII), a technique that is known to facilitate the self-regulation of goal pursuit, to schoolchildren (sixth-and seventh-graders) both at risk and not at risk for ADHD. Parents rated their children's level of selfregulation 2 weeks after the intervention. Children at risk and not at risk benefited from MCII more than from a learning style intervention only and the benefits of MCII were particularly strong for children at risk for ADHD. The results have implications with respect to supporting children's self-regulation in their everyday school lives. Keywords Self-regulation Á Mental contrasting Á Implementation intentions Á Children at risk for ADHD Self-regulation of goal pursuit: Interventions Research outside the field of education suggests that interventions have the potential to improve the self-regulation
Individuals with substance use disorder (SUD) often present with cognitive impairments, which may... more Individuals with substance use disorder (SUD) often present with cognitive impairments, which may impede their ability to make decisions for themselves, including treatment-related decisions. It is therefore important to assess whether individuals with SUD have adequate decision-making capacity. Indeed, there have not been any capacity assessment tools tailored for use with SUD populations that demonstrate adequate psychometric properties or that have the strong ethical foundation that is required of capacity assessment tools. The Compulsory Assessment and Treatment–Capacity Assessment Tool (CAT–CAT) was designed to fill this gap in the literature. Therefore, the aim of this study was to establish the interrater and test–retest reliability, and discriminative validity of the CAT–CAT. The first of this two-part study recruited healthcare professionals in New Zealand and asked them to conduct a capacity assessment on two hypothetical clients. Generally, excellent interrater reliabilit...
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