Recent investigations of the neuropsychological sequelae of chronic alcoholism have provided a general outline of the nature and time course of recovery of deficits in alcoholics once they cease drinking. The intent of the present proposal is to begin the application of knowledge deriving from the above research to the problem of ensuring maximal neuropsychological recovery following alcoholism and, concomitantly, to improving alcoholism treatment by maximizing cognitive recovery. We do not suggest that the neuropsychological sequelae of alcoholism have been thoroughly elaborated, but for the first time, sufficient guidelines do appear available for the initial application of neuropsychological knowledge to active intervention into the recovery process. Specifically, we have recently obtained evidence that some cognitive functions recover by experience-dependent processes, i.e., by those processes that are engaged when an individual gets repeated experience with tasks that tap the cognitive function in question. Experience-dependent recovery contrasts with recovery that occurs merely as a function of time passing, presumably due to spontaneously occurring biological processes. If experience-dependent recovery can be demonstrated for certain cognitive functions, e.g., visuo-spatial, concept-formation, and memory, that had been thought to be permanently impaired in alcoholics, then our alcoholism treatment strategies may show improved outcomes with the addition of cognitive remediation procedures. The current proposal presents one study which uses an extended neuropsychological recovery research design to separate time-dependent from experience-dependent recovery of visuo-spatial and concept-formation abilities. This design will also assess the transfer of learning from the training tasks to other tasks. We will thus determine if the alcoholic is merely improving on a specific task, or is recovering an ability. The second proposed study will use a standard, 3-group, psychotherapy evaluation design to assess the impact of cognitive remediation on actual alcoholism treatment outcome measured at 3, 6, and 12 months after discharge.
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