Research 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 present proposal will continue 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. Since evidence has accumulated that neuropsychological status is related to alchoholism treatment outcome, procedures for maximizing cognitive recovery may serve to increase success rates for alcoholism treatment. Specifically, in a series of recent studies we have obtained strong 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. The pattern of results from these studies has suggested that improvement due to experience-dependent recovery may be a consequence of enhanced attentional mechanisms, rather than the recovery of specific neuropsychological deficits, e.g., visuospatial deficits. The first study in the proposal will investigate this issue. A compound task designed specifically to tap attentional processes will be compared with a previously used visuospatial neuropsychological task in relation to their efficacy at promoting experience-dependent recovery. A six-group (4 alcoholics, 2 control) extended neuropsychological recovery research design will be used in this study. The second proposed study will assess the impact on actual alcoholism treatment outcome of adding to a standard alcoholism treatment program a multi-component cognitive remediation strategy. In this study, treatment outcome will be assessed at 3, 6, and 12 months after discharge using measures which tap general life functioning, as well as alcohol- consumption parameters.
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