More than half of alcoholics show diffusely distributed neurocognitive impairment at treatment entry. Brain dysfunction usually is not permanent following cessation of use. However, there are individual differences in extent and rate of recovery. This beterogeneity of deficit and of recovery rates suggests that the longitudinal assessment of neurocognitive impairment across multiple domains of functioning is needed to more adequately study the relationship of impairment to outcome following treatment. The goal of this proposal is to obtain funds to complete a computerized data base and planned analyses of the impact of neurocognitive impairment on treatment outcome using longitudinal data previously collected in four treatment outcome studies of alcohol use disordered individuals. Variables assessing predictor and outcome constructs were collected prospectively during the first week of treatment and on three additional occasions spanning 12 mon. The obtained sample was demographicaIly diverse. 217 individuals completed the battery at treatment entry. By imputing data for subjects missing no more than one of the three re-assessments, we will be able to analyze longitudinal data for 81 % of the subjects at 6 wks and 70% of the subjects at 6 and 12 mons. We propose to conduct descriptive analyses of short- and long-term patterns of stability and change in neurocognitive functioning both at the level of manifest variables and broader constructs representing four major domains of functioning: verbal abilities, memory, abstract reasoning/executive functioning, and perceptual/motor skills. Prototypical neurocognitive recovery groups based on initial level and intraindividual changes in neurocognitive functioning over time will be described. Relevant subject characteristics (e.g., age, sex, and familial alcoholism history) will be examined as predictors of differences in initial level and growth trajectories of neurocognitive performance. Differences in initial level and in subsequent changes in neurocognitive functioning will be tested as predictors of short-term (i.e., 6 wks) and longer term (i.e., 6 and 12 mon) treatment outcomes. In a subset of the data (N= 122), we will also test whether initial level and change in neurocognitive functioning moderate the effects of treatment process variables on treatment outcome, and whether their relation differs between those with an alcohol only, other drug only, or alcohol and other drug use disorder. Growth curve trajectories of changes in neurocognitive functioning, especially within the domains of executive controliabstraction and memory, are hypothesized to increase the prediction of treatment outcomes, over and above the effects of initial impairment. Further, initial level and subsequent changes in neurocognitive functioning are predicted to moderate the relation of change process factors (e.g. self-efficacy) to treatment outcomes.
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