Neuropsychological Impact Of Multiple Substance Use Disorders

As compared with non-polysubstance-using drug abusers, those with multiple SUDs demonstrate the greatest degree of chronic neuropsychological impairment and recover the least function with long-term abstinence (Beatty et al., 1997; Medina, Shear, Schafer, Armstrong, & Dyer, 2003). This may be due in part to the increased cumulative exposure of the brain to drugs and alcohol: Multiple substance users tend to use as much of a particular substance (e.g., alcohol or cocaine) as those who use only alcohol or cocaine (Selby & Azrin, 1998). Selby and Azrin (1998) conducted a comprehensive neuropsychological battery with 355 prison inmates classified by DSM-IV criteria into four groups: those with alcohol use disorders, cocaine use disorders, multiple SUDs, and no history of SUD. The multiple SUDs and the alcohol groups demonstrated significant impairment on most measures compared to the cocaine or no-drug groups, but the multiple SUDs group performed worse than the cocaine alone, alcohol alone or no SUD groups on measures of short-term memory, long-term memory, and visual motor ability. Beatty and colleagues (1997) found analogous results in their neuropsychological evaluation of spatial cognition in multiple SUD and non-multiple-SUD inpatient alcoholics who had at least 3 weeks of sobriety. Multiple SUD patients had significant impairment of geographical knowledge requiring place localization, over and above the impairment on all other measures of visuospatial perception, construction, learning, and memory that all of the alcoholics had compared to controls. After 3 weeks of sobriety, alcoholics with multiple SUD compared to alcoholics without multiple SUD also demonstrate greater memory deficits in tests of recall (Bondi, Drake, & Grant, 1998). The heavy cocaine users among the alcoholics had the worst deficits, suggestive of subcortical dysfunction due to small vessel infarcts. Subjects with multiple SUDs also demonstrated impaired decision making through poor performance on the Gambling Task compared to non-drug-using controls (suggesting dysfunction of the ventromedial prefrontal cortex [Bechara, 1999; Grant et al., 2000]).

Given the neuropsychological effects of multiple SUDs, it is important to recognize that the baseline cognitive function also has a role in vulnerability to multiple SUDs. Premorbid intellectual functioning is a predictor of drug use: Compared to matched non-drug-using controls, multiple substance users were demonstrated to have lower fourth-grade Iowa Test composite and individual scores on Vocabulary, Reading, Language, Work-Study Skills, and Mathematics tests (Block, Erwin, & Ghoneim, 2002)

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