Neuropsychological Testing and Substance Use Disorders
By Ronnit Nazarian, Psy.D.
Most of us are aware of the long standing emotional and behavioral effects of substance abuse. However, the more subtle and detrimental effects that are harder to assess are the negative impacts substance abuse has on a person’s cognitive abilities (e.g., short term memory, fluid reasoning, processing speed). For example, we see that opioid addiction increases depressive emotions and behaviors. More subtle impacts of opioid addiction, according to research, is the effect on a person’s prefrontal cortex and temporal lobe.2 Consequently, these areas of impact in turn affect a person’s cognitive abilities, which we can identify with a neuropsychological evaluation. Specifically, with an impact on the prefrontal cortex (e.g., influences emotion, memory, and executive function) and temporal lobe (e.g., influences language and visual perception), we would find that most opioid users would have difficulty retaining visual memory, comprehending spoken language, planning, and making decisions.2 Before going into the most common areas impacted by substance abuse, let’s discuss what neuropsychological testing is and how it can inform the type of treatment plan you receive medically and therapeutically.
What is a Neuropsychological Evaluation?
A neuropsychological evaluation is an in-depth assessment of a person’s cognitive strengths and weaknesses, academic achievement, and social emotional functioning. The evaluation measures areas such as attention, emotions, executive functioning, memory, visual-spatial reasoning, processing speed, verbal comprehension, reading, writing, and math. In order to assess a person’s neuropsychological functioning, a variety of measures are administered such as the Wechsler Adult Intelligence Scale, Woodcock Johnson Test of Cognitive Abilities, Wechsler Individual Achievement Test, Minnesota Multiphasic Personality Inventory, Conners 3, and many others. Concerns that suggest for neuropsychological testing are typically difficulties in the following areas: attention, memory, problem solving, and comprehension. These concerns can be due to a variety of reasons (e.g., Anxiety, Depression), as well as an underlying effect of substance use.
What are the benefits of a Neuropsychological Evaluation?
A major benefit of having a neuropsychological evaluation is using the results to assist professionals and clients in obtaining a comprehensive picture of the client’s concern and, consequently, informing their selection of an effective treatment for the client. For example, let’s imagine a client who is experiencing symptoms of anxiety, neuropsychological testing can inform the patient in understanding that their presentation of anxiety impacts their processing speed (ability to complete tasks within the allotted time) and verbal memory. If this were an adult client, this information can be valuable in understanding the difficulty of working in high pressure environments with timelines on projects and demand for high quality work. Tying it back to therapy, neuropsychological testing assists the therapist to better understand the impact of the concern on the client’s life across different settings (e.g., work, school, home, relationships), which can in turn influence the therapeutic treatment to be centered around the client’s needs.
With neuropsychological testing, we can also find the current impacts of substance abuse on a person’s functioning. In addition, the evaluation can help identify long standing underlying conditions (e.g., Post-Traumatic Stress Disorder, Anxiety Disorders, Bipolar Disorder, Depression) that may have driven substance use to begin with. For example, research shows clients who abuse specific substances may have presented with anxiety since a young age, which could have influenced their use of substances in order to cope with the anxiety.4 In other cases with neuropsychological testing, we may find that the client experienced a traumatic event, which triggered an increase in alcohol usage and leading to dependence in order to cope.3
What are common impacts of substance abuse on cognitive abilities?
An overwhelming amount of research shows that people with addiction typically have cognitive deficits affecting predominantly executive functions, decision making, emotion regulation, attention, and memory.1 The cognitive area impacted differs as a function of the principal drug of choice. Specifically, research has shown that “cocaine and methamphetamine are linked to deficits in working memory, response inhibition, cognitive flexibility, and decision making. Opioid addiction is associated with deficits in verbal episodic and working memory as well as fluency and decision-making. Alcohol addiction relates to cognitive deficits across the board, spanning from basic abilities such as speed and language to attention and memory and more complex executive functions and decision-making. Cannabis addiction, however, is linked to specific alterations in episodic memory although they can be short-lived. MDMA (ecstasy) users also show discrete alterations of memory processes. Most populations with addiction problems have deficits in emotion processing and regulation as well as social cognition and interaction problems.”2
Can cognitive abilities improve after being impacted by substance use?
While these areas are heavily impacted, there are effective therapies out that can help alleviate the impact of substance abuse and result in improvements (e.g., Cognitive Behavior Therapy, Dialectical Behavior Therapy, Individualized Withdrawal Treatments, Motivational Interviewing, Medication Management, Group Therapy).6 With the ability to use neuropsychological test to identify areas of concern and the influence on use of substance abuse, we can use this information to pave the way for treatment planning and effectively treat these areas to show improvements and change.
At Fifth Avenue Psychiatry, we strive to provide our clients with an integrative and client centered approach. We gather pertinent information across all areas of a client’s life and then formulate a more tailored treatment plan. Neuropsychological testing is one aspect of informing an effective treatment plan that is individualized and improving recovery by understanding a person’s psychological functioning. It will allow you to understand the experiences, abilities, and areas that may impact you.
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- Bruijnen, C., Dijkstra, B., Walvoort, S., Markus, W., VanDerNagel, J., Kessels, R., & DE Jong, C. (2019). Prevalence of cognitive impairment in patients with substance use disorder. Drug and alcohol review, 38(4), 435–442. https://doi.org/10.1111/dar.12922
- García, A.V. (2018). The neuropsychologist working in addiction: What to know? Ten questions and answers. Revista Iberoamericana de Neuropsicología, 1(2), 170-179.
- Khoury, L., Tang, Y. L., Bradley, B., Cubells, J. F., & Ressler, K. J. (2010). Substance use, childhood traumatic experience, and Posttraumatic Stress Disorder in an urban civilian population. Depression and anxiety, 27(12), 1077–1086. https://doi.org/10.1002/da.20751
- McCauley Ohannessian C. (2014). Anxiety and substance use during adolescence. Substance abuse, 35(4), 418– https://doi.org/10.1080/08897077.2014.953663
- Punzi, E. H. (2015). Neuropsychological Assessment in Substance Abuse Treatment—Focusing on the Effects of Substances and on Neuropsychological Assessment as a Collaborative Process. Smith College Studies in Social Work, 85(2), 128-145. doi: 1080/00377317.2015.1017357
- Sofuoglu, M., DeVito, E. E., Waters, A. J., & Carroll, K. M. (2013). Cognitive enhancement as a treatment for drug addictions. Neuropharmacology, 64(1), 452– https://doi.org/10.1016/j.neuropharm.2012.06.021
