title: Cognitive impairment influences drinking outcome by altering therapeutic mechanisms of change.
abstract: Serious neuropsychological impairments are seen in a minority of addiction treatment clients, and, theoretically, these impairments should undermine behavioral changes targeted by treatment; however, little evidence supports a direct influence of impairment on treatment response. To address this paradox, the authors used structural equation modeling and Project MATCH data (N=1,726) to examine direct, mediated, and moderated paths between cognitive impairment, therapeutic processes, and treatment outcome. Mediated relations were found, wherein impairment led to less treatment compliance, lower self-efficacy, and greater Alcoholics Anonymous Involvement, which, in turn, more proximally predicted drinking. Impairment further moderated the effect of self-efficacy, making it a poor predictor of drinking outcomes in impaired clients, thereby suggesting that impaired and unimpaired clients traverse different pathways to addiction recovery.
authors.affiliation: Center of Alcohol Studies, Rutgers University, Piscataway, NJ, USA. mebates@rci.rutgers.edu
authors.forename: Marsha E
authors.initials: ME
authors.lastname: Bates
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Pawlak
authors.forename: J Scott
authors.initials: JS
authors.lastname: Tonigan
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Buckman
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000453:epidemiology* / Q000534:rehabilitation*; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D010349:Patient Compliance / Q000706:statistics & numerical data; D016896:Treatment Outcome