title: Mediated and moderated effects of neurocognitive impairment on outcomes of treatment for substance dependence and major depression.
abstract: OBJECTIVE
  Neurocognitive impairment has not consistently predicted substance use treatment outcomes but has been linked to proximal mediators of outcome. These indirect effects have not been examined in adults with substance dependence and co-occurring psychiatric disorders. We examined mediators and moderators of the effects of neurocognitive impairment on substance use among adults in treatment for alcohol or drug dependence and major depression (MDD).
  
  
  METHODS
  Participants were veterans (N = 197, mean age = 49.3 years, 90% male, 75% Caucasian) in a trial of 2 group interventions for alcohol/drug dependence and MDD. Measures examined here included intake neurocognitive assessments and percent days drinking (PDD), percent days using drugs (PDDRG), self-efficacy, 12-step affiliation, and depressive symptoms measured every 3 months from intake to the 18-month follow-up.
  
  
  RESULTS
  Greater intake neurocognitive impairment predicted lower self-efficacy, lower 12-step affiliation, and greater depression severity, and these time-varying variables mediated the effects of impairment on future PDD and PDDRG. The prospective effects of 12-step affiliation on future PDD were greater for those with greater neurocognitive impairment. Impairment also interacted with depression to moderate the effects of 12-step affiliation and self-efficacy on PDD. Adults with greater impairment and currently severe depression had the strongest associations between 12-step affiliation/self-efficacy and future drinking.
  
  
  CONCLUSIONS
  Greater neurocognitive impairment may lead to poorer outcomes from group therapy for alcohol/drug dependence and MDD due to compromised change in therapeutic processes. Distal factors such as neurocognitive impairment can interact with dynamic risk factors to modulate the association between therapeutic processes and future drinking outcomes.
authors.affiliation: San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Worley
authors.affiliation: Veterans Affairs San Diego Health Care System.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Tate
authors.affiliation: Veterans Affairs San Diego Health Care System.
authors.forename: Eric
authors.initials: E
authors.lastname: Granholm
authors.affiliation: Department of Psychology, University of California-San Diego.
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Brown
mesh_terms: D000328:Adult; D000436:Alcoholics Anonymous; D000437:Alcoholism / Q000628:therapy; D060825:Cognitive Dysfunction / Q000523:psychology*; D003865:Major Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011613:Psychotherapy; D020377:Self Efficacy; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome; D014481:United States; D014728:Veterans