Recovery of Cognitive Functioning in Alcoholics: The Relationship to Treatment

A quick review of this issue of Alcohol Health & Research World reveals the impact of chronic excessive alcohol use on cognitive functioning. The most severe impairments are the profound memory dysfunction caused by Wernicke-Korsakoff syndrome (for a definition of this syndrome, see the glossary, pp. 136-137) or the more global intellectual deterioration (including memory impairment) of alcoholic dementia (i.e., general loss of memory functioning, judgment, and abstract thinking). Even among people admitted to alcoholism treatment facilities(1) who show no dramatic cognitive impairment, between 75 and 100 percent of the cases (depending on the samples and measures used) perform below normal for their age group on sensitive tests of cognitive functioning (McCrady and Smith 1986). Until recently, researchers often have attributed the many levels and types of cognitive deficits seen among alcoholics to differing forms of alcohol-related damage to the drinkers' neuroanatomy (i.e., the brain's various parts) and neurophysiology (i.e., the functions of these parts). Researchers considered such differences in impairment to be responsible for any performance discrepancies observed among alcoholics. In addition, researchers attributed Wernicke-Korsakoff amnesia to thiamine deficiency and to the lesions accompanying this syndrome in a variety of brain structures, such as the diencephalon, mammillary bodies, and basal forebrain, which are associated with memory functions (for definitions and further descriptions, see the diagram of the brain on p. 137). Deficits in problem-solving, abstracting (i.e., ascertaining the principles or rules that govern a particular task), and shifting of sets (i.e., recognizing the need for using new rules when the previous rules no longer apply) were associated with frontal lobe damage caused by alcohol consumption or related factors. Some visuospatial impairments were connected with a wasting away (i.e., atrophy) of the frontal and/or right hemisphere. In recent years, however, investigators have used more sophisticated brain imaging and cerebral blood flow techniques and found similar neuroanatomical damage in all alcoholics, including those whose deficits are detectable only on sensitive behavioral tests. Thus, differences in cognitive capacity among alcoholics cannot be attributed exclusively to differences in their neurophysiology. How similar forms of damage to the nervous system can result in differing behavioral consequences, including cognitive deficits, in different alcoholics remains unclear. The behavioral changes that researchers observe may result from the general effects of alcohol-related toxicity and other factors (e.g., head injury, liver damage, psychiatric factors, or neurochemical abnormalities) combined with individual differences, such as age and drinking history (Bowden 1990; National Institute on Alcohol Abuse and Alcoholism 1993). Some researchers also have suggested that a portion of the impairments are present in people with a family history of alcoholism even before they begin consuming alcohol (the accumulated evidence for preexisting dysfunction has been mixed, however; see Drake et al. 1995). Alcohol researchers do not know whether cognitive impairments impede alcoholism treatment. Can a cognitively impaired alcoholic readily absorb all the information that is usually imparted during treatment? Do these deficits make the necessary adjustments and adaptations to a "dry" (i.e., nondrinking) way of life more difficult? If so, can anything be done to help the alcoholic recover from these deficits? This article discusses the partial answers to these questions, first reviewing the course of recovery from alcohol-related deficits, then considering how these deficits may affect treatment outcomes. It concludes by reviewing research on ways to improve treatment outcome by facilitating cognitive recovery. THE NATURE OF THE DEFICITS AND How THEY ARE DETERMINED Test findings from a wide group of studies show that alcoholics are remarkably free of impairment of general intelligence. …