The differential roles of objective neuropsychological testing and self report measures in assessing neurocognitive impairment in relation to addiction severity among alcohol abusing individuals.

Background: Individuals with varying levels of alcohol use severity may present with unique neuropsychological deficits. While some of these deficits are apparent, others may not be noticeable until challenged to utilize them in specialty settings such as residential treatment. These deficits span areas such as behavioral inhibition, cognitive flexibility, working memory, and attentional control. While self report measures of executive function are widely used, studies have indicated subjective perceptions of one’s impairment are impacted by a variety of factors, including lack of insight and depressed mood. Objective, performance based measures tend to produce more accurate markers of actual executive function but are less likely used in alcohol treatment settings. This preliminary study was conducted based on pilot study results indicating a combination of objective performance based measures and subjective self report data may best associate with alcohol addiction severity. Methods: Archival de-identified medical record data were attained from medical records from a neuropsychological assessment private practice (N = 98) and were included in multiple regression analyses. This study employed a within subjects design comparing performance across objective (WCST, TMT, IVA, WMI) and subjective (BRIEF) measures of executive function with a dependent measure of alcohol addiction severity (AUDIT). Results: When controlling for mood disruption and age of drinking onset, both objective and self report measures were significantly associated with alcohol addiction severity. Specifically, the combination of objective measures of perseveration as well as self report measures of behavioral inhibition deficits in behavioral inhibition and task completion were significantly associated with alcohol addiction severity. Also, age of drinking onset was significantly associated with alcohol addiction severity. Conclusion: Results from this preliminary analysis illustrate that both performance based and self report measures are vital to identifying subsyndromal executive deficits that may impede an alcohol abusing individual’s progress in treatment. This line of research extends previous literature findings in TBI, epilepsy and dementia to the realm of alcohol abuse in an effort to merge theory with practice. Practical findings suggest the most effective assessment tools to identify cognitively impaired individuals with alcohol use disorders to direct them to the most appropriate alcohol treatment setting