Worley Matthew J, Tate Susan R, Granholm Eric, Brown Sandra A
San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology.
Veterans Affairs San Diego Health Care System.
J Consult Clin Psychol. 2014 Jun;82(3):418-28. doi: 10.1037/a0036033. Epub 2014 Mar 3.
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).
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.
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.
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.
神经认知障碍并非一直能预测物质使用治疗结果，但与结果的近端中介因素有关。这些间接影响在患有物质依赖和共病精神障碍的成年人中尚未得到研究。我们研究了神经认知障碍对酒精或药物依赖及重度抑郁症（MDD）治疗中的成年人物质使用影响的中介因素和调节因素。
参与者为退伍军人（N = 197，平均年龄 = 49.3岁，90%为男性，75%为白种人），参与一项针对酒精/药物依赖和MDD的两组干预试验。此处研究的测量指标包括入组时的神经认知评估、饮酒天数百分比（PDD）、使用药物天数百分比（PDDRG）、自我效能感、12步参与度，以及从入组到18个月随访期间每3个月测量一次的抑郁症状。
入组时神经认知障碍程度越高，预测的自我效能感越低、12步参与度越低、抑郁严重程度越高，而这些随时间变化的变量介导了障碍对未来PDD和PDDRG的影响。对于神经认知障碍程度较高的人，12步参与度对未来PDD的前瞻性影响更大。障碍还与抑郁相互作用，调节12步参与度和自我效能感对PDD的影响。障碍程度较高且目前患有重度抑郁症的成年人，12步参与度/自我效能感与未来饮酒之间的关联最强。
由于治疗过程中的变化受损，较高的神经认知障碍可能导致酒精/药物依赖和MDD的团体治疗效果较差。神经认知障碍等远端因素可与动态风险因素相互作用，调节治疗过程与未来饮酒结果之间的关联。
