Congrès 2025 de la Research Society on Alcoholism (RSA)

Purpose: Therapeutic Communities (TCs) are care units that provide treatment for individuals with Substance Use Disorder (SUD) who also have frequent psychiatric, neurological, and medical comorbidities. These SUDs, along with the associated comorbidities, can result in neuropsychological impairments that may impede the efficacy of addiction treatment. Nevertheless, the efficacy of cognitive remediation in TC residents with SUD and comorbidities
remains largely uninvestigated.
Methods: Two groups of age- and education-matched TC residents, who had benefited (N=22) or not (N=23) from a cognitive remediation program during their stay, were clinically examined and completed questionnaires assessing the presence of psychiatric, neurological, and hepatic comorbidities at the time of admission. All residents were screened for neuropsychological disorders using the BEARNI tool at the time of admission to the CT (T1) and after a period of eight months (T2). Linear mixed-effects models were used to examine the effects of time (T1, T2) and experimental condition (with or without cognitive remediation) on BEARNI scores. Time and condition were included as fixed effects, while random intercepts were specified for participants to account for individual variability. The model also incorporated a time-by-condition interaction term to explore differential effects of the experimental condition over time.
Results: The two groups of patients exhibited comparable levels of SUD severity, neuropsychological disorders, and comorbidities at T1. The linear mixed-effects models revealed a significant main effect of time on all the BEARNI scores indicating that cognitive performance improved between T1 and T2. The analysis revealed notable trends in the interaction between time and condition for several BEARNI scores. This indicates that the cognitive remediation group tend to exhibit a more pronounced improvement between T1 and T2 in comparison to the non-cognitive remediation group.
Conclusion: The preliminary results indicate that, despite the presence of numerous comorbidities that can exacerbate neuropsychological disorders in TC residents, cognitive remediation can facilitate their improvement over an eight-month period. However, the data also suggest that, in view of the severity of neuropsychological impairment, an eight-month recovery period combined with a remediation program may not be sufficient to allow full recovery of neuropsychological disorders in patients with SUD and comorbidity.

Key Words: Therapeutic community, Neuropsychological screening, Cognitive remediation

Purpose: Therapeutic Communities (TCs) are care units welcoming people with Alcohol and Drug Use Disorder (AUD/DUD) associated with frequent psychiatric, neurological and medical comorbidities. These substance disorders, associated with such complications, can lead to neuropsychological impairments that may to hinder the benefit of addiction treatment. However, the specific risk factors associated with the neuropsychological profile of TC residents at entry have never been explored.
Methods: Residents of three French TCs (n=61; 82% male) underwent clinical interviews and questionnaires assessing psychiatric, neurological and liver history, substance use, alcohol-related problems (with the AUDIT), nicotine dependence (with the Fagerstrom test) and current anxiety and depression comorbidities (with the HAD scale). They also underwent an extensive neuropsychological examination assessing four cognitive domains: episodic memory, working memory, visuospatial abilities and executive functions. Moderate impairment was defined as at least two affected cognitive domains. All assessments were conducted within the first fifteen days of admission to the TC. To identify risk factors associated with neuropsychological impairment, forward logistic regression was performed, using demographic (age, sex, education and TC), clinical and substance use variables as predictors, and moderate impairment (0 =preserved and 1 =impaired) as the outcome.
Results: The majority of TC residents had AUD and used tobacco (88% and 96%, respectively), consuming cannabis (80%) and drugs including benzodiazepines (57%), with most being polysubstance users. Regarding medical conditions, 39% had a history of liver disease, 57% a history of neurological disease, and at entry, 60% reported current anxiety and 84% current depression. More than 1/3 of residents (36%) had moderate impairment. Sex (male), higher Fagerstrom score, a negative anxiety score on the HAD, younger age, a positive liver history, and higher depression score on the HAD were significant risk factors for moderate impairment at TC entry.
Conclusion: The results indicate that demographic variables, nicotine dependence, a liver history and current psychiatric comorbidities were significant predictors of moderate impairment in TC’s residents at entry. These findings suggest a complex interaction between protective and risk factors contributing to the severity of the neuropsychological profile, and emphasize the need to document these variables at TC entry, as they may impact cognitive functioning and the effectiveness of treatment strategies.

Key Words: Therapeutic community, Neuropsychological impairment, Risk factors