Risk factors and neuropsychological recovery in clients with alcohol use disorders who were exposed to different treatments

Abstract

Risk covariates of neuropsychological ability (NA) at treatment entry and neuropsychological recovery (NR) across 15 months were examined and replicated in 2 samples (Ns = 952 and 774) from Project MATCH, a multisite study of alcoholism treatments. NA at treatment entry was associated with age, education, and other covariates. Statistically significant mean increases in NA over time had small effect sizes, suggesting limited clinical significance of NR in the samples as a whole. However, initial NA and a combination of risk factors in direct and mediated pathways predicted a large proportion of individual differences in NR. Statistically significant but modest differential treatment effects on NR suggest that addiction treatments may need to be modified or developed to facilitate this important aspect of recovery.

Figure 1

Measurement Model: Baseline and 15 Months. Residuals for outpatient sample (baseline, 15-months) are in the top ovals connected to each test on the right side of the diagram; aftercare sample residuals are in the bottom ovals.

Figure 2

Risk factor Path Model. All significant paths were replicated across outpatient and aftercare samples with the exception of the path from female gender to alcohol consumption (dashed line). When unstandardized outpatient and aftercare path coefficients or standard deviations differed, the outpatient value was listed first. For dichotomous variables, the unstandardized path coefficients represent the difference between the ability means of the two groups. The point ranges of continuous variables are shown in parentheses; standard deviations (SD) of the latent factors and continuous manifest variables are provided because the effect sizes of unstandardized path coefficients need to be interpreted with respect to the standard deviations of the variables. For the readers’ convenience, paths with estimated effect sizes (ES, unique proportion of variance explained) <.10 were coded as small (S), ES = .10 – .24 as medium (M), and ES = .25 and up as large (L) (Murphy & Myors, 2004). Note that several continuous variables were rescaled to facilitate iterative estimation: # Std Drinks^a = square root (# Std Drinks/300); # Std Drinks^b (treatment entry to 15 months) = square root (# Std Drinks (treatment entry to 15 months/1800); BDI^c = BDI/10; BDI^d = BDI/10; and Age^e = Age/11.