Prevalence of executive dysfunction in cocaine, heroin and alcohol users enrolled in therapeutic communities

Many studies have observed relevant executive alterations in polysubstance users but no data have been generated in terms of prevalence of these alterations. Studies of the prevalence of neuropsychological impairment can be useful in the design and implementations of interventional programs for substance abusers. The present study was conducted to estimate the prevalence of neuropsychological impairment in different components of executive functions in polysubstance users enrolled in therapeutic communities. Moreover, we estimated the effect size of the differences in the executive performance between polysubstance users and non substance users in order to know which neuropsychological tasks can be useful to detect alterations in the executive functions. Study results showed a high prevalence of executive function impairment in polysubstance users. Working memory was the component with the highest impairment proportion, followed by fluency, shifting, planning, multi-tasking and interference. Comparisons between user groups showed very similar executive impairment prevalence for all the analyzed executive components. The best discriminating task between users and controls was Arithmetic (Wechsler Adult Intelligence Scale, WAIS-III). Moreover FAS and Ruff Figural Fluency Test was discriminating for fluency, Category Test for shifting, Stroop Colour-Word Interference Test for interference, Zoo Map (Behavioural Assessment of the Dysexecutive Syndrome, BADS) for planning and Six Elements (BADS) for multi-tasking. The existence of significant prevalence of executive impairment in polysubstance users reveals the need to redirect the actuation policies in the field of drug-dependency towards the creation of treatments addressed at the executive deficits of the participants, which in turn would facilitate the individuals' compliance and final rehabilitation. (C) 2009 Elsevier B.V. All rights reserved.