Abstract
According to neurocognitive models of addiction, a vicious combination of altered executive functions (EF) and dysfunctional reward system represent a main determinant of clinical picture. We then report first evidence from the testing of the Battery for Executive Functions in Addiction (BFE-A), a novel battery for EF screening. The BFE-A consists of seven digitized subtests tap** on learning and memory, working memory, cognitive flexibility, focused attention, attention regulation and suppression of interference, and inhibitory control. One hundred fifty-one patients diagnosed with substance-use disorder and 56 healthy participants were administered the BFE-A. First-level statistical analyses highlighted lower performance of the clinical sample with respect to healthy participants across all the battery subtests, though verbal memory and focused attention proved to be the most impaired functions. Regression analyses, then, revealed that longer withdrawal periods led to greater memory performance and that a longer history of substance abuse specifically led to less efficient information-processing speed in an attention regulation task. Findings provide first support to the evaluation of the BFE-A as a brief but informative screening battery, potentially complementing the diagnostic process.
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References
Antons, S., Brand, M., & Potenza, M. N. (2020). Neurobiology of cue-reactivity, craving, and inhibitory control in non-substance addictive behaviors. Journal of the Neurological Sciences, 415(May), 116952. https://doi.org/10.1016/j.jns.2020.116952
APA. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. American Psychiatric Association.
Baidoo, N., Wolter, M., & Leri, F. (2020). Opioid withdrawal and memory consolidation. Neuroscience and Biobehavioral Reviews, 114, 16–24. https://doi.org/10.1016/j.neubiorev.2020.03.029
Balconi, M., & Crivelli, D. (2021). The assessment of executive functions: A new neuropsychological tool for addiction. In M. Balconi & S. Campanella (Eds.), Advances in Substance and Behavioral Addiction. The Role of Executive Functions (pp. 61–86). Springer.
Balconi, M., & Finocchiaro, R. (2016). Left hemispheric “Imbalance” in drug addiction. Neuropathology of Drug Addictions and Substance Misuse, 3, 229–238. https://doi.org/10.1016/B978-0-12-800634-4.00023-8
Balconi, M., Losasso, D., Balena, A., & Crivelli, D. (2022). BFE-A - Batteria per le Funzioni Esecutive nell’Addiction [Battery for Exective Functions in Addiction]. Giunti Psychometrics.
Battisti, R. A., Roodenrys, S., Johnstone, S. J., Pesa, N., Hermens, D. F., & Solowij, N. (2010). Chronic cannabis users show altered neurophysiological functioning on Stroop task conflict resolution. Psychopharmacology (berl), 212(4), 613–624. https://doi.org/10.1007/s00213-010-1988-3
Bechara, A. (2005). Decision making, impulse control and loss of willpower to resist drugs: A neurocognitive perspective. Nature Neuroscience, 8(11), 1458–1463. https://doi.org/10.1038/nn1584
Best, J. R., Miller, P. H., & Jones, L. L. (2009). Executive functions after age 5: Changes and correlates. Developmental Review, 29(3), 180–200. https://doi.org/10.1016/j.dr.2009.05.002
Bora, E., Yucel, M., & Pantelis, C. (2009). Cognitive endophenotypes of bipolar disorder: A meta-analysis of neuropsychological deficits in euthymic patients and their first-degree relatives. Journal of Affective Disorders, 113(1–2), 1–20. https://doi.org/10.1016/j.jad.2008.06.009
Brand, M., Wegmann, E., Stark, R., Müller, A., Wölfling, K., Robbins, T. W., & Potenza, M. N. (2019). The Interaction of Person-Affect-Cognition-Execution (I-PACE) model for addictive behaviors: Update, generalization to addictive behaviors beyond internet-use disorders, and specification of the process character of addictive behaviors. Neuroscience and Biobehavioral Reviews, 104, 1–10. https://doi.org/10.1016/j.neubiorev.2019.06.032
Bruijnen, C. J. W. H., Dijkstra, B. A. G., Walvoort, S. J. W., Markus, W., VanDerNagel, J. E. L., Kessels, R. P. C., & De Jong, C. A. J. (2019a). Prevalence of cognitive impairment in patients with substance use disorder. Drug and Alcohol Review, 38(4), 435–442. https://doi.org/10.1111/dar.12922
Bruijnen, C. J. W. H., Jansen, M., Dijkstra, B. A. G., Walvoort, S. J. W., Lugtmeijer, S., Markus, W., De Jong, C. A. J., & Kessels, R. P. C. (2019b). The Montreal Cognitive Assessment (MoCA) as a cognitive screen in addiction health care: A validation study for clinical practice. Journal of Substance Use, 24(1), 47–54. https://doi.org/10.1080/14659891.2018.1497102
Buckholtz, J. W., & Meyer-Lindenberg, A. (2012). Psychopathology and the human connectome: Toward a transdiagnostic model of risk for mental illness. Neuron, 74(6), 990–1004. https://doi.org/10.1016/j.neuron.2012.06.002
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (II). Lawrence Erlbaum Associates.
Copersino, M. L., Fals-Stewart, W., Fitzmaurice, G., Schretlen, D. J., Sokoloff, J., & Weiss, R. D. (2009). Rapid cognitive screening of patients with substance use disorders. Experimental and Clinical Psychopharmacology, 17(5), 337–344. https://doi.org/10.1037/a0017260
Crivelli, D., & Balconi, M. (2021). Psychopathology of EFs. In M. Balconi & S. Campanella (Eds.), Advances in substance and behavioral addiction. The Role of Executive Functions (pp. 41–60). Springer.
De Panfilis, C., Meehan, K. B., Cain, N. M., & Clarkin, J. F. (2013). The relationship between effortful control, current psychopathology and interpersonal difficulties in adulthood. Comprehensive Psychiatry, 54(5), 454–461. https://doi.org/10.1016/j.comppsych.2012.12.015
EMCDDA. (2022). Statistical Bulletin 2022. https://www.emcdda.europa.eu/data/stats2022_en
Fernández-Serrano, M. J., Pérez-García, M., Perales, J. C., & Verdejo-García, A. (2010). Prevalence of executive dysfunction in cocaine, heroin and alcohol users enrolled in therapeutic communities. European Journal of Pharmacology, 626(1), 104–112. https://doi.org/10.1016/j.ejphar.2009.10.019
Fernández-Serrano, M. J., Pérez-García, M., & Verdejo-García, A. (2011). What are the specific vs generalized effects of drugs of abuse on neuropsychological performance? Neuroscience & Biobehavioral Reviews, 35(3), 377–406. https://doi.org/10.1016/j.neubiorev.2010.04.008
Finocchiaro, R., & Balconi, M. (2017). Left/right hemispheric “unbalance” model in addiction. In R. R. Watson & S. Zibadi (Eds.), Addictive substances and neurological disease (pp. 383–391). Academic Press. https://doi.org/10.1016/B978-0-12-805373-7.00033-5
Goldstein, R. Z., & Volkow, N. D. (2011). Dysfunction of the prefrontal cortex in addiction: Neuroimaging findings and clinical implications. Nature Reviews. Neuroscience, 12(11), 652–669. https://doi.org/10.1038/nrn3119
Goldstein, R. Z., Craig, A. D. B., Bechara, A., Garavan, H., Childress, A. R., Paulus, M. P., & Volkow, N. D. (2009). The neurocircuitry of impaired insight in drug addiction. Trends in Cognitive Sciences, 13(9), 372–380. https://doi.org/10.1016/j.tics.2009.06.004
Goschke, T. (2014). Dysfunctions of decision-making and cognitive control as transdiagnostic mechanisms of mental disorders: Advances, gaps, and needs in current research. International Journal of Methods in Psychiatric Research, 23(S1), 41–57. https://doi.org/10.1002/mpr.1410
Hall, P. A., Elias, L. J., & Crossley, M. (2006). Neurocognitive influences on health behavior in a community sample. Health Psychology, 25(6), 778–782. https://doi.org/10.1037/0278-6133.25.6.778
Ioannidis, K., Hook, R., Goudriaan, A. E., Vlies, S., Fineberg, N. A., Grant, J. E., & Chamberlain, S. R. (2019). Cognitive deficits in problematic internet use: Meta-analysis of 40 studies. British Journal of Psychiatry, 215(5), 639–646. https://doi.org/10.1192/bjp.2019.3
Koob, G. F., & Volkow, N. D. (2016). Neurobiology of addiction: A neurocircuitry analysis. The Lancet Psychiatry, 3(8), 760–773. https://doi.org/10.1016/S2215-0366(16)00104-8
Kutlu, M. G., & Gould, T. J. (2016). Effects of drugs of abuse on hippocampal plasticity and hippocampus-dependent learning and memory: Contributions to development and maintenance of addiction. Learning and Memory, 23(10), 515–533. https://doi.org/10.1101/lm.042192.116
Maracic, C. E., & Moeller, S. J. (2021). Neural and behavioral correlates of impaired insight and self-awareness in substance use disorder. Current Behavioral Neuroscience Reports, 8(4), 113–123. https://doi.org/10.1007/s40473-021-00240-x
Marín-Navarrete, R., Toledo-Fernández, A., Villalobos-Gallegos, L., Pérez-López, A., & Medina-Mora, M. E. (2018). Neuropsychiatric characterization of individuals with inhalant use disorder and polysubstance use according to latent profiles of executive functioning. Drug and Alcohol Dependence, 190, 104–111. https://doi.org/10.1016/j.drugalcdep.2018.06.005
McTeague, L. M., Goodkind, M. S., & Etkin, A. (2016). Transdiagnostic impairment of cognitive control in mental illness. Journal of Psychiatric Research, 83, 37–46. https://doi.org/10.1016/j.jpsychires.2016.08.001
McTeague, L. M., Huemer, J., Carreon, D. M., Jiang, Y., Eickhoff, S. B., & Etkin, A. (2017). Identification of common neural circuit disruptions in cognitive control across psychiatric disorders. The American Journal of Psychiatry, 174(7), 676–685. https://doi.org/10.1176/appi.ajp.2017.16040400
Menon, V. (2011). Large-scale brain networks and psychopathology: A unifying triple network model. Trends in Cognitive Sciences, 15(10), 483–506. https://doi.org/10.1016/j.tics.2011.08.003
Mesholam-Gately, R. I., Giuliano, A. J., Goff, K. P., Faraone, S. V., & Seidman, L. J. (2009). Neurocognition in first-episode schizophrenia: A meta-analytic review. Neuropsychology, 23(3), 315–336. https://doi.org/10.1037/a0014708
Millan, M. J., Agid, Y., Brüne, M., Bullmore, E. T., Carter, C. S., Clayton, N. S., Connor, R., Davis, S., Deakin, B., DeRubeis, R. J., Dubois, B., Geyer, M. A., Goodwin, G. M., Gorwood, P., Jay, T. M., Joëls, M., Mansuy, I. M., Meyer-Lindenberg, A., Murphy, D., … Young, L. J. (2012). Cognitive dysfunction in psychiatric disorders: Characteristics, causes and the quest for improved therapy. Nature Reviews Drug Discovery, 11(2), 141–168. https://doi.org/10.1038/nrd3628
NIDA. (2022). Sex and gender differences in substance use. https://nida.nih.gov/publications/research-reports/substance-use-in-women/sex-gender-differences-in-substance-use
Nolen-Hoeksema, S., & Watkins, E. R. (2011). A heuristic for develo** transdiagnostic models of psychopathology. Perspectives on Psychological Science, 6(6), 589–609. https://doi.org/10.1177/1745691611419672
Snyder, H. R. (2013). Major depressive disorder is associated with broad impairments on neuropsychological measures of executive function: A meta-analysis and review. Psychological Bulletin, 139(1), 81–132. https://doi.org/10.1037/a0028727
Snyder, H. R., Miyake, A., & Hankin, B. L. (2015). Advancing understanding of executive function impairments and psychopathology: Bridging the gap between clinical and cognitive approaches. Frontiers in Psychology, 6, 328. https://doi.org/10.3389/fpsyg.2015.00328
Solowij, N., Michie, P. T., & Fox, A. M. (1995). Differential impairments of selective attention due to frequency and duration of cannabis use. Biological Psychiatry, 37(10), 731–739. https://doi.org/10.1016/0006-3223(94)00178-6
Toledo-Fernández, A., Villalobos-Gallegos, L., & Marín-Navarrete, R. (2016). Is the Mini-Mental State Examination (MMSE) useful for eligibility screening of research participants with substance use disorder. Revista Internacional De Investigación En Adicciones, 2(1), 39–44. https://doi.org/10.28931/riiad.2016.1.06
Valiente, C., Eisenberg, N., Spinrad, T. L., Haugen, R., Thompson, M. S., & Kupfer, A. (2013). Effortful control and impulsivity as concurrent and longitudinal predictors of academic achievement. The Journal of Early Adolescence, 33(7), 946–972. https://doi.org/10.1177/0272431613477239
van Timmeren, T., Daams, J. G., van Holst, R. J., & Goudriaan, A. E. (2018). Compulsivity-related neurocognitive performance deficits in gambling disorder: A systematic review and meta-analysis. Neuroscience and Biobehavioral Reviews, 84, 204–217. https://doi.org/10.1016/j.neubiorev.2017.11.022
Yücel, M., Lubman, D. I., Solowij, N., & Brewer, W. J. (2007). Understanding drug addiction: A neuropsychological perspective. Australian & New Zealand Journal of Psychiatry, 41(12), 957–968. https://doi.org/10.1080/00048670701689444
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The authors of this manuscript are also the developers of the Battery for Executive Functions in Addiction [Batteria per le Funzioni Esecutive nell’Addiction — BFE-A], which has been released in 2022.
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Crivelli, D., Balena, A., Losasso, D. et al. Screening Executive Functions in Substance-Use Disorder: First Evidence from Testing of the Battery for Executive Functions in Addiction (BFE-A). Int J Ment Health Addiction 22, 1315–1332 (2024). https://doi.org/10.1007/s11469-022-00928-5
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DOI: https://doi.org/10.1007/s11469-022-00928-5