Craving

Cognitive Impairments

Research has shown that abuse of alcohol, stimulants, and most other drugs of abuse result in significant cognitive impairment due to toxic damage to brain cells. For example, damage to the prefrontal cortex—the area of the brain involved with executive brain functions of decisions making, planning, and response control—results in functional anomalies that correlate to 30% to 80% of substance abusers' having mild to severe cognitive impairments. The abuse of metham-phetamine has been shown to result in 11.3% destruction of limbic gray matter. The cingula gyrus, paralimbic cortices, and hippocampus are the brain areas damaged by methamphetamine abuse. These areas are associated with memory, emotions, mood, and craving. The greatest deficit occurred in the hippocampus. Heavy abuse of methamphetamine users results in 7.8% smaller hippocampus volume, which corresponds to the severe cognitive deficits seen in chronic users.

Deficits of cognition impair the ability of addicts to understand what they need to do to prevent cravings that lead to slips and relapse. A public hospital study by A. W. Blume and colleagues found that the majority of substance use disorder patients suffered mild-to-severe cognitive impairments that made it difficult for them to participate in treatment. Reviewing screening exams on neurocognitive functioning at a VA hospital, researchers found that approximately 50% of the patients were mildly to severely impaired.

The most common cognitive impairments associated with substance use disorders consist of problems with attention, memory, understanding, learning, use and meaning of words, problem solving, cognitive inflexibility, abstract thinking and judgment. Abuse of drugs also causes temporal processing problems, which consist of poor understanding of time planning, difficulty processing goals over time, and delayed discounting, the inability to appreciate delayed gratification.

Patients treated for substance use disorders often appear normal during the early phase of recovery treatment, but are actually experiencing an inability to fully understand and process the treatment curriculum. For example, the patient can repeat what he or she hears, but the information and the therapy do not sink in. It may take weeks or months after detoxification for reasoning, memory, and thinking to come back to a point where the individual can begin to fully engage in treatment. Educational strategies during treatment must be tailored to the person's ability to process the information being provided.

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