Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

40 II. ASSESSMENT OF ADDICTIONPSYCHOLOGICAL PROCESSES INTEGRALTO SUBSTANCE ABUSECognitive processes encompass both cognitive style and cognitive capacity.Both aspects are relevant to understanding substance abuse. Cognitive stylerefers to the general strategy an individual uses to process information. Forexample, substantial evidence indicates that substance abusers are more inclinedthan the general population to analyze perceptual stimuli in a global,inarticulate manner (Sugerman & Schneider, 1976). This stable trait is referredto as perceptual field dependence. Significantly, field-dependence cognitive styleappears to be related to treatment prognosis (Karp, Kissin, & Hustmeyer,1970).Another facet of cognitive style commonly found among substance abusersis stimulus augmentation—the propensity to magnify sensory input (Buchsbaum& Ludwig, 1980). Stimulus augmentation is overtly featured by impulsivity,behavioral disinhibition and sensation, or novelty seeking. Interestingly, thiscognitive style correlates with low platelet monoamine oxidase (MAO) activity(Schooler, Zahn, Murphy, & Buchsbaum, 1978). Low platelet MAO activity isparticularly associated with alcoholism in cases in which there is a comorbidantisocial disorder (Von Knorring, Bohman, Von Knorring, & Oreland, 1985).Understanding the person’s cognitive style may thus assist in treatmentplanning and in formulating a differential diagnosis. Unfortunately, the techniquesfor assessing this aspect of cognition have not been inculcated into generalpsychometric assessment practice, although it is possible to make inferencesabout perceptual field dependence by using a simple test measuringflexibility of perceptual closure (Jacobson, Pisani, & Berenbaum, 1970) andstimulus augmenting by measuring sensation-seeking behavior (Zuckerman,Bone, Neary, Mangelsdorff, & Brastman, 1972).Another important aspect of cognition pertains to attributional style. Ineffect, individuals at high risk for substance abuse and currently active users areinclined mistakenly to harbor beliefs about the putative benefits of alcohol andother drugs (Finn, Sharkansky, Brandt, & Turcotte, 2000; Vernon, Lee, Harris,& Jang, 1996). Because these types of cognitions portend how an individualwill behave, it is important also to assess attributional style.Cognitive capacities are commonly impaired in people with alcohol usedisorders as a result of CNS injury either directly caused by alcohol neurotoxicityor indirectly mediated by organ–system damage (e.g., hepatic encephalopathy,obstructive pulmonary disease, hypertension). Multiple factors typicallycompromise CNS functioning. Besides the direct effects of drugs oralcohol on the brain, these factors include trauma (e.g., head injuries from accidentsand fights), poor nutrition, and exposure to toxic substances in the environment.The psychological evaluation must therefore not only be aimed atdetecting and describing the pattern of CNS disturbances by means of validated