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

42 II. ASSESSMENT OF ADDICTIONology. For instance, poor performance may be reflective of multiple minor braininjuries, poor overall health, and premorbid neurodevelopmental disorder.Neuropsychological tests are very sensitive indicators of cerebral integrity(Lezak, Howieson, & Loring, 2004). In the early stages of a demential disease,these psychometric procedures complement neuroradiological procedures,where gross morphological injury may not be detectable upon visual inspection.Neuropsychological tests are especially informative for rehabilitation purposes,because the data describe functional cerebral integrity and, as such, characterizethe person according to the cognitive processes (e.g., attention, memory, language,learning, and concentration) that are generally understood to be importantfor educational, vocational, and social adjustment. Indeed, it is the relationshipbetween neurological status and these latter processes, rather than thetest scores per se, that underscores the importance of the neuropsychologicalassessment.Documenting cognitive capacity and efficiency via neuropsychologicalassessment is important for several reasons. During the drug withdrawal phaseat the onset of rehabilitation, cognitive capacity may be too impaired for theperson to achieve meaningful gains from didactic therapy or counseling. Assessmentof the subjective effects of intoxication or withdrawal status from varioussubstances of abuse has been developed by the Addiction Research Center(Haertzen, 1974). Handelsman and colleagues (1987) have also developedassessment instruments to evaluate severity of withdrawal.A brief cognitive screening used on repeated occasions is an efficientmethod to determine the client’s readiness for rehabilitation. Individuals withsubstantial cognitive limitations may not be able to solve daily problems,develop strategic plans to organize their lives, acquire insight into their problems,or benefit from vocational rehabilitation. A neuropsychological assessmentcan thus assist in formulation of a treatment plan and aftercare program.For instance, most persons respond to didactic psychotherapy, whereas thosewhose thinking is concrete benefit most from structured interventions that dorequire problem solving (Kissin, Platz, & Su, 1970). Furthermore, it is importantto note that everyday activities such as driving a car, using power machinery,or performing tasks in which there are safety risks may be impaired becauseof CNS damage consequent to chronic heavy substance use. Neuropsychologicaltesting, particularly in the area of psychomotor capacities, may thereforeassist in the determination of injury risk to self and others.Neuropsychological assessment has also been increasingly utilized as partof forensic evaluation. In criminal cases, objective quantitative assessment ofcognitive capacities contributes to a better understanding the underlying causesof behavior disturbance. In this regard, expertise of the neuropsychologist whounderstands brain–behavior relationships that may be disrupted following alcoholor substance use can inform about the mechanisms underlying cognitivedisturbances such as blackouts and anterograde amnesia.