Why use neuropsychological testing for drug abuse treatment?
Substance abuse – opioid abuse in particular – causes considerable damage not only to the body, but also to the brain and its ability to function normally. This damage can be especially persistent if the user is physically dependent on the substance, and it can lead to altered cognitive, behavioral and emotional functioning.
This is why neuropsychological testing is such an important component of a comprehensive treatment plan. Neuropsychological assessments help us better understand the nature of the patient’s symptoms, any feelings of distress they may be experiencing, as well as psychological or medical comorbidities (i.e., one or more co-occurring diseases or disorders) the patient might be experiencing. These neuropsychological assessments – taken before and after treatment – also help addiction experts better understand how well certain patients respond to specific treatment interventions. Moreover, an individualized treatment plan can be created for each patient based on the results.
Structural effects on the brain
While there has been considerable research examining the long-term effects of opioid addiction, there is emerging evidence that abusing opioids can affect changes on the brain in only a few weeks. In fact, research has shown that just one month of opioid abuse can lead to changes in the volume of gray matter in the brain. These gray matter changes increase with the amount of opioid use and persist for several months after ceasing use.
MRIs show that these changes primarily affect the prefrontal cortex, temporal lobes, cingulate cortex and insular cortex of the brain. The following illustrates some of the more important functions and roles these parts of the brain play:
| PREFRONTAL CORTEX | TEMPORAL LOBE | CINGULATE CORTEX | INSULAR CORTEX |
| Planning complex cognitive behavior | Retention of visual memory | Emotion formation and processing | Motor control |
| Personality expression | Language comprehension | Memory formation and retention | Perception, self-awareness |
| Decision making | Emotional association | Learning | Cognitive functioning |
Functional effects on the brain
Opioids cause functional changes to the brain, and a longer period of opioid use is correlated with lower metabolism in the frontal and temporal cortices in the right hemisphere. MRIs also show reduced connectivity with other brain regions, such as frontal lobes and cingulate cortex. These functional changes can lead to significant impairment, including slower learning and reaction times, poorer working memory and planning, and more impulsive decision making.
These problems usually get better with treatment, especially on a maintenance regimen. However, they may be evident even after a prolonged abstinence. Healing takes time, and post-acute withdrawal symptoms may include:
- Anxiety
- Mood swings
- Low energy and enthusiasm
- Problems with concentration
- Sleep issues
- Feeling tired
- Irritability
Because of the way opiates affect the brain, people will generally experience many challenges, and the recovery process can take a significant period of time as the brain attempts to stabilize and restore itself.
What does neuropsychological testing look like? What does it test for?
Neuropsychological testing is completely non-invasive, patients are simply asked to think and act. The neuropsychologist or other clinician might present a written list of questions for the patient to complete in a certain amount of time. They may also ask them to answer a series of specific questions or repeat specific phrases. Some tests may require the patient to move about or perform complicated gestures, and others may require the patient to complete a series of actions in a prescribed order. When put together, these tests can give the neuropsychologist a snapshot of a person’s:
- Intelligence
- Memory
- Executive functioning
- Attention skills
- Language ability
- Motor skills
- Mood
- Personality type
- Perception
The test results are evaluated and compared with the test results of other people who are approximately the same age, ethnicity, economic and health background. Neuropsychologists and other clinicians use the results of these tests to better understand each patient, providing insight into their cognitive and behavioral dysfunctions.
These tests also allow a neuropsychologist or other clinician to gather information about motor, linguistic, and higher functioning skills. This understanding of a person’s psychological functioning is a prime consideration in neuropsychological testing and informs much of the individualized treatment strategy.
Mental Illness, Substance Abuse and Neuropsychological Tests
Substance abuse and mental illness often play a major role in these neuropsychological evaluations. Finding evidence of one or both can provide a wealth of information into that person’s psychological state. The American Academy of Neurology recently published an article on neuropsychological testing of adults wherein they noted that both mental health disorders and substance abuse or addiction can influence psychological traits.
Because neuropsychological tests assist in diagnoses of mental health disorders, clinicians can better determine whether some traits are psychological or organic (meaning a result of brain trauma or the onset of a disease such as Alzheimer’s). By understanding the cause of certain behaviors, each individual can be helped in the most appropriate way.
Psychological testing with Enterhealth
Enterhealth offers premier drug and alcohol addiction treatment across the continuum of care at our multiple locations. Enterhealth Ranch, our inpatient treatment facility just north of the Dallas/Fort Worth metro area, employs a variety of methods and behavioral therapies, including psychological feedback therapy, Eye Movement Desensitization and Reprocessing (EMDR) and more.
Psychological feedback treatment teaches patients how to properly manage their mood and emotions, as well as improve their sleep. By incorporating psychological feedback therapy into our addiction treatment program, we give patients the skills they need to help them gain control, leading to decreased chances of relapse and higher success rates.
Psychological testing is just one aspect of our treatment plans. It benefits our staff to know what exactly you are experiencing, and it helps you to better understand your experience as well. Together, we can work out an individualized rehabilitation and recovery plan that addresses your unique needs and goals.
This approach has been found to have an especially dramatic increase in the success rates for those with a dual-diagnosis. In combination with medical maintenance, psychological feedback therapy has also been shown to greatly reduce drug or alcohol cravings, allowing patients to focus on treatment, which further increases the likelihood of a successful recovery.
Written by Joshua M. Masino, PsyD, Neuropsychologist and Enterhealth Director of Neuropsychological Services
Sources:
- Board of Directors (2007) American Academy of Clinical Neuropsychology (AACN) Practice Guidelines for Neuropsychological Assessment and Consultation, The Clinical Neuropsychologist, 21:2, 209-231, DOI: 10.1080/13825580601025932
- Elisabeth H. Punzi (2015) Neuropsychological Assessment in Substance Abuse Treatment—Focusing on the Effects of Substances and on Neuropsychological Assessment as a Collaborative Process, Smith College Studies in Social Work, 85:2, 128-145, DOI: 10.1080/00377317.2015.1017357
- Dassanayake, T. L., Michie, P. T., Jones, A., Carter, G., Mallard, T., & Whyte, I. (2012, August). Cognitive impairment in patients clinically recovered from central nervous system depressant drug overdose. Retrieved September 17, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/22722510
- Neuropsychological Testing. (n.d.). Retrieved September 17, 2018, from https://www.dualdiagnosis.org/testing-assessments-comorbidity/neuropsychological/
