The role of neurocognitive abilities in coping with adolescent relapse to alcohol and drug use

Objective: Neurocognitive abilities are hypothesized to influence coping with temptations to relapse to alcohol and drug use. In particular, a moderator model was proposed whereby neurocognitive abilities moderate the influence of coping strategies on treatment outcome. Method: Participants (N = 79) were consecutive admissions to inpatient alcohol and drug treatment centers in the San Diego, California, area, (age range = 14 to 18 years; 41% female). Treatment programs were abstinence focused, with an average inpatient stay of 5 weeks. Participants met DSM-III-R lifetime criteria for alcohol abuse or dependence and abuse or dependence of at least one other substance. Follow-up assessments were conducted 1 and 2 years following discharge, including a battery of neuropsychological tests, coping questionnaire, and detailed assessment of alcohol and other drug involvement. Results: The interaction between general intelligence and coping diversity significantly predicted alcohol and drug use 1 year later (F = 10.71, 1/72 df, p < .005, R-2 change = .08), even when controlling for current use. Attention-coping and problem solving-coping interactions also significantly predicted outcome, but not above the intelligence-coping interaction. Conclusions: Teens with poor neurocognitive abilities used little or no alcohol and drugs if good coping skills were evidenced, but used more alcohol and drugs if their coping skills were poor. This association between coping skills and outcome did nor exist for teens with better neurocognitive abilities. Clinically, teens with poorer neurocognitive skills may maximally benefit from coping skills training programs, and neuropsychological evaluations may be particularly helpful in addressing these individual needs in treatment.