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Year : 2021  |  Volume : 16  |  Issue : 2  |  Page : 273-278

A study to assess the cognitive functions and the general health in patients with substance dependence

Department of Psychiatry, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, Haryana, India

Date of Submission17-Jan-2020
Date of Decision30-Jun-2020
Date of Acceptance18-Nov-2020
Date of Web Publication18-Oct-2021

Correspondence Address:
Dr. Leezu Bhusri
House No. 212, Sector 15, Panchkula - 134 113, Haryana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdmimsu.jdmimsu_11_20

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Introduction: Cognitive function has been addressed as a hallmark feature of substance use disorders, with alteration in “executive” domains of attention, inhibition/regulation, working memory, and decision-making. Poor cognition or cognitive dysfunction has been recognized as a fundamental impairment in addiction and a potentially important target for intervention. The present study was planned with the aim to assess the cognitive functions and general health in patients with substance dependence and also to correlate general health with the level of cognitive function. Methodology: Ninety participants were included in the study and were categorized into three groups of thirty each as patients taking alcohol, opioids, and nicotine. Consecutive sampling was adopted for the sample collection. Each participant was assessed for dependence, demographic data, and tested by the Addenbrooke's Cognitive Examination Scale-III and General Health Questionnaire-12. Descriptive statistics were applied to calculate the frequencies, percentage, mean, median, and standard deviation. Data were further analyzed for significance using the Chi-square, correlation, and Mann–Whitney test. Results: There is a statistically significant difference seen in marital status (P = 0.005), education (P = 0.001), family type (P = 0.008), and locality (P = 0.000). Furthermore, with substance use, there is a significant change in the domains of general health with P < 0.001, and there is a significant decline in sustaining attention with P = 0.007. Conclusion: Thus, we conclude that substance use has a significant negative impact on cognition mainly attention and working memory with the impact on general health as well.

Keywords: Addenbrooke's, alcohol, cognition, general health, nicotine, opioid, substance use

How to cite this article:
Bhusri L, Bathla M, Gupta P, Singh AH. A study to assess the cognitive functions and the general health in patients with substance dependence. J Datta Meghe Inst Med Sci Univ 2021;16:273-8

How to cite this URL:
Bhusri L, Bathla M, Gupta P, Singh AH. A study to assess the cognitive functions and the general health in patients with substance dependence. J Datta Meghe Inst Med Sci Univ [serial online] 2021 [cited 2021 Nov 28];16:273-8. Available from: http://www.journaldmims.com/text.asp?2021/16/2/273/328442

  Introduction Top

Cognition is “the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses.”[1] It includes processes such as sustaining attention, knowledge, different types of memory, decision-making and judgment, language production, comprehension, and problem-solving skills. These processes help in generating the new knowledge based on the previous knowledge. The cognition of human mind is a combination of conscious and subconscious thinking along with concrete and abstract ability inclusive of power to conceptualize and exhibit intuitiveness.[2],[3] Jean Piaget was one of the most important persons in the field of developmental psychology. He believed that humans are unique in comparison to animals because of their capacity to abstract thinking. Cognitive functions are mental processes that allow human being to carry out various tasks by actively participating in the processes of receiving and retaining, choosing, processing, transforming, storing, and retrieval of information when needed. Therefore, allowing the person to explore the world around him.[4] These include orientation, gnosis, attention, executive functions, praxis, memory, language, and visual-spatial skills.

Substance dependence is characterized by a strong urge or compulsion to consume the substance, tolerance to substance, and withdrawal symptoms on cutting down or suddenly stopping the consumption. The dependence of the user can be limited to one particular substance (e.g., alcohol, tobacco, etc.) or it can vary in one particular group of psychoactive substances (e.g., opioid drugs and benzodiazepines), or broad range of different substances. Substance dependence is a disorder of altered cognition as per the neuropsychological aspects. There is a overlapping of brain structure and neurophysiological process that underlie addiction and the major function of cognition such as memory (immediate, recent, and remote), attention along with concentration, ability to learn, ability to reason out things, planning, and impulse. Addiction starts in a person as a tag-team chain of events where occasional drug consumption with progressive increments, leading to a person using substance in uncontrolled manner because it causes the deregulation of neurotransmitter (drug induced) leading to effect on reward pathway of the brain and subsequently withdrawal due to abstinence, which causes a never-ending vulnerability for the user to go in relapse and along with it also dents the capacity to decide and other cognitive functions.[5]

Health, as defined by the World Health Organization, is “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.[6] Health is the body's capacity to adapt to various changes in physical, mental, and social state of a being.[7] Substance use disorders were initially thought to be a part of person's character, but with advanced knowledge and research, it is now considered to be chronic diseases that are subject to relapse and characterized by clinically significant impairments in irresistible desire to obtain the substance, general health, and social function.[8] It is seen that a large proportion of people with substance use disorders have a comorbid psychiatric disorder such as anxiety disorders, depressive disorders, bipolar disorders, and sleep disorders and vice versa.[9] It is also noted in studies that a person of substance dependence has a significant reduced quality of life as compared to normal persons. This study is being conducted to understand these issues of cognition associated with substance abuse, impact of substance abuse on general health as well as any correlation between cognition and general health of patients of substance abuse, so as to help clinicians to identify and respond to such issues that may affect patient's treatment outcome.

Hence, in view of the above literature, the present study was planned with the aim to assess the cognitive functions and general health in patients with substance dependence and also to correlate general health with the level of cognitive function.

  Methodology Top

The present study is an observational study with a cross-sectional design, conducted in the Department of Psychiatry at the Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana (Ambala). Patients who attended the regular outpatient department (OPD) were screened based on a history of any drug intake were assessed, and the final diagnosis was made as per the International Classification of Mental and Behavioral disorders-10th version[10] (ICD-10). As majority of the patients presented to psychiatry opd were of alcohol and opioids, therefore all the study subjects were categorized into three groups: patients taking alcohol (30), patients taking opioids (30), and nicotine (30). Consecutive sampling was adopted for sample collection. Patients of either gender, age 18–60 years, knowing Hindi, Punjabi, English languages, dependent on above-mentioned substances, and fulfilling the diagnostic criteria of substance dependence according to ICD-10 were included in the study. Written informed written consent was obtained from the patient. However, patients who refuse to give informed written consent, with a history of mental retardation/epilepsy/dementia, or any other organic brain disorder or any other major psychiatric disorder, and already on medication that can affect cognition (e.g., benzodiazepines) were excluded from the study. Instruments used for the assessment include Addenbrooke's Cognitive Examination Scale-III (ACE III)[11] and General Health Questionnaire-12 (GHQ-12).[12] ACE III is one of the standardized scales to assess and monitor the cognitive changes in dementia and mild cognitive impairment. ACE III includes 19 activities which test five domains such as attention/orientation (18 points), memory (26 points), fluency (14 points), language (26 points), and visual-spatial ability (16 points), adding up to a maximum total score of 100. ACE III has a high sensitivity and specificity at cutoffs 1.88 (sensitivity 1.0 and specificity 0.96) and 2.82 (sensitivity 0.93 and specificity 1.0). Internal reliability measured by the Cronbach's α coefficient is 0.88. The GHQ is a self-administered Psychometric Screening Scale. GHQ-12 is a short version consisting of 12 questions. Rating of each question can be given in four responses that is, “better than usual,” “same as usual,” “less than usual,” and “much less than usual.” Scoring is done on the Likert scale as 0, 1, 2, and 3 from left to right in our study. The total score ranges from 0 to 36. A high score indicates more severity of disease. Score more than 15 indicates distress; score more than 20 suggests severe problems and psychological dysfunction.

After the statistical analysis of data, scores were calculated and presented in tables. Descriptive statistics were applied to calculate the frequencies, percentage, mean, median, and standard deviation. Data were further analyzed for the significance using Chi-square, Pearson co-relation, and Mann-Whitney test. Finally, the findings of the study were discussed in the light of previous researches. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) software (version 19.0).[13] P < 0.05 is statistically significant. Ethical clearance has been taken from the committee of the Maharishi Markandeshwar University.

  Results Top

[Table 1] and [Table 2] show percentage and frequency distribution of various sociodemographic variables in relation to different categories of substance in the study sample. Majority of the substance users are males (92%Z); are in the age group of 21–30 years (37.8%); almost 3/4th of them were married (majority of them using alcohol). Almost 60% of the abusers belong to the family headed by skilled workers; 34.4% having education status till high school and 35.6% having income in the range of Rs. 3908–11,707; majority were Hindus followed by Muslims. There is a statistically significant difference seen in marital status with P = 0.005, of education with P = 0.001, family type with P = 0.008, and locality with P = 0.000.
Table 1: Frequency and percentage distribution of socioeconomic variables among various substances of study participants

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Table 2: Frequency and percentage distribution of socioeconomic variables of head of family of the study participants

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[Table 3] shows the percentage and frequency distribution of GHQ in relation to substance use. It is observed that opioid users showed maximum decline in general health overall. It is also observed that there is no statistically significant difference between alcohol users when compared to opioid users. While comparing alcohol and nicotine group, alcohol showed a significant disturbance in various domains of general health with highly significant in the domain of unable to overcome difficulties (P < 0.001). Whereas, when comparing opioid and nicotine group, opioid group showed much significant change in various domains of general health with highly significance in being felt constantly under strain (P < 0.001).
Table 3: Correlation of general health among various substances

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[Table 4] shows relation of cognitive deficits with substance use. It is observed that significant visual-spatial problems were seen among alcohol use participants with P = 0.002 as compared to nicotine users having more of language problems with P = 0.031.
Table 4: Correlation of cognitive domains among various substances

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[Table 5] shows the corelationship of general health with cognition of the study participant. It is seen that with impact on general health, there is a significant decline in sustaining attention with P = 0.007 which is statistically significant.
Table 5: Correlation of total health score with five components

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  Discussion Top

In the present study, it is observed that maximum substance use is seen among the age group of 21–30 years of age that is consistent with the findings of previous studies.[14],[15] Among gender, maximum substance use is seen among males in our study, which is consistent with the findings of previous studies that also showed similar results that substance use is common among males as compared to females and more use is seen of alcohol among them.[16],[17] In another study which is a longitudinal prospective study also showed similar results in which more men were reported to be using alcohol than females.[18] Thus, it is concluded that young adults are more vulnerable to addiction when further evaluated are found to be having more use of opioids as compared to other drugs of use.

Considering marital status, it is observed that maximum substance use is seen among married which is contrary to the findings seen in previous studies where more substance use is seen among singles or divorced or separated.[17] Thus, it is concluded that this variation may be due to among singles and various factors such as family and work obstacles that more of married participants have reported use of substance than singles or other categories.

In the present study, it is observed that more use of substance is seen in farmers and laborers, which is consistent with the findings of other studies, which also state that maximum substance use is seen among participants belonging to the agricultural and low socioeconomic background.[16],[19] Considering education status, it was found that undergraduates and participants educated till high school reported more use of alcohol than with a higher degree, which were similar to our findings.[20],[21] Thus, it is concluded that families with higher education are aware about the consequences of substance use and due to stress and less knowledge, it is more prevalent in families with less education.

In the present study, it is seen that maximum substance use is seen in families with a total income of Rs 3,908–11,707. In other studies, it is seen that alcohol use is more seen in families with higher income which states that alcohol use is seen in participants who are raised in families with high income, and nicotine use is seen more in families with lower income.[20],[21] Thus, it is concluded that this substance use is more seen among low socioeconomic strata due to various reasons such as stress, long-labored hours, and work pressure.

In the present study, maximum substance use is observed among participants residing in the urban areas, though equal number of participants was reported to have use of substance. Similar results were reported by previous studies.[22] This change from rural or semirural can be attributed to the decline in intercultural barriers and introduction of gateway drugs, stimulants and more easy accessibility of drugs, peer pressure, and societal influence.

In the present study, it is observed that alcohol users have a significant impact on attention, language, and visual-spatial abilities in relation to general health. In the present study, it is observed that if taking into account the total general health of study sample, significant decline is seen in cognitive domain of attention. As far as the literature is concerned, to the best of our knowledge, we could not find any existing data in comparison to results in our study regarding the correlation of general health with cognition.

  Conclusion Top

Thus, we conclude that, in clinical practice, cognitive deficit is less commonly addressed which is caused due to the substance use, and they often remain untreated at the start of treatment. Therefore, early detection is necessary for favorable outcome and compliance of treatment. If addressed properly can help in improving cognitive performance through cognitive training and subsequently improve the general health and thus reduce the economic burden.


The strength of our study is the design which is relevant to the clinical practice, by assessing cognition through ACE-III and addressing general health through GHQ-12 due to substance use. No other study has compared the domains of cognition among each other and general health.


The major limitation of our study was a small sample size, cross-sectional study, and noninclusion of other substances such as cannabis, cocaine, and stimulants. Hence, the results cannot be generalized to the general population.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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