Substance/Medication-Induced Major Or Mild Neurocognitive Disorder

The signs and symptoms of substance/medication-induced neurocognitive disorder can vary depending on the type of substance or medication responsible for triggering the disorder. Symptoms also tend to vary based on different categories of cognitive function. The following are some of the possible ways that this disorder can affect people:

1. Memory impairment

• Difficulty recalling recent events or information
• Forgetfulness of important appointments or tasks
• Challenges in retaining new information

2. Attention and concentration deficits

• Inability to focus on tasks or conversations
• A tendency to be easily distracted by irrelevant stimuli
• Difficulty multitasking or maintaining sustained attention

3. Executive function deficits

• Impaired decision-making abilities
• Challenges with planning and organizing tasks
• Reduced ability to initiate and complete complex actions

4. Learning difficulties

• Reduced ability to acquire new skills or knowledge
• Slower processing speed in learning new information
• Difficulty understanding and applying instructions

5. Language and communication problems

• Slurred speech or difficulty articulating thoughts clearly
• Impaired comprehension and expression of language
• Challenges in following conversations or expressing ideas coherently

6. Psychomotor impairment

• Slowed movements or reactions
• Difficulty with fine motor skills, such as writing or buttoning clothes
• Coordination problems, leading to unsteady gait or balance difficulty

7. Emotional and behavioral changes

• Mood swings, irritability, or agitation
• Decreased motivation and interest in previously enjoyable activities
• Impulsivity and risky behaviors

The severity and specific manifestations of these symptoms can vary widely among individuals and depend on factors such as the type of substance used, the duration of use, and individual susceptibility. 

Additionally, substance/medication-induced neurocognitive disorder may be mistaken for other medical or mental health conditions¹ that do not have a direct link to substance or medication use. Because of this, a comprehensive evaluation through a medical or mental health professional can be vital in determining an appropriate and effective method of treatment.

The common causes of substance/medication-induced neurocognitive disorder are generally rooted in the use of various substances or medications that can have detrimental effects on cognitive functioning. 

Some substances are known to directly affect brain structures and neurotransmitter systems, which can lead to cognitive impairment. Additionally, medications prescribed for medical conditions can have unintended side effects on cognitive processes.

Common causes of substance/medication-induced neurocognitive disorder may include:

• Substance use: Prolonged and excessive use of substances like alcohol, opioids, cannabis, cocaine, and amphetamines can lead to neurotoxic effects, resulting in cognitive deficits over time.

• Medications: Certain medications, such as benzodiazepines, anticholinergics, anticonvulsants, and antipsychotics, have been associated with neurocognitive impairment as a side effect. In these cases, the condition is referred to as medication induced neurocognitive disorder.

• Polydrug use: Combining multiple substances (polysubstance use) can intensify the negative impact on cognitive function and increase the risk of developing neurocognitive disorders.

Risk factors associated with this condition include: 

• Age: Older adults may be more susceptible to cognitive impairment from substance use or medications due to age-related changes in brain function and metabolism. Also, adults will likely have used a substance longer.

• Genetics: Some individuals may have a genetic predisposition2 that makes them more vulnerable to cognitive effects of substances.

• Co-occurring mental health disorders: Individuals with existing mental disorders, such as depression or anxiety, may be at a higher risk of developing neurocognitive disorders when using substances.

• Underlying health conditions: Certain medical conditions or neurological disorders can increase the risk of cognitive impairment or cognitive disorders when combined with substance use or medication.

Understanding these causes, risk factors, and triggers can be essential for medical and mental health professionals to develop appropriate prevention strategies and tailored treatment plans for individuals experiencing substance/medication-induced neurocognitive disorder.

The primary goal of treatment for substance/medication-induced neurocognitive disorder is typically to minimize cognitive impairments and enhance cognitive function in order to improve quality of life. Effective treatment generally aims to address the underlying causes of cognitive deficits, identify triggering substances or medications, manage co-occurring mental health challenges, and promote overall cognitive well-being.

Medication

The treatment of substance/medication-induced neurocognitive disorder may involve a healthcare professional modifying an individual’s medication regimen to  minimize or eliminate substances or medications that may be implicated in causing their neurocognitive symptoms.

In addition medications may be prescribed to help treat symptoms or co-occurring conditions, examples include:

• Antidepressants: In cases of co-occurring depression, antidepressants may be prescribed to manage certain symptoms.
• Anti-anxiety medications: For individuals experiencing severe anxiety or agitation, short-term use of anti-anxiety medications may be considered.
• Antipsychotics: For individuals experiencing psychotic symptoms antipsychotic medications may be prescribed. 

It is important to consult with a doctor or medical professional before beginning or changing any medication plan. The information provided in this article is not intended as medical advice; please consult a qualified healthcare professional for personalized guidance. 

Other treatment options

• Detoxification: In cases of severe substance dependence, medically supervised detoxification may be required to safely manage withdrawal symptoms.
• Dual diagnosis treatment: Co-occurring disorders can be addressed in conjunction with neurocognitive disorders for comprehensive treatment.

Self-care

• Cognitive training: Engaging in brain-training activities and games may help stimulate cognitive functioning and complement formal cognitive remediation therapy.
• Lifestyle changes: Adopting a healthy lifestyle, including regular exercise, balanced nutrition, and sufficient sleep, can positively impact overall cognitive health.

By combining various therapeutic approaches, lifestyle adjustments, and self-care practices, individuals affected by this substance-induced neurocognitive disorder may find that they can optimize their cognitive functioning and work toward achieving better cognitive outcomes. 

Additionally, for those with substance use disorders, treatment often aims to support recovery and prevent further cognitive decline by eliminating or reducing substance use.

In many cases of substance/medication-induced neurocognitive disorder, therapy plays a role in helping individuals understand the connections between substance use and cognitive impairment. A number of online therapy platforms offer therapy via audio, videoconferencing, and live chat, allowing participants to receive specialized treatment from the comfort of their own home.

Additional resources

• Substance Abuse and Mental Health Services Administration
• American Addiction Centers
• Mental Health America
• National Alliance on Mental Illness

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357).

A study published in 2023 advanced research on the way that alcohol and cocaine use impairs cognitive ability. Specifically, the researchers found that substance use inhibits cholinergic interneurons (CINs), which has a negative impact on cognitive flexibility. The researchers hope that this study might lead to more effective treatments for those who experience cognitive decline as a result of substance use. 

A study published in Drug and Alcohol Review examined cognitive problems in people with substance use challenges and found that about 31% of individuals seeking treatment for alcohol, cannabis, stimulant, and opioid use had cognitive problems. 

Additionally, the study found that alcohol users had memory problems, while opioid users experienced difficulty with visuospatial ability. Younger patients appeared to fare better on cognitive testing overall. The study concluded that early screening for cognitive problems is important for better treatment, though more research is needed for opioids and age effects.

Below are some statistics on substance/medication-induced neurocognitive disorder:

• Substance/medication-induced neurocognitive disorder is a significant concern, with an estimated prevalence ranging from 15% to 50% among individuals with substance use disorders. 
• Alcohol, opioids, cannabis, and benzodiazepines are among the reported substances associated with neurocognitive impairment. 
• According to research published in 2022, approximately “half of the substance dependence treatment population is estimated to have a cognitive impairment, which reduces participation, retention, and post-treatment outcomes.”
• According to SAMHSA, “of the 29.0 million adults who perceived that they ever had a substance use problem, 72.2% (or 20.9 million) considered themselves to be in recovery or to have recovered from their drug or alcohol use problem.”