Long-term alcohol abuse is linked with organic, psychiatric and neurological diseases. Structural and functional neuroimaging techniques show grey matter volume reduction, micro-structural changes in some white matter tracts, a decrease in glucose metabolism and disturbances in neurotransmission systems. These alterations sometimes result in cognitive impairment and functional dependence. The most common alterations are related to problems with memory, abstraction, problem-solving, visuospatial analysis and syntheses, speed of psychomotor functioning and information processing, and cognitive efficiency. Metacognition and social cognition may also be affected. Alcohol abusers with cognitive impairment present poorer treatment outcomes, including worse adherence and a higher rate of relapse, poorer perceived self-efficacy, less insight and more addiction denial. These patients thus require specialized treatments, such as cognitive rehabilitation or environmental adaptations.

Unfortunately, neuropsychological assessment is not systematically performed in addiction treatment centres because it consumes considerable time and resources. Hence, some subtle deficits can go unnoticed (Davies et al., 2005) and patients are referred to dementia units only when their impairment is obvious. The Mini Mental State Examination (MMSE) is one of the most commonly used screening tools in the general population, although it yields a high number of false negatives in some disorders (Carnero-Pardo, 2013, Oudman et al., 2014). As an alternative, Copersino (2009) and Rojo-Mota (2013) suggest that the Montreal Cognitive Assessment (MoCA) is a suitable instrument for detecting cognitive impairment in people with substance abuse.

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