Predicting relapse and recovery in alcoholism and addiction: neuropsychology, personality, and cognitive style.

Neuropsychological studies of substance abuse treatment outcome have generally found successful recoverers to show intact functioning on most measures, whereas relapsers do poorly on tests of language, abstract reasoning, planning, and cognitive flexibility. These have been related to involvement of left hemisphere and frontal lobe functions. Personality profiles of successful remitters, with or without formal treatment, include future goal-orientation, frustration-tolerance, and self-efficacy, while relapsers are characterized by impulsivity, antisocial personality, and affective disorders. It is proposed that what these neuropsychological and personality indexes are actually describing in successful recoverers is the neuropsychodynamic trait variable of ego autonomy, which is related to a reflective, nonimpulsive, goal-directed cognitive style. Implications of the neuropsychodynamic model for the evaluation and treatment of substance abusers is discussed.