Memory Retraining with Adult Male Alcoholics

Transcription

1 Archives of C/inica/ Neuropsychology, Vol. 4, pp $ oo Printed in the USA. All rights reserved. Copyright National Academy of Neuropsychologists Memory Retraining with Adult Male Alcoholics Roseann Hannon, Dorothy E. de la Cruz-Schmedel, Timothy C. Cano, Kim Moreira, and Rhonda Nasuta University of the Pacific George V. Staub Salvation Army Adult Rehabilitation Unit The purpose of the present study was to evaluate the use of group memory retraining in adult male alcoholics. Subjects were 29 residents of a Salvation Army Adult Rehabilitation Center. Fourteen of the men volunteered to be in a memory retraining group and 15 to be in a control group, and all had memory functioning assessed during a pretest and again during a posttest eight weeks later. Memory retraining occurred in groups of three to six men who met one hourper week for eight weeks. Only one test improved significantly with memory retraining. Despite that fact, subjects appreciated the retraining and were more confident of their ability to learn and remember. Since alcoholics have many subjective complaints about memory dysfunction and previous research has demonstrated memory impairment, both a standardized clinically useful memory test battery and effective memory retraining techniques are needed. An area of cognitive dysfunction often reported in the neuropsychological literature on alcoholics is impairment in memory and new learning (Bolter & Hannon, 1986; Brandt, Butters, Ryan, & Bayog, 1983; Miller & Saucedo, 1983; Nixon, Kujawski, Parsons & Yohman). Increasing research interest has focused on whether cognitive deficits in alcoholics can be reduced using cognitive retraining techniques. Goldman (1987) has been the primary proponent of the importance of experience-dependent recovery in alcoholics and has demonstrated that experience facilitates recovery on a variety of tasks, but he has not focused on tasks which primarily involve memory. Requests for reprints should be sent to Roseann Hannon, PhD, Department of Psychology, University of the Pacific, Stockton, CA

2 228 R. Hannon et al. Rehabilitation of memory deficits has been attempted in alcoholics with some positive results using techniques which have been successfully applied with brain damaged subjects (Binder & Schreiber, 1980; Dougan & Engel, 1984; Parsons, 1987). Treatment is usually given individually which limits the number of patients who can be economically treated. Memory retraining for brain damaged patients has been attempted in groups (Wilson & Moffat, 1984), but no work in group settings has been reported for alcoholics. The purpose of the present study was to evaluate the effectiveness of group memory retraining in alcoholics by comparing recovery in clients who received such training with recovery in clients who did not. Subjects METHOD Subjects tested on the memory test battery were 29 male alcoholic residents of the local Salvation Army Adult Rehabilitation Center who had been detoxified for a minimum of 21 days. Fourteen subjects were selected for Memory Group retraining on the basis of willingness to participate in retraining and to be retested on the memory test battery. Fifteen subjects were selected as a Control Group on the basis of willingness to be retested. Nonrandom assignment was necessary to obtain large enough sample sizes in each group as many of the men were not willing to participate in memory group training. Age, education, drinking, and nonmemory cognitive variables data are presented in Table 1 for each group. There were no significant differences between any of the samples on any of these critical variables. Procedure All subjects completed an interview regarding demographic information and alcohol consumption variables and were administered a brief test battery designed to assess various aspects of memory functioning: Boston Remote Memory Test (odd numbered items at pretest and even numbered at posttest), Babcock Story Recall Test (immediate and 30 minute delayed trials), Hidden Objects Test, Memory Matrix Test (noninterference and interference trials), and Rey Auditory Verbal Learning Test (noninterference and interference trials). The Memory Matrix Test was developed by Mungas (personal communication, February 1, 1983) as a nonverbal test which is similar in format to the Rey Auditory Verbal Learning Test. All tests were administered to groups of subjects (with instructions modified as necessary, for example, responses to the Babcock Story Recall Test were written down by each subject instead of given orally) except the Boston Remote Memory Test which was administered individually. Memory groups consisted of three to six men and were held for 1 hour

3 Memory in Alcoholics 229 TABLE 1 Means (SDS) for Age, Education, Drinking, and Nonmemory Cognitive Variables for Memory Retraining Sample (n = 14) and Control Sample (n = 15) Memory Retraining Sample Control Sample Age Education Days Since Last Drink Years of Alcoholic Drinking Spical Ounces Drunk when Drinking Heavily Shipley Vocabulary Test Symbol Digit Modalities Test 42.6 (11.6) 43.3 (9.7) 11.6 (1.8) 11.3 (2.5) (226.2) 46.3 (36.2) [Median=551 [Median=44.5] 17.9 (8.11) 21.4 (11.5) 30.1 (30.0) 24.2 (20.7) 24.9 (7.7) 25.9 (6.6) 43.2 (15.7) 39.9 (11.2) once a week for eight weeks. Memory retraining techniques were based on Wilson and Moffat (1984) and included attention training, visual imagery, verbal strategies, and external cue strategies. Materials similar to those in the memory tests were used as part of memory retraining where appropriate (e.g., strategies used for remembering what was read in paragraphs from the newspaper paralleled the material in the Babcock Story Recall Test, strategies used for remembering items on a grocery list paralleled the Rey Auditory Verbal Learning Test, etc.). Subjects were tested on different material than they were trained on as we were interested in whether the effects of training were generalizable to similar material (as would be required for the training to have any practical significance in everyday life), not in whether training would improve performance on identical material. Only subjects who complied with treatment by attending a minimum of six of the eight retraining sessions, turning in homework assignments for each session attended, and taking quizzes on the previous week s material were used in the data analysis. Quizzes consisted of 10 recall questions requiring short answers (word or phrase) and the average score was 70 to 80% correct each week, suggesting that the subjects were absorbing the memory retraining information. Following the completion of memory retraining, a posttest was given to Memory Group subjects on the neuropsychological test battery (using alternative forms of tests where possible). Control subjects received posttesting after the same period of time as the Memory Group subjects. RESULTS Mean performance by Memory and Control Groups at Pre and Posttesting on each cognitive test is presented in Table 2. A two-way split-plot ANOVA (Memory Group versus Controls x Pretest versus Posttest) was performed on these data. There were no significant overall differences between

4 230 R. Hannon ef al. TABLE 2 Mean Performance by Memory Retraining and Control Groups at Pre and Posttesting on Each Cognitive Test Pre-Testing Post-Testing Test Names Memory Control Memory Control Boston Remote Memory Test Famous Faces Recall Test Recognition Test Babcock Story Recall Test Immediate Delayed Hidden Objects Memory Matrix Noninterference Interference Rey Auditory Verbal Learning Test Noninterference Interference the Memory Group and the Control Group on any cognitive test. Significant overall changes across time showing the expected finding of posttesting better than pretesting occurred on only the Memory Matrix Test, noninterference [F(l, 27)=6.79; p<.o5] and interference [F(l, 27)=9.19; p<.o5] trials. Conversely, Pretesting was significantly better than Posttesting on the Babcock Story Recall Test, immediate trial [F( 1, 27) = 22.4; p c.ol]. Superiority of the Memory Group over the Control Group was analyzed by looking for significant interactions showing greater improvement across time for the Memory Group than for the Control Group. Only one interaction was found confirming this relationship: the Memory Group score improved over time for the Boston Remote Memory Recognition subtest, but decreased over time for the Control Group [F(l, 27)=7.31; p<.osl. DISCUSSION The results provided little confirmation for the hypothesis that memory retraining can facilitate recovery in abstinent alcoholics. Only the Boston Remote Memory Recognition subtest showed this pattern, and this is not a test which memory retraining would be expected to facilitate unless the retraining somehow improves retrieval mechanisms. One problem with interpreting the results is that comparison with normative data suggested that the memory tests used may not have been adequately sensitive to impairment in

5 Memory in Akohofics 231 alcoholics. Eckhardt and Martin (1986) have indicated the need for a standardized memory test battery which is both sensitive to deficits in alcoholics and clinically useful. The difficulty is compounded by the fact that memory deficits in many alcoholics may be quite subtle or may be a secondary function of a more basic problem in the brain s ability to process information (Goldman, 1987; Goldstein, 1987). The lack of improvement following memory retraining in the present study may also reflect the limitations of current memory retraining techniques. Godfrey and Knight (1985) randomly assigned 12 amnesiac alcoholics with moderate to severe memory impairment to memory training or control groups. There was no difference between the two groups in improvement on most measures used, particularly on measures which assessed generalization of memory skills. Studies of memory retraining in nonalcoholic populations have also produced variable results on the effectiveness of many popular retraining techniques, especially when generalization of training to everyday life skills has been investigated (Miller, 1984; Schacter, Rich & Stampp, 1985). Though measurable memory deficits may be subtle, they have been repeatedly reported in the literature and may not spontaneously recover over time (Brandt et al., 1983). In the present study, only one measure (Memory Matrix Test) improved significantly from pre to posttesting. In addition, alcoholics subjectively perceive that their memory functioning is impaired and are willing to participate in treatments to improve it, and there is some evidence of improvement with training in the small amount of research conducted to date. Parsons (1987) used a memory training strategy similar to that used in the present study, and preliminary data analysis showed a significant improvement in performance on the Wechsler Memory Scale Semantic Memory Test. Parsons also noted that the subjects reacted to the training quite positively and seemed to have increased self-esteem. This was also true in the present study, with many of the memory retraining subjects expressing appreciation for the experience and a renewed sense of confidence in their ability to learn and to remember new material. Given both the objective and subjective importance of impaired memory functioning in chronic alcoholics, future research should focus on (a) developing a standardized clinically useful memory test battery for alcoholics, and (b) on developing effective memory retraining techniques for alcoholics with impaired memory functioning. REFERENCES Binder, L. M., & Schreiber, V. (1980). Visual imagery and verbal mediation as memory aids in recovering alcoholics. Journal of Clinical Neuropsychology, 2,l l-74. Bolter,.J. F., & Hannon, R. (1986). Lateralized cerebral dysfunction in early and late stage alcoholics. Journal of Studies on Alcohol, 47,

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