Demographic, nicotine dependence, liver history and current psychiatric comorbidities as risk factors of moderate impairment in therapeutic community residents at entry

International audience ; Purpose: Therapeutic Communities (TCs) are care units welcoming people with Alcohol and Drug Use Disorder (AUD/DUD) associated with frequent psychiatric, neurological and medical comorbidities. These substance disorders, along with such complications, can lead to neuropsychological impairments that may to hinder the benefit of addiction treatment. However, the specific risk factors associated with the neuropsychological profile of TC residents at entry have never been explored. Methods: Residents of three French TCs (n=61; 82% male) underwent clinical interviews and questionnaires assessing psychiatric, neurological and liver history, substance use, alcohol-related problems (with the AUDIT), nicotine dependence (with the Fagerstrom test) and current anxiety and depression comorbidities (with the HAD scale). They also underwent an extensive neuropsychological examination assessing four cognitive domains: episodic memory, working memory, visuospatial abilities and executive functions. Moderate impairment was defined as at least two affected cognitive domains. All assessments were conducted within the first fifteen days of admission to the TC. To identify risk factors associated with neuropsychological impairment, forward logistic regression was performed, using demographic (age, sex, education and TC), clinical and substance use variables as predictors, and moderate impairment (0 = preserved and 1 = impaired) as the outcome. Results: The majority of TC residents had AUD and used tobacco (88% and 96%, respectively), consuming cannabis (80%) and drugs including benzodiazepines (57%), with most being polysubstance users. Regarding medical conditions, 39% had a history of liver disease, 57% a history of neurological disease, and at entry, 60% reported current anxiety and 84% current depression. More than 1/3 of residents (36%) had moderate impairment. Sex (male), higher Fagerstrom score, a negative anxiety score on the HAD, younger age, a positive liver history, and higher depression score on ...