The Test Solution “Substance Use Disorders - Neurocognitive Assessment” is used to assess the cognitive functional profile of persons with substance-related disorders as defined by the DSM-5-TR and ICD-11. The diagnostic frameworks describe disorders due to substance use as a group of conditions that arise from the repeated consumption of psychoactive substances and encompass a broad spectrum of cognitive, behavioral, and physiological symptoms. A characteristic feature is the ability of these substances to activate central reward systems and thereby influence learning, memory, and decision-making processes. Both ICD-11 and DSM-5-TR differentiate substance-related disorders according to the substance consumed and include, among others, disorders related to alcohol, cannabis, opioids, cocaine, amphetamines, and nicotine (American Psychiatric Association, 2022; WHO, 2022).
In the scientific literature, extensive findings are available on trans-substance and substance-specific cognitive changes. The systematic review by Ramey et al. (2018) describes consistent impairments in attention, working memory, Response Inhibition, and planning-related executive functions as common characteristics across different substance use disorders. These impairments are expected, since addiction-related stimuli activate automatic attentional processes, inhibitory control mechanisms are strained by repeated consumption behavior, chronic substance use impairs working memory processes, and decision-making processes become increasingly driven by immediate, habitualized reactions rather than deliberative strategies. These cognitive limitations increase relapse risk, complicate treatment adherence, and impair everyday functioning. They therefore represent central targets for assessment and targeted therapeutic interventions. At the same time, recent meta-analyses indicate that the strength and manifestation of these cognitive changes vary depending on the substance class and that substance-specific patterns can be identified.
In alcohol dependency (AUD), a meta-analysis covering k = 62 studies showed that the profile of neurocognitive deficits largely recovers within one year after cessation of use. The most pronounced impairments immediately after cessation were found in planning ability (k = 20; n = 1816; d = 0,53 [0,44; 0,63]), attention (k = 3; n = 116; d = 0,70 [0,32; 1,08]), and working memory (k = 14; n = 818; d = 0,53 [0,36; 0,70]). Other executive functions such as inhibition, processing speed, as well as learning and memory performance showed smaller effects in the range of 0,37 < d < 0,47. Overall, these effects remained relatively stable during the first year of abstinence, whereas findings after more than one year of abstinence showed only small to negligible effect sizes (Stavro et al., 2012). The authors conclude that alcohol-related impairments are not selective but diffusely distributed across different neurocognitive domains, supporting the “diffuse brain hypothesis”.
In cannabis dependency (CUD), a meta-analysis across k = 23 studies showed clear impairments in several cognitive areas. The largest effects were found in general intelligence (d = 0,50 [0,33; 0,67]), verbal learning (d = 0,48 [0,32; 0,64]), processing speed (d = 0,40 [0,23; 0,58]), and working memory (d = 0,40 [0,26; 0,54]). Findings on attention, impulsiveness, and visuospatial abilities, however, showed mostly small to negligible effects (0,20 < d < 0,28). These results indicate a specific, focused pattern of cognitive impairments in CUD that differs from the more diffuse profiles of other substances (Pilon et al., 2025).
In cocaine dependency, a meta-analysis covering k = 46 studies showed clear impairments across several cognitive domains depending on abstinence status. During short abstinence (positive urine sample), moderate deficits were found primarily in impulsiveness (d = 0,41 [0,21; 0,61]) and working memory (d = 0,44 [0,17; 0,71]), while effects in attention, processing speed, and visual abilities were mostly small (d < 0,30). At ≤12 weeks of abstinence, several deficits became more pronounced, particularly in attention (d = 0,59 [0,32; 0,87]), impulsiveness (d = 0,58 [0,41; 0,76]), processing speed (d = 0,45 [0,29; 0,60]), and working memory (d = 0,52 [0,30; 0,75]). Verbal learning and memory showed consistently moderate effects (0,52 < d < 0,56). Overall, the findings indicate broadly distributed and abstinence-dependent impairments, with some deficits becoming more pronounced during early abstinence (Potvin et al., 2014).
In methamphetamine dependency (MUD), a meta-analysis across k = 44 studies showed broadly pronounced deficits in intelligence, attention, verbal fluency, long-term and working memory (0,43 < d < 0,59). Particularly strong impairments were found in impulsiveness (k = 8; d = 0,93 [0,72; 1,14]) and social cognition (k = 3; d = 1,12 [0,81; 1,42]), although the latter should be interpreted cautiously due to small sample sizes. Areas such as visual learning, processing speed, and visuospatial abilities showed smaller effects (0,27 < d < 0,38). Overall, the evidence demonstrates substance-related, broad cognitive deficits, with patterns comparable to or slightly more pronounced than those found in alcohol and cocaine dependency (Potvin et al., 2018).
In opioid dependency (OUD), a meta-analysis covering k = 61 studies showed clear impairments in complex psychomotor speed (k = 22; g = 0,97 [0,74; 1,20]). Further strong to moderate deficits were found in immediate visual memory (k = 7; g = 0,97 [0,70; 1,25]), visuospatial abilities (k = 4; g = 0,76 [0,45; 1,06]), verbal memory (k = 14–13; 0,56 < g < 0,60), working memory (k = 20; g = 0,77 [0,56; 0,98]), as well as planning ability (k = 12; g = 0,70 [0,53; 0,87]). Smaller effects were observed in cognitive flexibility (k = 22; g = 0,42 [0,27; 0,58]) and attention (k = 13; g = 0,57 [0,41; 0,72]), while motor and processing speed showed negligible differences (k = 10–5; g < 0,25). Meta-regressions suggest that longer abstinence is associated with a reduction in specific deficits, particularly in the psychomotor domain. Overall, a broad profile of cognitive impairments emerges, characterized by especially pronounced deficits in complex psychomotor functioning, memory performance, working memory, and planning (Wollman et al., 2018).
In tobacco dependency, a meta-analysis covering k = 24 studies on chronic or heavy tobacco use showed clear differences in cognitive impulsiveness (k = 5; d = 0,88 [0,31; 1,46]), while motor impulsiveness, for example measured by the Stroop, showed no significant group differences (k = 4; d = 0,11 [–0,07; 0,28]). Moderately impaired were long-term memory (k = 7; d = 0,62 [0,28; 0,96]), planning ability (k = 8; d = 0,51 [0,23; 0,78]), cognitive flexibility (k = 9; d = 0,45 [0,06; 0,84]), as well as working memory (k = 11; d = 0,41 [0,18; 0,64]). Negligible effects (d < 0,20) were found in attention and intelligence. The authors point out that lighter or moderate use is associated with smaller or no group differences (Conti et al., 2019).
Overall, substance-related disorders show both commonalities and clear differences in the nature and strength of their neurocognitive profiles. It should be considered that most of these findings are based on cross-sectional studies and therefore do not allow causal conclusions. However, a systematic review showed that neurocognitive disorders are often caused by substance use and highlighted the relevance of assessing impairments in everyday functioning (Toledo-Fernández et al., 2017).
The following domains cover those neurocognitive dysfunctions that occur most consistently across substances and are described in DSM-5-TR and ICD-11 as central functional areas related to substance-related disorders. The Test Solution “Substance Use Disorders - Neurocognitive Assessment” includes the following cognitive domains and associated tests:
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Attention
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Selective attention (TACO)
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Processing speed (TMT-S, Part A)
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Executive functions
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Inhibition (STROOP)
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Cognitive flexibility (TMT-S, Part B)
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Learning and memory
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Working memory (SPAN)
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Fluid intelligence (BMT)
Depending on the assessment question, additional tests may be integrated, for example verbal fluency (WIWO) and social cognition (TOM) in methamphetamine dependency or (complex) psychomotor skills (2HAND) in opioid dependency. In addition, AUDIT (Alcohol Use Disorders Identification Test) and DUDIT (Drug Use Disorders Identification Test) are available as free supplementary questionnaires for symptom assessment (see Open access tests). It should be noted that when configuring the test sequence and adding tests that are not part of the SCHUHFRIED Selection, the combined results overview is no longer automatically available (see Notes on evaluation and interpretation ).
The test duration of the standard form is approximately 47 minutes.
References can be found here: Literature