Self-reported Cognitive Scales in a U.S. National Survey: Reliability, Validity, and Preliminary Evidence for Associations with Alcohol and Drug Use
To evaluate relationships between measures of cognitive functioning and alcohol or drug use among adults (≥18 years) in the U.S. general population.
Two cognitive scales were created based on dimensionality and reliability of self-reported Executive Function Index items. Relationships between the two scales and validators were evaluated. Associations between the cognitive scales and past-year frequency of alcohol or other drug use were estimated with adjusted odds ratios (aOR).
USA, using the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III, a nationally representative adult sample selected by multistage probability sampling.
Past-year substance use outcome variables categorized binge alcohol use, marijuana, cocaine, opioid, sedative/tranquilizer, and stimulant use as frequent (at least weekly to daily), infrequent (any to 2-3 times/month), or no use, assessed by the Alcohol Use Disorder and Associated Disabilities Interview Schedule-V.
Key predictors were the two cognitive scales. Construct validators included education and functional impairment. Covariates included age, gender, income, and race/ethnicity.
Nine cognitive items fit a two-factor model (Comparative Fit Index=.973): attention (5 items) and executive functioning (4 items). Both scales were positively associated with higher education (ps<.001) and negatively associated with functional impairment (ps<.001), demonstrating construct validity.
Poorer attention was associated with frequent and infrequent binge alcohol consumption and use of drugs (aOR range=1.07 [binge alcohol use] to 1.72 [stimulants], ps≤0.01).
Poorer executive functioning was associated with frequent binge alcohol intake and use of drugs (aOR range=1.22 [binge alcohol use] to 2.03 [cocaine], ps<0.001), and infrequent use of all drugs (aOR range=1.19 [marijuana] to 1.63 [cocaine], ps<0.001).
Impairments in attention and executive functioning are positively correlated with substance use in the U.S. general population.