Self-reported cognitive scales in a US National Survey: reliability, validity, and preliminary evidence for associations with alcohol and drug use.

Abstract

To evaluate relationships between measures of cognitive functioning and alcohol or drug use among adults (≥18years) in the US 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 drug use were estimated with adjusted odds ratios (aOR). United States, using the 2012-13 National Epidemiologic Survey on Alcohol and Related Conditions-III, a nationally representative adult sample selected by multi-stage probability sampling. 36 085 respondents. Past-year substance use outcome variables categorized binge drinking, marijuana, cocaine, opioid, sedative/tranquilizer and stimulant use as frequent (at least weekly to daily), infrequent (any to two to three times/month) or no use, assessed by the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5. 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 fitted a two-factor model (comparative fit index=0.973): attention (five items) and executive functioning (four items). Both scales were associated positively with higher education (Ps<0.001) and negatively with functional impairment (Ps<0.001), demonstrating construct validity. Poorer attention was associated with frequent and infrequent binge drinking and use of drugs [aOR range=1.07 (binge drinking) to 1.72 (stimulants), Ps≤0.01]. Poorer executive functioning was associated with frequent binge drinking and use of drugs [aOR range=1.22 (binge drinking) 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 associated with substance use in the US general population.