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Graduate Student Journal of Psychology          Copyright 2011 by the Department of Counseling and Clinical Psychology 

2011, Vol. 13               Teachers College, Columbia University 

60 

 

 

Cognitive and Functional Deficits of Alcohol Abuse: A Review 
 

Nikita Malakhov 
Teachers College, Columbia University 

 
Due to the high prevalence of alcohol abuse and alcohol-related mortalities worldwide, it is 

important to investigate the impact of alcohol abuse on cognitive and functional deficits.  The aim 

of this review is to synthesize the disparate research on cognitive and functional deficits due to 

alcoholism and delineate the different moderating factors that affect these deficits.  The review of 

the literature suggests that the relationship between alcohol abuse and cognitive and functional 

deficits is multifaceted and is moderated by age, gender, dose, and prior treatment history.  The 

review also indicates limitations of the cited studies and suggests multiple directions for future 

research. 

 

  

Alcoholism (i.e., Alcohol Use Disorders) is the third 

leading cause of preventable death in the United States, and 

the lifespan of people who suffer from alcoholism is roughly 

12 years shorter than their non-alcoholic counterparts 

(Maddux & Winstead, 2008).  According to the World Health 

Organization (2008), alcohol use disorders cause 88 million 

deaths yearly.  In addition, 125 million people worldwide are 

estimated to have alcohol use disorders. 

Based on the Diagnostic and Statistical Manual, 4
th

 

Edition (American Psychiatric Association [DSM-IV-TR], 

2000) alcohol use disorders include both abuse and 

dependence. Alcohol abuse refers to a maladaptive pattern of 

alcohol use that is manifested through recurrent alcohol use in 

dangerous situations (e.g., driving drunk, operating 

machinery while intoxicated), despite legal, social or 

interpersonal problems, and resulting in a failure to fulfill 

major role obligations.  Alcohol dependence is defined by a 

maladaptive pattern of alcohol use manifested by at least 

three of the following: tolerance, withdrawal, larger 

consumption of alcohol than intended, unsuccessful efforts to 

cut down use, a great deal of time spent on obtaining the 

alcohol or using it, important social/occupational/recreational 

activities being given up or reduced because of alcohol use, 

and continued use despite physical or psychological problems 

attributed to alcohol use.  Tolerance is described as the need 

for significantly increased amount of alcohol to achieve 

intoxication or desired effect and diminished effect with 

continued use of the same amount of alcohol.  Alcohol 

withdrawal symptoms include hand tremors, headache, 

seizures, vomiting, and nausea (Lessa & Scanlon, 2006).  

Alcohol withdrawal is also characterized by the consumption 

of more alcohol or a substance similar to it in order to avoid 

withdrawal symptoms.  Recreational alcohol use does not 

involve a maladaptive relationship with alcohol like alcohol 

dependence and abuse.  

                                                 
The author would like to thank Derek Eckert for his support and 

help.  

Correspondence concerning this article should be addressed to 

Nikhita Malakhov, 2727 Ocean Parkway, Apt. E-15, Brooklyn, NY 

11235. Email: nm2495@tc.columbia.edu. 

Chronic consumption of alcohol has been found to be 

associated with cognitive deficits, including difficulties 

learning new information (McGlinchey-Berroth, Fortier, 

Cermak, & Disterhoft, 2002; Ryan & Butters, 1980; 

Schottenbauer, Hommer, & Weingartner, 2007), problems 

with retaining information over periods of long delay (Rose, 

Shaw, Prendergast, & Little, 2010), and impairment in 

prospective memory (Heffernan, Moss, & Ling, 2002; Ling et 

al., 2003), verbal and non-nonverbal contextual memory 

(Sullivan, Shear, Zipursky, Sagar, & Pfefferbaum, 1997), 

short-term memory, general memory, and verbal memory 

(Ryan & Butters, 1980; Rosenbloom, O’Reilly, Sassoon, 

Sullivan, Pfefferbaum, 2005; Sullivan, Rosenbloom, & 

Pfefferbaum, 2000; Sullivan, Fama, Rosenbloom, & 

Pfefferbaum, 2002).  It has also been found to be associated 

with functional deficits in the areas of visuospatial abilities, 

upper limb mobility, and gait and balance (Sullivan et al., 

2000; Sullivan et al., 2002).  In addition, alcohol abuse has 

been found to negatively impact executive functioning, 

decision-making, behavioral inhibition, task shifting, working 

memory, and problem solving (Hildebrandt, Eling, Brokate, 

& Lanz, 2004; Leckliter & Metarazzo, 1989; Noel, Bechara, 

Dan, Hanak, & Verbanck, 2007; Sullivan et al., 2000; 

Sullivan et al., 2002),  

Additionally, research suggests that abstinence allows for 

recovery of some cognitive impairments associated with 

alcohol abuse (e.g., Brandt, Butters, Ryan, & Bayog, 1983; 

Bates, Voelbel, Buckman, Labouvie, & Barry, 2005; Mann, 

Gunther, Stetter, & Ackerman, 1999; Rosenbloom, Rohlfing, 

O'Reilly, Sassoon, Pfefferbaum, & Sullivan, 2007).  Bates et 

al. (2005) found a modest recovery in the cognitive domains 

of executive functioning, verbal processing speed, and verbal 

ability domains, and a medium recovery in the memory 

domain of abstaining alcoholics.  Rosenbloom and colleagues 

(2007) found improvements on measures of general memory 

and ataxia in abstaining alcoholics.  Brandt and colleagues 

(1983) showed that alcoholics with a prolonged period of 

abstinence (more than 5 years) improved in short-term 

memory and non-verbal memory skills.  In addition, Mann 

and colleagues (1999) found significant improvement on 

measures of perceptual-motor speed, verbal knowledge, non-



MALAKHOV 

 

61 

 

verbal reasoning, and spatial imagination in alcoholics who 

abstained from alcohol for a 5-week period.  The 

aforementioned studies will be explored in more details 

further along in this review. 

 

Effects of Alcoholism on Memory 

 

Prospective Memory 

Prospective memory is an important part of everyday 

cognitive functioning and is defined as the type of memory in 

which a person has to remember to do something in the near 

future, similar to a mental “to do” list (Heffernan et al., 

2002).  There is evidence that individuals with heavy alcohol 

use have impaired prospective memory compared to 

individuals with low-level alcohol use. An alcohol abuser 

with deficits in prospective memory may forget to perform 

important tasks from their “to do” list, such as attending 

doctor’s appointments and completing work responsibilities. 

A study conducted by Heffernan and colleagues (2002) 

investigated the effects of alcohol use on memory. The 

authors recruited a sample of 60 college students and asked 

them to complete the Prospective Memory Questionnaire 

(PMQ), a self-report measure that assesses prospective 

memory and effects of alcohol abuse.  The alcohol-abusing 

group was found to have significantly impaired prospective 

memory functioning.  The heavy alcohol use group self-

reported significantly higher levels of prospective forgetting 

for short-term, long-term, and internally cued prospective 

memory.  However, the authors cautioned about 

interpretation of the results obtained because the PMQ is a 

self-report measure and can therefore be biased. 

Similar to Heffernan and colleagues (2002), Ling and 

colleagues (2003) conducted an Internet-based study to 

investigate prospective memory function in alcohol abusers. 

Seven-hundred sixty-three participants completed the PMQ, 

the Everyday Memory Questionnaire (EMQ), and a 

demographic questionnaire.  Results indicated a significant 

impairment in long-term aspects of prospective memory with 

increased cognitive failures among the heavy alcohol abusing 

group, corroborating previous results by Heffernan and 

colleagues (2002).  Findings by Ling and colleagues (2003) 

add further support to the negative association between 

prospective memory deficits and alcohol abuse.   

 

Contextual Memory 

Another avenue of research on memory deficits in 

alcohol abusers has been the assessment of contextual 

memory, which is defined as the memory for the source of 

information, the temporal positioning of information, and the 

context in which that information was presented (Sullivan et 

al., 1997).  Sullivan and colleagues (1997) assessed 

contextual memory in alcoholics using an order recognition 

test of verbal and non-verbal items.  In order to test their 

contextual memory, the participants were shown 233 nouns 

and then were asked the question, “Which words did you see 

more recently?” (Sullivan et al., 1997, p. 198).  Alcoholics 

were found to have significant deficits in contextual memory 

as compared to healthy controls.  This study has important 

implications because it suggests that alcohol abuse has a 

negative impact on contextual memory.   

 

Effects of Alcoholism on Executive Functioning 

 

Bechara and Martin (2004) proposed that there is an 

underlying deficit in executive functioning components of 

working memory and decision-making in people who abuse 

substances.  Bechara and Martin (2004) found performance 

differences between individuals with substance dependence 

and control participants on measures of working memory and 

decision-making with the substance dependent individuals 

performing significantly worse than controls.  Thus, the 

authors established evidence to support the notion that 

individuals who abuse substances have underlying working 

memory and decision-making deficits. 

Hildebrandt and colleagues (2004) further explored 

executive functioning deficits in people with long-term, 

heavy alcohol consumption diagnosed with alcohol 

dependence according to the ICD-10.  Hildebrandt and 

colleagues (2004) assessed executive functioning (i.e., 

working memory, behavioral inhibition, and task shifting) 

using a two-back paradigm; participants were instructed to 

watch a computer screen presenting double-digit numbers 

from 10 to 99 and to press a response key when the number 

was the same as the previous number, two numbers back.  

The authors found that people with a history of long-term 

heavy alcohol consumption showed no impairment in 

working memory as compared to the matched healthy 

controls, but showed deficits in behavioral inhibition and task 

shifting.  These results suggest that subdividing executive 

functioning into its constituent parts should be an integral 

part in studying executive functioning deficits in alcohol 

abusers (Hildebrandt et al., 2004). 

Similarly, a study by Noel and colleagues (2007) looked 

at the performance of individuals who met the criteria for 

alcohol dependence according to the DSM-IV on the Iowa 

Gambling Task (IGT) in comparison to healthy controls.  

IGT is designed as a game in which four decks of cards, each 

of which has different rewards/punishments, are presented 

and the person has to choose one card out of a deck and they 

are either rewarded or punished for their choice.  The goal of 

the task is for the participant to pick out the most risk-

avoidant card deck.  Results indicated that individuals with 

alcoholism had poor executive functioning, impairment in 

behavioral inhibition, and performed worse than control on 

the last 20 trials of IGT.  The authors suggested that 

individuals with alcoholism display difficulties with 

decision-making, especially when these decisions involve 

risk.  Moreover, the authors proposed that working memory 

in alcohol dependent individuals shows normal storage 

capacity, but the ability to manipulate information held in 

working memory is impaired. 

Contrary to study findings by Hildebrandt and 

colleagues (2004) that found no evidence of deficits in 

working memory among alcohol dependents, Noel and 



ALCOHOL ABUSE DEFICITS 

 

62 

 

colleagues (2007) showed a partial deficit in working 

memory function among alcohol dependents.  Both studies 

found deficits in behavioral inhibition among alcohol 

abusers; however, the study by Noel and colleagues (2007) 

indicated impairment in the manipulation of information 

component of working memory, whereas the study by 

Hildebrandt and colleagues (2004) did not.  More research is 

needed on the executive functioning of working memory.  

Executive functioning, as was suggested by Hildebrandt and 

colleagues (2004), should be divided into its constituent parts 

in order for researchers to be able to reach a consensus about 

executive function impairment in alcohol abusers. 

 

Tests of Premature-Aging Hypothesis and the 

Relation to Amount of Lifetime Alcohol Consumption 

 

It has been hypothesized that the cognitive deficits seen 

in alcoholism are due to the premature aging of cognitive 

functioning caused by chronic alcohol consumption, a 

hypothesis known as the “premature-aging hypothesis” 

(Ryan & Butters, 1980).  Ryan and Butters (1980) tested the 

“premature-aging” hypothesis by administering various 

learning and memory tasks to younger alcoholics (ages 34-

49), older alcoholics (ages 50-59), and age-matched controls.  

Among the various tests administered by the researchers 

(Ryan & Butters, 1980), one was the Four-Word Short-Term 

Memory Test, in which participants are presented with four 

words and, following a distractor activity (i.e., count down 

from a three digit number by a certain number) are asked to 

recall these words.  Their results provided evidence for the 

premature-aging hypothesis, showing that younger alcoholics 

consistently performed at a level similar to the 10 years older 

normal controls.   

A study by Holden, McLaughlin, Reilly, and Overall 

(1988) looked to expand these findings.  Using the Wechsler 

Adult Intelligence Scale (WAIS, 1955), which allows for 

discerning a person’s mental age alongside their 

chronological one, Holden and colleagues (1988) tested 

participants who met the criteria for alcohol abuse or 

dependence according to the DSM-III. The results of the 

study indicated that the mental age of the alcoholic sample 

was seven years older than their actual chronological one, as 

compared to the age-matched sample.  These results are in 

accord with the findings of Ryan and Butters (1980) and 

provide further evidence for the premature-aging hypothesis.   

Nichols, Hochla and Parsons (1982) further explored the 

premature-aging hypothesis in females that met the criteria 

for alcoholism and were currently in a residential treatment 

facility.  They found that alcoholic women performed 

significantly better than elderly non-alcoholic women on 

neuropsychological tests.  The researchers, however, found 

that a subsample of female alcohol abusers who reported 

more severe alcohol intake performed comparably to non-

alcoholic females that were 20-years their elder.  Thus, the 

authors established partial support for the premature-aging 

hypothesis in females.  

Shelton, Parsons, and Leber (1984) tested the premature-

aging hypothesis by comparing the cognitive performance of 

middle-aged chronic alcoholics whose alcohol consumption 

was disruptive to their daily living to the performance of 

middle-aged controls and elderly controls. Cognitive 

performance was measured using a paired-associate learning 

test consisting of separate verbal and visuospatial subtests.  

Elderly controls were found to perform significantly worse 

than both the middle-aged controls and the middle-aged 

chronic alcoholics; middle-aged alcoholics performed on a 

similar level to middle-aged controls rather than the elderly 

controls.  Therefore, the premature-aging hypothesis was not 

supported in this study. 

Schottenbauer and colleagues (2007) further tested the 

premature-aging hypothesis by looking at the performance on 

a Selective Reminding Task (SRT) of participants who met 

the DSM-III-R criteria for alcohol dependence and 

comparing their performance to the performance of healthy 

controls.  The authors described the SRT as a measure of 

learning and memory impairment.  Alcoholics were found to 

have deficits in both learning and memory as compared to 

controls.  Results indicated that age significantly predicted 

memory deficits among alcoholics, but lost statistical 

significance after controlling for dose effect (i.e., years of 

heavy drinking).  These findings suggest that dosage is an 

important predictor variable of cognitive deficits alongside 

age and should be taken into consideration in future studies. 

Pfefferbaum and colleagues (1992) performed a brain 

imaging study using Magnetic Resonance Imaging on 

participants who met alcohol dependence criteria on the 

Research Diagnostic Criteria (RDC, Spitzer, Endicott, & 

Robins, 1975) and discovered an age-related, not dose-

related, structural damage in alcohol dependent individuals as 

compared to age matched healthy controls.  Age significantly 

predicted structural damage above and beyond lifetime 

dosage of alcohol consumption, suggesting that even when 

the levels of lifetime alcohol consumption are comparable 

between younger and older alcoholics, older alcoholics seem 

to manifest greater structural damage in their brains.  The 

significance of the neuroanatomical study by Pfefferbaum 

and colleagues (1992) lies in the finding of actual 

morphological differences in the brain structures among 

alcohol abusers contingent on their age and not dosage.  Age 

and chronic alcohol abuse, as separate or compounded 

factors, have been linked to cause neuroanatomical damage.  

The premature-aging hypothesis has been extensively 

researched (e.g., Nichols Hochla & Parson, 1982; Ryan & 

Butters, 1980; Schottenbauer et al., 2007; Shelton, Parsons, 

& Leber, 1984).  Some studies provide support for the 

premature-aging hypothesis (Holden, McLaughlin, Reilly, & 

Overall, 1988; Ryan & Butters, 1980), while others provide 

partial or no evidence for this hypothesis (Nichols Hochla & 

Parson, 1982; Shelton, Parsons, & Leber, 1984).  Even 

though researchers have not reached a consensus on the 

validity of the premature-aging hypothesis, age seems to have 

an effect on the cognitive and functional deficits associated 

with alcohol abuse.  It also seems to have an effect on the 



MALAKHOV 

 

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structure of the brain as has been found by Pfefferbaum and 

colleagues (1992).  Dosage, likewise, seems to have an effect 

on the cognitive and functional deficits of alcohol abuse and 

will be explored further along in this review.  More research 

is needed in order to pinpoint the mechanism by which age 

seems to have an effect on cognitive and functional deficits 

associated with alcohol abuse and the structural changes that 

are associated with it. 

 

Effects of Gender on the Cognitive and Functional 

Deficits 

 

A study by Sullivan and colleagues (2000) tested and 

compared the performance of 71 recently detoxified (1 

month) alcoholic males on several neuropsychological 

measures to healthy male controls.  All of the alcoholic males 

met the RDC criteria for alcohol dependence.  Study 

participants underwent a thorough neuropsychological 

evaluation, which assessed executive functioning using the 

Wisconsin Card Sorting Task, short-term memory and 

production using the Brown-Peterson distractor tests, upper 

limb mobility by measuring grip strength and fine finger 

movement, declarative memory by using the delayed 

Wechsler Memory Scale stories, visuospatial abilities by the 

Hidden Figure Test, and gait and balance by using the Ataxia 

Battery.  Consistent with previous research findings (e.g., 

Bechara & Martin, 2004; Hildebrandt et al., 2004; Noel et al., 

2007; Ryan & Butters, 1980; Schottenbauer et al., 2007), 

Sullivan and colleagues (2000) found that recently detoxified 

alcoholic males exhibited deficits in measures of executive 

functioning, working memory, short-term memory, upper 

limb mobility, visuospatial abilities, and gait and balance as 

compared to healthy male controls.  Furthermore, alcoholic 

males were found to be more vulnerable to deficits in upper 

limb mobility when age was taken into consideration.   

This finding suggests that age, in combination with 

alcohol dependence, has a deleterious effect on functional 

deficits with older alcoholic males exhibiting more deficits in 

upper limb motor mobility as compared to younger male 

alcoholics.  In addition, the authors found that age did not 

have an effect on cognitive functioning, but did have a 

predictive effect on deficits found in gait and balance, which 

is suggestive of age-related cerebellar damage due to alcohol 

abuse. Sullivan and colleagues (2000) found a dosage effect 

of alcohol consumption on gait and balance, but not on 

cognitive functioning.  This finding contrasts previous 

findings reported by Schottenbauer and colleagues (2007) 

showing that lifetime alcohol consumption significantly 

predicted learning and memory performance as measured 

with SRT. 

A study by Sullivan and colleagues (2002) tested the 

performance of 43 detoxified (3.6 months) females on several 

neuropsychological measures and compared them to healthy 

female controls and the males from the Sullivan and 

colleagues (2000) study.  The study used the same 

neuropsychological measures as the Sullivan and colleagues 

(2000) study.  As compared to the nonalcoholic control 

females, the alcoholic females exhibited many of the same 

cognitive and functional deficits as the alcoholic males did in 

the Sullivan et al. (2000) study - such as deficits in verbal and 

non-verbal working memory, visuospatial processing, and 

gait and balance.  Sullivan and colleagues (2002), however, 

found that alcoholic females had a lifetime alcohol 

consumption that was 2.5 times lower than the alcoholic 

males in the Sullivan and colleagues (2000) study.  Thus, 

female alcoholics who were detoxified for 3.6 months and 

had a lifetime consumption that was 2.5 times lower than the 

alcoholic males in the Sullivan et al. (2000) study still 

exhibited many of the same cognitive and functional deficits, 

suggesting that there is a difference in the way alcohol 

consumption affects the cognitive and functional deficits in 

the two genders.  Females consume less alcohol, but still 

show the same signs of cognitive and functional deficits as 

males do, suggesting that alcohol has an especially 

deleterious effect on females.  However, the findings of this 

study should be interpreted with caution because the Sullivan 

and colleagues (2000) study was not aimed at investigating a 

gender difference in the way alcohol affects the two genders.  

In Sullivan et al. (2002) study an ad hoc comparison was 

performed between the males and females from the two 

different samples and the authors cautioned about the 

interpretation of the results. More research is warranted in 

order to further understand the relationship between 

alcoholism and cognitive and functional deficits in the two 

genders. 

 

Effects of Treatment History and Amount of Alcohol 

Consumption  

 

In a study with chronic alcoholics who met lifetime 

criteria for alcohol dependence, Fein and Landman (2005) 

compared alcoholic patients with and without history of 

alcohol treatment, the latter being referred to as treatment 

naïve alcoholics.  Retrospective information about the 

participants’ alcohol use was gathered using a lifetime 

follow-back interview procedure, in which subjects broke 

their drinking history into periods with consistent alcohol 

use.  The two groups were further matched into pairs, based 

on the age at which they first met the criteria for heavy 

drinking.  Results indicated that, compared to treatment naïve 

alcoholics, those with treatment histories had higher dose 

alcohol consumption (58% for males and 68% for females) 

during the period since they first met the criteria for heavy 

drinking.  The study by Fein and Landman (2005) suggests 

that treatment naïve alcoholics and alcoholics with treatment 

histories are distinct populations in terms of their alcohol use, 

with dosage being an important differentiating factor between 

the two groups.  Therefore, Fein & Landman (2005) 

cautioned against generalizing research findings found 

amongst alcohol abusers with treatment histories to those that 

have never had treatment.  

Another study by Fein, McGillivrary, and Finn (2006) 

compared a sample of 58 treatment naïve alcohol dependent 

(TNAD) participants, who met DSM-IV criteria for current 



ALCOHOL ABUSE DEFICITS 

 

64 

 

alcohol dependence, to a matched sample of non-alcoholic 

controls (NAC) on a Simulated Gambling Task (SGT) that 

measures decision-making and behavioral inhibition.  Results 

indicated that the two groups did not differ with respect to 

decision-making.  Contrary to previous findings showing 

decision-making and behavioral inhibition impairment in 

alcohol abusing sample with treatment histories (Noel et al., 

2007), the study by Fein and colleagues (2006) showed that 

treatment naïve young adults with alcohol dependence do not 

have global deficits in decision-making.  The poor decision-

making that treatment naïve young adults with alcohol 

dependence exhibit regarding their alcohol consumption 

seems to be more specific to drinking. 

The aforementioned findings were further supported by 

the Smith and Fein (2010) study, which compared a sample 

of TNAD participants who met DSM-IV criteria for current 

alcohol dependence with a matched sample of NACs on 

performance in nine performance domains.  The domains 

included attention, auditory working memory, verbal 

processing, abstraction/cognitive flexibility, psychomotor 

function, immediate memory, delayed memory, reaction 

time, and spatial processing. Smith and Fein (2010) did not 

find a significant difference between the two samples on any 

of the nine performance domains.  The absence of any 

difference between the NAC group and the TNAD group, 

when most studies consistently reported  discernible 

differences between alcoholics and healthy controls (e.g., 

Sullivan et al., 2000; Rosenbloom et al., 2005), further 

supports the findings of Fein and Landman (2005), which 

suggested that treatment naïve alcoholics and alcoholics with 

treatment histories are different populations.  Therefore, 

future research must continue to investigate these two groups, 

the treatment naïve alcohol dependents and the non-alcoholic 

controls. 

 

Improvements with Abstinence and Potential Clinical 

Implications 

 

A large study by Brandt and colleagues (1983) of 134 

alcoholics with at least a 10-year history of daily alcohol 

consumption and at least 1-month abstinence at testing time 

revealed that alcoholics showed improvements on measures 

of short-term memory and psychomotor skills, but not long-

term memory.  At the follow-up phase of the study, the 

authors grouped the alcoholic abstainers into three groups:  

the “short-term abstinence” group, including participants who 

were abstinent between 1 and 2 months; the “long-term 

abstinence” group, including those who were abstinent 

between 1 and 3 years; and the “prolonged abstinence” 

group, for those who were sober for at least 5-years.   

The authors found no significant difference between 

prolonged abstainers and non-alcoholic controls in terms of 

their short-term memory function, suggesting a recovery of 

short-term memory function among prolonged abstainers.  

The researchers, however, found a significant difference 

between prolonged abstainers and normal controls on 

measures of attention, perceptual speed, motor speed, visual 

scanning, and memory suggesting the irreversibility of the 

deficits in these areas even after prolonged abstinence.  In 

addition, the researchers did not find a significant difference 

between prolonged abstainers and normal controls on a 

measure of non-verbal memory skills indicating recovery of 

these skills with prolonged abstinence. 

A study by Rosenbloom and colleagues (2007) using 

various neuropsychological measures determined that 

alcoholics who met the DSM-IV criteria for alcohol 

dependence and were abstinent for 2 to 2.5 years showed 

significant improvement on measures of memory, and gait 

and balance as compared to controls.  The alcoholic 

participants were self-reported abstainers.  The participants 

were sober for over 4-months as they were tested at baseline.  

The authors (Rosenbloom et al., 2007) were also able to find 

structural changes in the brain of the abstaining participants 

with abstaining alcoholics showing a significantly decreased 

lateral ventricular volume as compared to relapsing 

alcoholics. Rosenbloom and colleagues (2007) concluded 

that both memory and ataxia could improve with sustained 

sobriety alongside structural changes in the brain. 

A study by Bates and colleagues (2005) looked at the 

recovery of cognitive abilities of alcoholics who were in 

treatment for 6-weeks.  The participants underwent a large 

neuropsychological evaluation before and after the 6-week 

treatment period.  A modest recovery was reported in the 

domains of executive functioning, verbal processing speed, 

verbal ability domains, and medium recovery in the memory 

domain.  Bates and colleagues (2005) cautioned that the 

improvements observed (with the exception of improvements 

in memory function) might be too minor to be of clinical 

relevance.  

A study by Mann and colleagues (1999) investigated the 

pattern of cognitive deficits and their time-dependent 

recovery in a sample of 49 males who met the DSM-III-R 

criteria for alcohol dependence using a test-retest design.  

The authors also included a healthy sample of 49 males who 

were also tested and retested after a 5-week interval.  The 

researchers (Mann et al., 1999) established significant 

improvement on measures of perceptual-motor speed, verbal 

knowledge, non-verbal reasoning, and spatial imagination.  

However, the authors did not find improvement in the area of 

short-term verbal memory.  This is an interesting finding 

because it is in contrast to the findings of Brandt and 

colleagues (1983), who found that short-term memory 

recovers with abstinence and long-term memory does not.  

An explanatory factor for the results that Mann and 

colleagues (1999) observed is that perhaps not enough time 

passed between test and retest in order for the authors to be 

able to observe an improvement in short-term memory.  The 

abstainers in the Brandt and colleagues (1983) study were 

abstinent for over 5-years and in the Mann and colleagues 

(1999) study the participants were only abstinent for 5-

weeks. 

The clinical implications of the recovery of some of the 

cognitive and functional deficits of alcohol abuse could 

potentially provide the ability for mental health practitioners 



MALAKHOV 

 

65 

 

to tailor treatments for specific populations of alcohol 

abusers, as pointed out by Bates and colleagues (2005).  The 

development of risk factor profiles that differentiate the 

cognitive and functional recovery among abstaining alcohol 

abusers can have a significant effect on how treatment is 

disseminated for the different profiles (Bates et al., 2005).  

The treatment process can be stifled if the treatment 

information is disseminated in such a way that an alcohol 

abuser with cognitive and functional deficits cannot 

assimilate it (Bates et al., 2005).  The inability to assimilate 

the information that is disseminated as part of the therapeutic 

technique can influence the treatment outcome for people 

that suffer from alcohol abuse.  The implication that the 

recovery of cognitive and functional deficits of alcohol abuse 

has is that specific therapeutic techniques can be better 

tailored to the needs of the people suffering from alcohol 

abuse.  

 

Findings From Longitudinal Studies 

 

A prospective study focusing on males was conducted in 

Denmark with 20-, 30-, and 40-year follow-ups.  The sample 

of participants was chosen from a large Copenhagen birth 

cohort.  At the 20-year follow-up of this cohort, Drejer, 

Theikjaard, Teasdale, Schulsinger, and Goodwin (1985) 

established that high-risk (i.e., having a father who is an 

alcoholic) 18- and 19-year-old males differed significantly 

from age-matched controls on measures of vocabulary, tests 

of categorizing ability, organization, and planning.  This is an 

important finding, as the authors pointed out, because other 

researchers found these problems with prolonged alcohol 

abuse (e.g., Sullivan et al., 2000, 2002) and the results from 

this study show that it seems that high-risk males already 

have many of the deficits that were found in alcoholics prior 

to prolonged alcohol abuse.  The 30-year follow-up studies 

on this cohort of high-risk males focused on the influence of 

genetic and environmental components of alcoholism (Knop 

et al., 1993) and the predictor variables of future alcoholism 

(Goodwin et al., 1994).  The follow-up studies did not 

employ the use of neuropsychological batteries and therefore 

the results of the 20-year follow-up, which established that 

the high-risk males differ from age-matched controls on 

several neuropsychological measures, were not further 

explored.  In a follow-up analysis by Knop and colleagues 

(2003), the authors concluded that the premorbid differences 

between the high and low-risk groups were only modestly 

related to problem drinking and alcohol dependence at age 

30.  

 

Discussion 

 

The research on cognitive and functional deficits of 

alcohol abuse has been extensive and there seems to be a 

consensus amongst researchers that alcohol abuse includes 

cognitive and functional deficits in: learning, general 

memory, prospective memory, contextual memory, 

visuospatial abilities, upper limb mobility, gait and balance, 

executive functioning, decision-making, behavioral 

inhibition, behavioral inhibition, task shifting, working 

memory, and problem solving.  However, there are some 

areas such as working memory, on which research has been 

inconclusive.  Hildebrandt and colleagues (2004) did not find 

deficits in working memory among alcohol abusers, but other 

researchers determined that indeed there are deficits in 

working memory (Noel et al., 2007; Sullivan et al., 2000; 

Sullivan et al., 2002).  Thus, more research is necessary in 

order to clarify how alcohol abuse impacts working memory.  

This can be done through clearly delineating working 

memory from executive functioning, as in the study by 

Hildebrandt and colleagues (2004), and classifying it in a 

way that would lead to consensus among different 

researchers.  

The research on age and severity of cognitive and 

functional deficits of alcohol abusers seems to also fall into 

the area of inconclusive research findings.  Researchers have 

found evidence to support the premature-aging hypothesis 

(Holden et al., 1988; Nichols Hochla & Parsons, 1982; Ryan 

& Butters, 1980) and neuroanatomical studies have reported 

age-related neuroanatomical damage even when dosage is 

controlled for (Pfefferbaum et al., 1992).  The study by 

Schottenbauer and colleagues (2007) found that age had a 

predictive effect on the SRT performance of alcoholics, but 

this effect was significantly reduced once dose was entered 

into the equation.  This suggests that age and dosage may 

have effects on cognitive functions and more research is 

needed to delineate what these effects are.  However, some 

researchers (e.g., Sullivan et al., 2000) found that age and 

dosage did not have an effect on the cognitive functioning of 

alcoholics, but did have an effect on their functional 

capacities such as gait and balance.  In addition, findings by 

Sheldon and colleagues (1984) did not provide support for 

the premature-aging hypothesis in their study of alcoholic 

males.  These contrasting findings suggest that more research 

into this topic is imperative. 

There are few studies covering the gender differences in 

cognitive and functional deficits of alcoholics. However, the 

study by Sullivan and colleagues (2002), which compared 

female alcoholics to male alcoholics, yielded important 

findings. The study showed that women tend to consume 

smaller amounts of alcohol for over a shorter period of time, 

but seem to exhibit many of the same cognitive and 

functional deficits as men do, such as upper limb strength, 

executive functioning, and speed.  While these findings 

suggest that alcohol has a different effect in the two genders, 

more research is needed to further extrapolate what the 

differences between the genders are in terms of sensitivity to 

alcohol’s deleterious effects.  

Fein and Landman (2005) explored an avenue of 

research by noticing that researchers have focused on a 

convenience population (i.e., alcoholics in treatment or with a 

history of treatment) and did not focus on the larger 

population (i.e., naïve alcoholics or alcoholics who have not 

received treatment).  Fein and colleagues (2006) and Smith 

and Fein (2010) did not report any cognitive or functional 



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66 

 

differences between treatment naïve alcoholics and normal 

non-alcoholic samples, when directly comparing these two 

groups.  These findings expand upon previous research that 

only examined alcoholics who have received treatment by 

including a sample of treatment naïve alcoholics.  Further 

research is warranted in order to pinpoint at what level of 

consumption alcohol begins negatively impacting cognitive 

functioning.  Also, research should be conducted to identify 

patient characteristics that distinguish treatment naïve 

alcoholics from alcoholics with treatment histories.  This type 

of research can be enlightening because it can add other 

dimensions to understanding the differences between 

alcoholics with treatment and treatment naïve alcoholics. 

Research in cognitive and functional deficits of alcohol 

use disorders can substantially benefit from longitudinal 

studies, which follow participants over time.  By following 

participants with alcohol use disorders over time and 

conducting multiple sequential assessments of cognitive and 

functional deficits, longitudinal studies allow researchers to 

identify predictors and moderators of these deficits and 

distinguish between short- and long-term effects.  The 

aforementioned Danish prospective study by Dreijer and 

colleagues (1985) was unique in that it employed a 

longitudinal design.  However, none of the subsequent 

follow-up assessments (e.g., Goodwin et al., 1994; Knop et 

al., 1993) assessed participants’ neuropsychological 

functioning, significantly limiting how much information 

regarding cognitive and functional deficits of alcohol abuse 

could be obtained from this prospective study.  Thus, it is 

difficult to pinpoint what the cognitive and functional deficits 

of alcohol abuse are from this particular prospective study.  

Another limitation of the Danish cohort study was that it only 

focused on males, which limits the external validity of this 

study, since there appears to be a difference between how the 

genders respond to alcohol abuse (Sullivan et al., 2002).  The 

Danish prospective study was ideal for discerning what the 

risk factors and predictors for alcohol abuse and dependence 

are, (e.g., Knop et al., 2003), but not the cognitive and 

functional deficits of alcohol abuse.  Therefore, new 

prospective studies with both female and male cohorts are 

needed in order to disentangle what the cognitive and 

functional deficits of alcohol abuse are. 

The findings presented in this review should be 

interpreted with caution because the nature of these studies is 

not of true experimentation. Therefore, the establishment of a 

causal relationship between alcohol abuse and cognitive and 

functional deficits was stifled.  Likewise, the directionality of 

the deficits is hard to pinpoint.  Are the cognitive and 

functional deficits seen in alcohol abusers a result of alcohol 

abuse or are they what led to the alcohol abuse in the first 

place?  One way that the causal relationship and 

directionality between alcohol abuse and cognitive and 

functional deficits can be established is through true 

experimentation with animals.  Random selection and 

random assignment can be accomplished in animal research 

and the internal validity of these types of studies would be 

quite strong.  On the other hand, the external validity of such 

research would be thwarted because of the differences 

between humans and animals.  Even with limited external 

validity, experimental studies with animals have a huge 

potential for elucidating the causal relationship between 

alcohol abuse and functional and cognitive deficits, and are 

therefore needed. 

Another important limitation of the studies reviewed 

refers to the heterogeneous use of diagnostic criteria for 

alcohol dependence and abuse.  Diagnosis of alcohol 

dependence or abuse was given based on a variety of 

diagnostic manuals, such as the ICD-10, DSM-III, DSM-IV, 

and RCD, which may account for the lack of consensus 

among different studies.  Additionally, the cited studies did 

not always specify the longevity and the severity of the 

alcohol dependence or abuse.  Future studies should agree on 

“gold standard” diagnostic criteria for alcohol dependence 

and abuse, in order to reach reliable and conclusive findings 

about the cognitive and functional deficits of alcohol abuse. 

In addition, research that focuses on the recovery of 

cognitive and functional deficits of alcohol abuse is a very 

important avenue of research because it has implications for 

clinical practice.  It is a necessary endeavor to establish the 

profile of risk factors that predict differences in cognitive 

recovery between individuals, as Bates and colleagues (2005) 

suggested.  Establishing risk factors profiles can guide 

therapeutic interventions that could be better tailored for 

specific populations.  Thus, more research is needed in order 

to identify the risk factors that predict differences in 

cognitive recovery of individuals.  Further research in the 

area of recovery of functional and cognitive deficits of 

alcohol abuse can inform therapeutic work and help people 

with alcohol abuse recovery. 

 

Conclusion 

 

The relationship between alcohol abuse and cognitive 

and functional deficits may seem elementary on the surface; 

the more a person drinks the more deficits they exhibit.  The 

results of numerous research studies, however, speak largely 

to the contrary.  There are multiple variables that affect the 

cognitive and functional deficits of alcohol abusers including 

age, gender, treatment history, and dosage.  There is 

documented recovery of some of the cognitive and functional 

deficits with abstinence and treatment.  More encompassing 

research is needed in order to fully grasp and discern the 

effects of the aforementioned factors on cognitive and 

functional deficits of alcohol abusers.  The details of this 

research could enlighten therapeutic practice and help to 

better understand and treat alcohol abuse. 

 

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