Medication or Substance-Induced Neurocognitive Disorder
When Alcohol, Drugs or Medications Cause Mild Problems With Brain Functioning
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Medically reviewed by Steven Gans, MD
Mild neurocognitive disorder due to substance/medication use and major neurocognitive disorder due to substance/medication use are the diagnostic names for two alcohol- or drug-induced neurocognitive disorders―"major" obviously being the more severe form.
Unlike the problems with mental functioning that happen during intoxication or with a hangover the morning after alcohol use—that pass fairly quickly—mild neurocognitive disorder continues to cause difficulty with mental functioning. For some people, it can impact their day-to-day functioning permanently.
Many people who develop a neurocognitive disorder after using alcohol, drugs, or medications, don't actually realize they have these problems.
Family and friends may be the first to notice problems with paying attention, remembering important things they need to do, and planning properly to manage their lives. In fact, the problems that people with mild neurocognitive disorder due to substance or medication use experience may only be helped by family or friends providing or arranging for additional support for the person in their daily lives.
What Are Cognitive Deficits?
Cognitive deficits are problems with mental functioning. Mental functioning ranges from perception to memory, from managing emotions to planning for the future, or even simply planning your meals and activities for today.
Mental functioning is also needed for controlling your body movements, balance, coordination, as well as speech, communication of all kinds, understanding and getting along with other people. Even recognizing people and knowing their role in your life is controlled by mental functioning.
So when cognitive deficits develop, a person can quickly find life challenging to cope with, and problems can multiply. A huge risk for people with a history of drinking or drug use is that they can return to these unhealthy ways of coping with problems, making cognitive functioning even worse.
There are a variety of cognitive deficits that can occur as part of this condition, including:
Difficulty paying attention or concentrating on what you are doing or what is going on around you
Difficulty with "executive functioning"—skills like making plans for the future, controlling impulses to do things that might not be a good idea, particularly in the long term, and making decisions about everything from what to wear on a hot or cold day to financial planning for the next 10 years
Learning new skills—this doesn't just mean learning in school or learning skills like driving, but learning everyday things we are all required to do, like learning to use a new type of technology
Problems with remembering information—not only difficult, abstract information, but everyday information, such as your phone number, address, and where you need to go today
Difficulties with speaking and communicating clearly with other people
Perceptual-motor skills—how you control your body and movements, even something you take for granted, such as walking
Social awareness and understanding of other people—from treating people with caring and courtesy to knowing when someone is trying to rip you off
Is It a Substance-Induced or Pre-Existing Disorder?
When doctors or psychologists give a diagnosis of mild neurocognitive disorder due to substance/medication use, they check to make sure that the cognitive deficits weren't there before the person used the alcohol, drug, or medication that is thought to be responsible for their difficulties.
This is because there are different types of neurocognitive disorders. If the symptoms were there before the substance use, the person probably does not have substance/medication-induced type of neurocognitive disorder. Instead, they may have some other type of neurocognitive disorder.
For people who have a long history of substance use, it can be difficult to know what came first—the substance use or the neurocognitive disorder—but this can often be determined by taking a careful history of substance use and cognitive functioning, as well as carefully managing detox with an extended period of abstinence from all alcohol, drugs, and medications that may have induced the disorder.
Related: DSM 5 Criteria for Substance Use Disorders
How Soon After Taking the Drug Can Neurocognitive Problems Be Induced?
In some cases, neurocognitive problems can develop almost immediately after taking the drug or medication. As the brain doesn't typically function at its best during drug intoxication and withdrawal, it can be difficult for doctors to know whether the mental problems the person is experiencing are the result of a slow recovery of normal brain functioning after using alcohol or drug use for a long time.
Usually, mental skills will improve a great deal within a few days of stopping drinking or taking drugs, and continue to improve as the person moves through the detox process over the next couple of weeks.
Sometimes, it can take months or even years for functioning to return to normal. However, in other cases, even if the person improves, the problems can be persistent, and normal functioning may not fully return.
Finally, for the diagnosis of mild (rather than major) neurocognitive disorder due to substance/medication use to be given, the person would still be independent in everyday activities, such as paying bills or managing medications, but these activities may take more effort or compensatory strategies, or the person might need extra help to accomplish them.
Which Drugs Cause Substance-Induced Neurocognitive Disorder?
A wide variety of psychoactive substances can cause mild neurocognitive disorder due to substance/medication use, including the following:
Alcohol
We know more about mild neurocognitive disorder in people who use alcohol than we do about other substances. This is because more research has been conducted on the impact of drinking than on the effects of substances. The impact of alcohol on the health of the brain is also well known.
About 30 to 40% of heavy drinkers have some form of alcohol-induced mild neurocognitive disorder during the first month or two after they stop drinking.
These problems are more likely to continue for a longer time in people who are 50 or older before they quit drinking.
Even though psychological tests show that their brains are not working normally, people with this condition may not be aware they are impaired, therefore family and friends may be the ones to notice the person is having difficulty.
Inhalants
People can sometimes suffer from mild neurocognitive disorder right after intoxication with inhalant drugs, and for some people—even after quitting inhalants—these problems can continue. A study of people who used inhalants showed that most had improved significantly after two years of discontinuing inhalant use, and most had returned to normal cognitive functioning after 15 years of abstinence.
The exception was a group of people using inhalants who had developed 'lead encephalopathy' from leaded petroleum (gasoline) inhalation. These people continued to have inhalant-induced neurocognitive disorder even 15 years after stopping.
In these cases, the disorder may not be mild but instead major, meaning that the person's ability to function independently is severely disrupted.
Cocaine
About a third of people who use cocaine experience mild neurocognitive disorder after they quit cocaine. Some people continue to have these problems long-term after they have quit.
A study has shown that people who are actively using cocaine perform significantly worse on various tests of neurocognitive functioning than people of the same age who do not use cocaine, regardless of their age.
However, the same study showed that older people who use cocaine perform much worse on tests of particular cognitive functions such as psychomotor speed, attention, and short-term memory than younger people who use the substance.
While it is normal and natural for people's neurocognitive abilities to decline with age, this normal deterioration is more pronounced in older people who use cocaine.
Older adults who use cocaine are also particularly vulnerable to problems that come with age, such as being able to control their movements, focus their attention on what they are doing and what is going on around them, and remembering everything from what they need to do today, to the important people and events in their lives.
Methamphetamine
As with cocaine, about a third of people who use methamphetamine suffer from a mild neurocognitive disorder, with persistent problems in some people after abstinence. Neurocognitive problems can also result from cerebrovascular disease which leads to diffuse or focal brain injury.
Combining substances can also make neurocognitive damage worse. The executive functioning of people who use methamphetamine is even worse in people who have also used the drug ketamine.
Opioids
About 33 to 39% of people who use opioids have neurocognitive problems, and some continue to have problems even after they have quit. Research has shown that opioid-dependent adults have high rates of neurocognitive impairment, with severe problems in learning and memory.
People who have been addicted to alcohol and cocaine at some point in their lives, as well as opioids, have a greater neurocognitive impairment, particularly in executive functioning.
Because executive functioning is critical for making decisions, and because having problems with learning and memory can interfere with properly taking in information, people with opioid addictions may need more support for making medical decisions than most people.
Phencyclidine
About a third of people who use phencyclidine have intermediate neurocognitive problems after they stop, with persistent problems in some people after abstinence.
Sedative, Hypnotic, or Anxiolytic Medications
As with many types of drugs, there are intermediate problems in about a third of those who use sedative, hypnotic, and anxiolytic medications, with persistent problems in some individuals after abstinence. The fact that most people who use these drugs are prescribed presents particular difficulties, especially with issues such as driving impairment.
Experimental research has shown specific deficits in driving ability in people who use these medications. Benzodiazepines, a type of central nervous system depressant, is also associated with the greatest likelihood of causing accidents.
If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. For more mental health resources, see our National Helpline Database.
