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Stefano Caneva,1 Marcella Ottonello,1 Elisa Torselli,1,2 Caterina Pistarini,3 Paola Spigno,1 Elena Fiabane1,4 1Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa SB, Institute of Genoa Nervi, Genoa, Italy; 2Miller Institute for Behavioral and Cognitive Therapy, Genoa, Italy; 3Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa SB, Scientific Institute of Pavia, Genoa, Italy; 4Department of Brain and Behavioral Sciences, University of Pavia, Pavia, ItalyCorrespondence: Caterina PistariniDepartment of Physical & Rehabilitation Medicine, ICS Maugeri Spa SB, Institute of Pavia, Via Maugeri 4, Pavia, Genoa 27100, ItalyTel +39 010 30791250Fax +39 010 3079 1269Email caterina.pistarini@icsmaugeri.itPurpose: Cognitive impairment is common among patients with alcohol use disorder (AUD). However, neuropsychological assessment is not usually included as routine practice in alcohol rehabilitation programs. The aim of this study was to describe qualitatively the cognitive deficits in early-detoxified AUD patients undergoing rehabilitation and to explore relevant associations with socio-demographic, clinical and psychological factors.Patients and Methods: Forty-one patients with a diagnosis of AUD were consecutively recruited from a residential rehabilitation hospital in Northern Italy. Cognitive impairment was assessed using the Brief Neuropsychological Examination 2 (ENB-2). Anxiety, depression and severity of alcohol dependence were also evaluated using validated self-report questionnaires. Alcohol relapse was investigated 1 month after discharge.Results: Overall, 31.7% of AUD patients showed cognitive impairments according to the global score scale. However, 70.7% had an impaired performance on at least one test of the ENB-2, with particular regard to executive function, visuospatial and memory domains. Age, education and abstinence at admission were the most relevant factors associated with cognitive deficits in this clinical population.Conclusion: The detection of cognitive impairments is essential in order to adapt alcohol rehabilitation treatment to patients with cognitive deficits and enhance clinical outcomes.Keywords: neuropsychological functioning, alcohol use disorder, alcohol detoxification, rehabilitation, relapse

M Ottonello,1 E Fiabane,1 C Pistarini,2 P Spigno,1 E Torselli3 1Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa SB, Genoa, Italy; 2Department of Physical and Rehabilitation Medicine, ICS Maugeri SPA SB, Pavia, Italy; 3Miller Institute for Behavioral and Cognitive Therapy, Genoa, ItalyCorrespondence: C PistariniIstituti Clinici Scientifici Maugeri IRCCS, Via Maugeri 4, Pavia 27100, ItaliaTel +3901030791250Email caterina.pistarini@icsmaugeri.itPurpose: Understanding how difficulties in emotion regulation can be related to metacognitive beliefs during early abstinence, identifying which factors are associated with craving and relapse risk may be useful in residential rehabilitation treatment of alcohol addiction.Methods: Sixty-five patients underwent a 28-day rehabilitation program for alcohol addiction. They underwent a brief semi-structured interview at admission and completed a battery of five self-report questionnaires between days 7 and 10 of alcohol abstinence (T0) and 3 days prior to discharge (T1).Results: After rehabilitation program, all symptoms of psychological distress decreased. We found a significant improvement in all emotional, cognitive and metacognitive scales except for “Cognitive harm” (NAM), “Awareness” (DERS) and a small effect size (low statistical power) for “Emotional clarity” (DERS). Compared to those still abstinent at 1 month from discharge, we found more difficulties in “Emotional clarity” in those who had an early relapse. Difficulties in “Emotional clarity” were observed also in patients with a high level of craving at discharge.Conclusion: Significant differences were observed between the groups “abstinence vs non-abstinence” at 1 month from discharge concerning difficulties in emotion regulation. In particular, we found difficulty in the awareness and understanding of emotion, precisely to identify correctly the emotions. The “Emotional Clarity” seems to be the emotional difficulty that characterized also the group with a high level of craving at discharge and the individuals with early relapse, suggesting the importance of this function as a preliminary factor in emotion regulation.Keywords: emotion regulation, alcohol, abstinence, metacognitions, relapse

Elisa Torselli,1 Marcella Ottonello,2 Emilio Franceschina,1 Emanuele Palagi,1 Giorgio Bertolotti,3 Elena Fiabane2,4 1Miller Institute for Behavioral and Cognitive Therapy, Genoa, Italy; 2Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa SB, Institute of Genoa Nervi, Genoa, Italy; 3Psychology Unit, ICS Maugeri SPA SB, IRCCS, Tradate, Italy; 4Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy Purpose: The aims of this pilot study were to examine cognitive factors (brooding and craving) together with positive/negative metacognitive beliefs about alcohol during a residential program for alcohol addiction and to explore relationships with psychological variables at discharge, with the scope of identifying predictive factors of psychological outcome and patients at greatest risk of relapse. Methods: Thirty patients underwent a brief semistructured interview on admission to a 28-day rehabilitation program for alcohol addiction, and completed at admission and discharge the following five self-report questionnaires: 1) brooding (Brooding subscale of Ruminative Response Scale [B-RRS]), 2) craving (Penn Alcohol Craving Scale [PACS]), 3) positive beliefs about alcohol use (Positive Alcohol Metacognitions Scale [PAMS]), 4) negative beliefs about alcohol use (Negative Alcohol Metacognitions Scale [NAMS]), and 5) the psychophysical state of health (Cognitive Behavioral Assessment – Outcome Evaluation [CBA-OE]). Results: Significant changes were found between admission and discharge in CBA-OE, B-RRS, and PACS. Brooding at admission was a significant predictor of post-treatment psychological variables of “anxiety”, “depression”, and “psychological distress”, whereas craving at admission was a good predictor of “perception of positive change” at discharge. Conclusion: Our results confirm the importance of brooding in mood regulation and its role in the development and maintenance of problem drinking. In addition, craving was negatively associated with the perception of positive change in the post-treatment outcomes and was a predictor of this psychological variable, which includes features related to the individual’s resilience and strength. The changes in metacognitive beliefs regarding alcohol use were not statistically significant, but we found a reduction in positive metacognitions and an increase in negative alcohol-related beliefs; future studies are needed to further explore this issue. Keywords: alcohol addiction, cognitive factors, metacognition, rehabilitation, craving, brooding

People in alcohol-detoxification experience deficits in motor and non-motor functions including cognitive performance. Imagery, the cognitive process of generating visual, auditory or kinesthetic experiences in the mind without the presence of external stimuli, has been little studied in Alcohol Use Disorders (AUD). This pilot study aims to observe the cognitive abilities useful for the inspection, maintenance, generation and manipulation of images in these patients during residential rehabilitation and investigate the relationships with their cognitive performance. Thirty-six subjects who completed the 28-day rehabilitation program for alcohol addiction, completed the Mental Imagery Test (MIT) and Neuropsychological Battery (ENB-2). The global score at MIT did not show pathological scores. The 11.1% of AUD patients showed an impaired global score in the cognitive performance and the 5.7% with scoring at limits of norm. Significant correlations were found between Mental Imagery abilities and ENB-2 subscale and stepwise regression analysis showed the close association between the ability of imagery (Mental Imagery Test) and the overall cognitive performance (ENB-2) in alcohol dependent patients and this relationship is stronger than other cognitive tasks., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Ottonello, Torselli, Caneva, Fiabane, Vassallo and Pistarini.)