Easy to reach, hard to research: cognitive function and substance use characteristics of people with severe drug use.
Background
Several studies report reduced cognitive functioning in populations with a high level of substance use. Such problems may precede and/or succeed substance use. A person’s cognitive function plays a key role in everyday functioning and decision-making processes. Thus, it is of utmost importance to take cognitive function into consideration when making decisions on the rights and needs of people with severe drug use.
The aim of the study was: (1) to identify cognitive problems among people with severe substance use and (2) to investigate whether debut age and factors related to substance use was associated with cognitive function.
Methods
Participants were recruited from Oslo municipality’s low threshold housing for people with substance use and the Division of Substance Use at Oslo University Hospital.
Data utilised in the present study is part of a large dataset including measures of substance use, mental health, physical health, and cognitive function. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA 8.1.). An obtained score below the cut-off of 26 indicates possible cognitive dysfunction. An adapted version of the EuropASI was employed to map the severity of substance use.
Results
171 participants (70.8% male) between the ages of 19 and 69 (mean = 39.88, SD = 10.54) were included in the study. We found that 75% of the participants scored below the cognitive cut-off of 26 points. 54% reported heroin to be their main substance, 14% cannabis, and 13% amphetamine. 67% reported having injected drugs in the past 4 weeks. Average debut age for alcohol was 12.7 years, 58% had used alcohol regularly over a longer period. Debut age for other substances than alcohol was 14.1 years, with 17.0 years being the average debut age for regular substance use. 99% of participants had used substances (other than alcohol) regularly. Participants had on average used 12 substances (out of 24 in the questionnaire) and had regularly used 5.5 substances.
We performed multilevel analyses on cognitive function and the substance use variables. Age, sex, and level of education were used as covariates. No associations were found.
Conclusions
The alarmingly high proportion of participants scoring below the cut-off should inform health and social care workers, policymakers, leaders, and researchers of the need to systematically screen for cognitive function in this population. With a high level of substance use and health problems, this population is often deemed ‘hard-to-reach’ in research. However, we argue that this population is easy to reach, but hard to research in traditional settings. Strategies and methods employed in this study demonstrate that it is possible to collect a large, original, and comprehensive dataset from a population that is often deemed ‘marginalised’, ‘high-risk’, and/or ‘hard-to-reach’. In addition to shedding light on the health-related problems of this population, we wish to inspire further research.
