Randomized controlled trial demonstrated selective improvements in response inhibition among men with alcohol use disorder in Zambia, indicating the need for targeted cognitive interventions.
Background: Alcohol Use Disorder (AUD) is associated with significant cognitive impairments, particularly in executive functioning, yet evidence for cognitive rehabilitation therapy (CRT) in low-resource settings remains limited. This study evaluated the efficacy of CRT for mild executive dysfunction among male AUD patients in Zambia. Methods: A randomized controlled trial was conducted with 56 participants (aged 18-40 years) recruited from a residential rehabilitation center in Lusaka. Participants were randomized to either an 8-week CRT program (Brain Wave-R, n=28) or active control (painting sessions, n=28), both delivered alongside standard treatment. Executive function was assessed pre- and post-intervention using the Zambian Neurobehavioral Test Battery, including the Wisconsin Card Sorting Test (WCST), Colour Trails Test 2 (CTT), and Stroop Test. Results: The CRT group demonstrated significant improvements in response inhibition (Stroop Test: fewer errors, p=0.01; more words completed, p<0.01) compared to controls. However, no significant between-group differences emerged for cognitive flexibility (WCST: correct responses p=0.87; categories completed p=0.06) or task-switching (CTT: errors p=0.12; time p=0.56). Secondary analyses revealed government-employed participants showed better outcomes on WCST (p=0.04) and CTT (p=0.03), while those with chronic medical conditions performed worse on WCST (p<0.001). The control group showed unexpected but significant Stroop Test improvements (p<0.001), suggesting non-specific benefits of structured activities. Conclusion: CRT shows selective efficacy for improving response inhibition in Zambian AUD patients, with employment status and health conditions moderating treatment effects. These findings support targeted implementation of CRT in low-resource settings, particularly for patients without significant comorbidities. Future research should investigate optimal intervention duration and strategies to enhance effects on complex executive functions.
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Chikontwe et al. (2025) studied this question.
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