Impact of Cognitive Reserve Factors on Addiction-Related Variables, Cognitive Performance, and Treatment Dropout in Patients with Substance Use Disorder

Introduction/Objective: Cognitive reserve (CR) refers to the capacity to withstand brain pathology through compensatory mechanisms developed throughout life. This study examined how five CR-related factors (educational level, employment status, occupational complexity, lifelong participation in stimulating activities, and physical activity) are related to addiction severity, cognitive performance, and treatment dropout among 91 individuals undergoing Substance Use Disorder (SUD) treatment. Methods: We used the PRISM interview to evaluate SUD, a large battery of neuropsychological tests to assess cognitive performance (executive function, attention, memory, and affectivity), and monitored therapeutic adherence after 18 months. Results: Low educational attainment and unemployment were associated with severe substance-use patterns, impairment in specific cognitive domains (particularly executive functions), and higher rates of treatment discontinuation. Having a higher educational level and being employed reduced the predicted probability of abandoning treatment from 71% to 33.90% and from 60% to 36.80%, respectively. Low participation in stimulating activities was related to an earlier initiation and progression of SUD and greater global cognitive decline, especially in verbal episodic memory. Low participation in stimulating activities increased the predicted probability of experiencing significant cognitive impairment from 32.60% to 68.90%. Physical activity was associated with affective symptoms. Discussion: Education, employment, and stimulating activities function as distinct (rather than unified) determinants of clinical outcomes, each contributing uniquely to vulnerability or resilience in SUD. Conclusion: Educational opportunities, the promotion of vocational participation, and the integration of cognitive rehabilitation into treatment may strengthen resilience, improve treatment adherence, and optimize recovery trajectories in the SUD population.