On Addiction Denial and Cognitive Dysfunction in Alcoholics

SIR: I read with interest but some dismay the article by Rinn et al. on addiction denial and cognitive dysfunction.¹ I commend the authors for their attention to denial in alcohol dependence and their intriguing idea that this linchpin in the psychology of addiction may be understood, in part, as resulting from cognitive deficits. The authors make explicit that this was a sample of convenience (“the records of 32 male and 12 female alcohol-dependent hospitalized inpatients…referred for routine neuropsychological evaluations”) and that this study was based solely on chart review. Nevertheless, I find it hard to take the authors' conclusions seriously because they confound an investigation of a trait (fixed denial) with state-dependent measures (cognitive functions assessed 6 days after admission).

Cognitive function (as well as mood) is known to be affected by chronic heavy alcohol ingestion, and it is not uncommon for one or more cognitive functions to continue to improve (toward a pre-drinking baseline) for 3 to 6 months after the last drink.² Those changes are a function of sobriety rather than treatment. If the authors wish to explore the relationship of denial to cognitive function, they not only should assess these at the same points in time (as they acknowledge) but also when most of the effects on cognition from alcohol dependence have cleared. Such an approach would yield more reliable data and allow a more meaningful assessment of the authors' hypothesis.