Cognitive impairments are widespread consequences of substance use disorders (SUDs), impacting executive functions such as cognitive flexibility, abstract reasoning, and problem-solving abilities. These deficits in cognitive functioning can significantly hinder a person’s recovery process, quality of life, and capacity to reintegrate into society. One neuropsychological tool that has been widely utilized to evaluate these executive functions is the Wisconsin Card Sorting Test (WCST). A recent study published in “Applied Neuropsychology: Adult” aimed to investigate the diagnostic precision of the WCST in distinguishing cognitive deficits in individuals with SUDs from the performance of the general population without cognitive issues.

The study, led by Faustino B., Oliveira J. J., and Lopes P. from the School of Psychology and Life Sciences at the Universidade Lusófona de Humanidades e Tecnologias (ULHT) and the Faculty of Psychology at Universidade de Lisboa in Portugal, sought to provide valuable insights into the sensitivity and specificity of the Wisconsin Card Sorting Test (WCST) in assessing cognitive deficits among individuals grappling with substance use disorders (SUDs). Such assessments are critical in formulating tailored intervention strategies to aid in the recovery and rehabilitation of those affected.

The “Wisconsin Card Sorting Test” is a neuropsychological instrument famed for its application in assessing executive functions that are integral to cognitive flexibility and abstract reasoning. The study meticulously evaluated the WCST’s capability to act as a reliable diagnostic tool for cognitive impairments linked with SUDs.

Methodology and Participants

The research team conducted a comparative analysis involving 587 participants divided into three groups of individuals with SUDs: those with opioid use disorder undergoing a methadone maintenance harm reduction program, individuals with opioid use disorder in treatment within a therapeutic community, and people with alcohol use disorder also in a therapeutic community. Additionally, a normative group comprising healthy adults was assembled to serve as a benchmark for cognitive health.

Each participant underwent a series of cognitive tests focusing on executive functions, general cognitive ability, and self-reported depressive symptoms. Data gleaned from these assessments provided a basis for determining significant differences between the groups and establishing the discriminant validity of the WCST.

Key Findings

The discoveries were quite compelling. The WCST emerged as a robust instrument, showcasing differences in performance across most variables of the test between the SUD groups and the normative group. This provided significant evidence of the test’s discriminant validity. The study also established convergent validity through the demonstration of weak to moderate correlations between the WCST variables and measures of general cognitive functioning.

One particularly novel aspect of this research was the establishment of cutoff points based on receiver operating characteristic (ROC) curves for the WCST variables. This analytical method allowed the scientists to quantify the sensitivity and specificity of the WCST in detecting changes in cognitive flexibility and abstract reasoning—a step forward in enhancing the diagnostic accuracy for cognitive deficits associated with SUDs.

Implications for Clinical Practice

These research findings could have profound implications for clinical practice. The establishment of the WCST as a sensitive measure means it can serve as an effective tool for clinicians in the early detection of cognitive deficits among those with SUDs. Moreover, the identification of specific cutoff points enhances the WCST’s utility by enabling more precise assessments, which in turn can guide the development of personalized treatment plans.

The study’s implications extend beyond the mere identification of cognitive issues; they underscore the inherent challenges in rehabilitating individuals with SUDs. Cognitive impairments can pose significant difficulties in adhering to and benefiting from treatment protocols. As such, understanding these deficits is pivotal for the implementation of comprehensive addiction treatment approaches, including cognitive rehabilitation strategies.


The study published by Faustino B., Oliveira J. J., and Lopes P. in “Applied Neuropsychology: Adult” reaffirms the Wisconsin Card Sorting Test as an invaluable tool for the neuropsychological assessment of individuals with SUDs. The WCST’s sensitivity to changes in executive functions, specifically cognitive flexibility and abstract reasoning, underlines its importance in both research and clinical settings. With these findings, healthcare professionals are better equipped to diagnose and treat cognitive deficits in SUDs, ultimately empowering patients on their journey towards recovery.

As this ground-breaking research continues to inform best practices in neuropsychological assessment, it is hoped that more individuals struggling with the multifaceted challenges of SUDs will receive the targeted support they need to regain cognitive function and achieve lasting sobriety.


1. Faustino, B., Oliveira, J. J., & Lopes, P. (2021). Diagnostic precision of the Wisconsin Card Sorting Test in assessing cognitive deficits in substance use disorders. Applied Neuropsychology: Adult, 28(2), 165-172. doi:10.1080/23279095.2019.1607737
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1. Wisconsin Card Sorting Test
2. Substance Use Disorders Cognitive Deficits
3. Executive Functions Assessment
4. Neuropsychological Instrument for SUDs
5. Cognitive Flexibility in Addiction Treatment