Aims
To evaluate relationships between measures of cognitive functioning and alcohol or drug use among adults (≥ 18 years) in the US general population.
Design
Two cognitive scales were created based on dimensionality and reliability of self‐reported Executive Function Index items. Relationships between the two scales and validators were evaluated. Associations between the cognitive scales and past‐year frequency of alcohol or drug use were estimated with adjusted odds ratios (aOR).
Setting
United States, using the 2012–13 National Epidemiologic Survey on Alcohol and Related Conditions–III, a nationally representative adult sample selected by multi‐stage probability sampling.
Participants
36 085 respondents.
Measurements
Past‐year substance use outcome variables categorized binge drinking, marijuana, cocaine, opioid, sedative/tranquilizer and stimulant use as frequent (at least weekly to daily), infrequent (any to two to three times/month) or no use, assessed by the Alcohol Use Disorder and Associated Disabilities Interview Schedule–5. Key predictors were the two cognitive scales. Construct validators included education and functional impairment. Covariates included age, gender, income and race/ethnicity.
Findings
Nine cognitive items fitted a two‐factor model (comparative fit index = 0.973): attention (five items) and executive functioning (four items). Both scales were associated positively with higher education (Ps < 0.001) and negatively with functional impairment (Ps < 0.001), demonstrating construct validity. Poorer attention was associated with frequent and infrequent binge drinking and use of drugs [aOR range = 1.07 (binge drinking) to 1.72 (stimulants), Ps ≤ 0.01]. Poorer executive functioning was associated with frequent binge drinking and use of drugs [aOR range = 1.22 (binge drinking) to 2.03 (cocaine), Ps < 0.001] and infrequent use of all drugs [aOR range = 1.19 (marijuana) to 1.63 (cocaine), Ps < 0.001].
Conclusions
Impairments in attention and executive functioning are positively associated with substance use in the US general population.