Cognitive functioning as an underutilized determinant of treatment planning: a review in alcohol use disorder

Cognitive functioning is a critical determinant of treatment engagement, learning, and functional recovery across psychiatric disorders, yet it remains insufficiently integrated into treatment planning. While cognitive impairment is well documented in alcohol use disorder (AUD), its role is most often limited to a prognostic marker rather than an actionable input into clinical decision-making. This review examines how cognitive and neuropsychological functioning have been assessed and used to inform treatment planning in AUD.

A PubMed (MEDLINE) search was performed on primary studies involving adults with AUD leading up to 2026, in which cognitive or neuropsychological assessment influenced, or was intended to influence, treatment planning or clinical decision-making. Studies assessing cognition solely as an outcome were excluded. Twenty-three (23) studies met inclusion criteria. Study designs included observational cohorts, feasibility trials, and controlled trials. Cognitive domains, assessment approaches, and treatment-related outcomes were synthesized narratively.

Across studies, cognitive functioning, particularly amongst executive function, attention, and memory domains, were consistently associated with treatment engagement, retention, and functional outcomes. Still, cognition was most often examined as a prognostic factor as opposed to an explicit input to treatment allocation or adaptation. Only a few studies incorporated cognitive assessment into treatment orientation or treatment modality selection. Assessment methods varied widely, limiting comparability and scalability.

Cognitive functioning is clinically relevant, but current evidence characterizes it predominantly as a prognostic marker rather than a demonstrated, actionable input into treatment planning. Dedicated research testing cognition-informed treatment allocation and adaptation is needed before its routine incorporation into AUD care can be recommended.