Effectiveness of Brain–Mind Integrated Neurorehabilitation Intervention (BM-INRI) on Executive Function and Relapse Tendency among Patients with Substance Use Disorder

Ida Ayu Eka Yuliati

doi:10.55927/fjmr.v5i9.201

Authors

Ida Ayu Eka Yuliati Rumah Sakit Jiwa Manah Shanti Mahottama

DOI:

https://doi.org/10.55927/fjmr.v5i9.201

Keywords:

Substance Use Disorder, Executive Function, Relapse Tendency, Neurorehabilitation, Mindfulness

Abstract

Substance use disorder (SUD) is associated not only with persistent substance-related behaviors but also with neurocognitive impairments, particularly executive dysfunction, which may compromise self-control, adaptive decision-making, and the ability to cope with relapse-related triggers. Conventional rehabilitation programs may benefit from interventions that simultaneously address cognitive function, emotional regulation, and relapse prevention. Brain–Mind Integrated Neurorehabilitation Intervention (BM-INRI) was developed as a multimodal nursing intervention integrating neurorehabilitation, cognitive rehabilitation, executive function training, mindfulness-based relapse prevention, and relapse prevention strategies. This study aimed to examine changes in executive function and relapse tendency among patients with SUD following BM-INRI. The mean FAB score increased from 5.04 (SD = 2.51) before intervention to 16.33 (SD = 1.43) after intervention, representing a mean increase of 11.29 points (95% CI 10.41–12.18; t = 26.403; p < 0.001; Cohen’s dz = 5.39). The mean relapse tendency score decreased from 52.38 (SD = 3.76) to 23.50 (SD = 4.81), representing a mean reduction of 28.88 points (p < 0.001; Cohen’s dz = 4.47). Difference scores for both outcomes met the normality assumption.

References

Alves, J., Petry, N. M., Fernandes, S., & Ferreira, M. B. (2021). Cognitive training effectiveness on memory, executive functioning, and processing speed in individuals with substance use disorders: A systematic review. Frontiers in Psychology, 12, 709365. https://doi.org/10.3389/fpsyg.2021.709365

Anderson, M. C., et al. (2021). Cognitive boosting interventions for impulsivity in addiction: A systematic review and meta-analysis of cognitive training, remediation and pharmacological enhancement. Addiction, 116(12), 3304–3319. doi:10.1111/add.15469

Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Prentice-Hall.

Bowen, S., Witkiewitz, K., Clifasefi, S. L., Grow, J., Chawla, N., Hsu, S. H., Carroll, H. A., Harrop, E., Collins, S. E., Lustyk, M. K., & Larimer, M. E. (2014). Relative efficacy of mindfulness-based relapse prevention, standard relapse prevention, and treatment as usual for substance use disorders: A randomized clinical trial. JAMA Psychiatry, 71(5), 547–556. doi:10.1001/jamapsychiatry.2013.4546

Bowen, S., Chawla, N., & Marlatt, G. A. (2011). Mindfulness-Based Relapse Prevention for addictive behaviors: A clinician's guide. Guilford Press.

Bowen, S., Chawla, N., Collins, S. E., Witkiewitz, K., Hsu, S., Grow, J., Clifasefi, S., Garner, M., & Larimer, M. E. (2009). Mindfulness-based relapse prevention for substance use disorders: A pilot efficacy trial. Substance Abuse, 30(4), 295–305. doi:10.1080/08897070903250084

Brooks, S. J., Wiemerslage, L., et al. (2021). Working memory training in substance use disorders: A systematic review. Addictive Behaviors, 114, 106731.

Caetano, T., et al. (2021). Cognitive training effectiveness on memory, executive functioning, and processing speed in individuals with substance use disorders: A systematic review. Frontiers in Psychology, 12, 730165. doi:10.3389/fpsyg.2021.730165

Chan, R. C. K., Shum, D., Toulopoulou, T., & Chen, E. Y. H. (2008). Assessment of executive functions: Review of instruments and identification of critical issues. Archives of Clinical Neuropsychology, 23(2), 201–216. https://doi.org/10.1016/j.acn.2007.08.010

Cicerone, K. D., Goldin, Y., Ganci, K., Rosenbaum, A., Wethe, J. V., Langenbahn, D. M., ... Harley, J. P. (2019). Evidence-based cognitive rehabilitation: Systematic review of the literature from 2009 through 2014. Archives of Physical Medicine and Rehabilitation, 100(8), 1515–1533. https://doi.org/10.1016/j.apmr.2019.02.011

Council for International Organizations of Medical Sciences. (2021). International ethical guidelines for health-related research involving humans. CIOMS.

Cunha, P. J., Nicastri, S., Andrade, A. G., & Bolla, K. I. (2010). The frontal assessment battery (FAB) reveals neurocognitive dysfunction in substance-dependent individuals in distinct executive domains: Abstract reasoning, motor programming, and cognitive flexibility. Addictive Behaviors, 35(10), 875–881. doi:10.1016/j.addbeh.2010.05.005

Diamond, A. (2013). Executive functions. Annual Review of Psychology, 64, 135–168. https://doi.org/10.1146/annurev-psych-113011-143750

Doidge, N. (2015). The brain that changes itself (Rev. ed.). Penguin Books. Kolb, B., & Gibb, R. (2014). Searching for the principles of brain plasticity and behavior. Cortex, 58, 251–260.

Domínguez-Salas, S., Díaz-Batanero, C., Martin-Lozano-Rojas, O., & Verdejo-García, A. (2016). Impact of general cognition and executive function deficits on addiction treatment outcomes: Systematic review and discussion of neurocognitive pathways. Neuroscience & Biobehavioral Reviews, 71, 772–801. doi:10.1016/j.neubiorev.2016.09.030

Dubois, B., Slachevsky, A., Litvan, I., & Pillon, B. (2000). The Frontal Assessment Battery at bedside (FAB): A frontal lobe function assessment. Neurology, 55(11), 1621–1626.

Ekhtiari, H., Rezapour, T., Aupperle, R. L., Paulus, M. P., & Baldacchino, A., et al. (2022). A Delphi consensus framework for cognitive training and remediation in addiction treatment. Neuroscience & Biobehavioral Reviews, 143, 104923.

Ferreira, S., Virgolino, A., Pombo, S., Bacelar-Nicolau, L., Vásquez-Justo, E., & Ribeiro, C. (2026). Neuropsychological rehabilitation in executive deficits resulting from alcohol use disorder: Systematic review of literature. Frontiers in Psychology, 17, 1805577. https://doi.org/10.3389/fpsyg.2026.1805577

Field, A. (2024). Discovering statistics using IBM SPSS Statistics (6th ed.). Sage Publications.

Gillespie, A. L., et al. (2024). Cognitive training interventions for substance use disorders: A systematic review of effectiveness and implementation. Drug and Alcohol Dependence, 264, 111529.

Goldberg, S. B., Tucker, R. P., Greene, P. A., et al. (2021). Mindfulness-based interventions for substance use disorders. Cochrane Database of Systematic Reviews, CD011723.

Goldstein, R. Z., & Volkow, N. D. (2011). Dysfunction of the prefrontal cortex in addiction: Neuroimaging findings and clinical implications. Nature Reviews Neuroscience, 12(11), 652–669. https://doi.org/10.1038/nrn3119

Grant, S., Potenza, M. N., Weinstein, A., & Gorelick, D. A. (2010). Introduction to behavioral addictions. The American Journal of Drug and Alcohol Abuse, 36(5), 233–241.

Heslop, K., Elsom, S., & Parker, N. (2022). Integrated nursing care for people with combined mental health and substance use disorders: A systematic review. International Journal of Mental Health Nursing. (PubMed)

Knopf, A. (2024). WHO says there's a critical gap worldwide for SUD treatment. Alcoholism & Drug Abuse Weekly, 36(28), 6–7. https://doi.org/10.1002/adaw.34183 (Wiley Online Library)

Koob, G. F., & Volkow, N. D. (2016). Neurobiology of addiction: A neurocircuitry analysis. The Lancet Psychiatry, 3(8), 760–773. https://doi.org/10.1016/S2215-0366(16)00104-8

Lorenzetti, V., Gaillard, A., Beyer, E., et al. (2023). Do mindfulness-based interventions change brain function in people with substance dependence? A systematic review of the fMRI evidence. BMC Psychiatry, 23, 407. https://doi.org/10.1186/s12888-023-04789-7

Marlatt, G. A., & Donovan, D. M. (2005). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors (2nd ed.). Guilford Press.

Miyake, A., & Friedman, N. P. (2012). The nature and organization of individual differences in executive functions: Four general conclusions. Current Directions in Psychological Science, 21(1), 8–14. https://doi.org/10.1177/0963721411429458

Mumba, M. N., & Mugoya, G. T. (2022). Recovery ecosystems: A whole health approach to substance use prevention and treatment. Journal of Psychosocial Nursing and Mental Health Services, 60(9), 10–14. (PubMed)

Nardo, T., et al. (2022). Cognitive remediation as an adjunct treatment for substance use disorders: A systematic review. Neuropsychology Review, 32(1), 161–191. doi:10.1007/s11065-021-09506-3

Polit, D. F., & Beck, C. T. (2021). Nursing research: Generating and assessing evidence for nursing practice (11th ed.). Wolters Kluwer.

Polit, D. F., Beck, C. T., & Owen, S. V. (2007). Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Research in Nursing & Health, 30(4), 459–467.

Powell, A., Sumnall, H., Smith, J., Kuiper, R., & Montgomery, C. (2024). Recovery of neuropsychological function following abstinence from alcohol in adults diagnosed with alcohol use disorder: A systematic review of longitudinal studies. PLOS ONE, 19(1), e0296043. https://doi.org/10.1371/journal.pone.0296043

Putra, F. K. V., et al. (2024). Pengaruh self-efficacy terhadap relapse tendency pada pasien rehabilitasi narkoba BNN di Sumatera Barat. Psibernetika, 17(1), 1–9. doi:10.30813/psibernetika.v17i1.4710

Putri, I. A., & Astuti, Y. D. (2018). Hubungan antara efikasi diri dan kecenderungan kambuh pada pecandu narkoba yang menjalani rehabilitasi di Yogyakarta. Psikologika: Jurnal Pemikiran dan Penelitian Psikologi, 23(2), 151–164. doi:10.20885/psikologika.vol23.iss2.art6

Ramadas, E., Pedroso de Lima, M., Caetano, T., Lopes, J., & Dixe, M. A. (2021). Effectiveness of mindfulness-based relapse prevention in individuals with substance use disorders: A systematic review. Brain Sciences, 11(10), 133. doi:10.3390/brainsci11100133

Rezapour, T., Ekhtiari, H., & Paulus, M. P. (2021). Cognitive rehabilitation in opioid use disorder: Current evidence and future directions. Frontiers in Psychiatry, 12, 704960.

Rozi, H. F. (2016). Pengaruh pelatihan efikasi diri terhadap kecenderungan relapse pada pecandu narkoba di Balai Besar Rehabilitasi Badan Narkotika Nasional Bogor [Skripsi, Universitas Sebelas Maret].

Sampedro-Piquero, P., & Begega, A. (2017). Environmental enrichment as a positive behavioural intervention across the lifespan. Current Neuropharmacology, 15(4), 459–470. https://doi.org/10.2174/1570159X14666160325115909

Shapiro, S. S., & Wilk, M. B. (1965). An analysis of variance test for normality (complete samples). Biometrika, 52(3–4), 591–611.

Tamayo, N., & Lane, A. (2022). Effective nursing recovery-oriented interventions for individuals with substance use disorder: A literature review. Journal of Addictions Nursing, 33(4), 233–246. (Athabasca University)

Undang-Undang Republik Indonesia Nomor 35 Tahun 2009 tentang Narkotika.

United Nations Office on Drugs and Crime. (2023). World Drug Report 2023. United Nations.

United Nations Office on Drugs and Crime. (2022). International Standards for the Treatment of Drug Use Disorders. Vienna: UNODC.

Verdejo-García, A., Chong, T. T. J., Stout, J. C., Yücel, M., & London, E. D. (2019). Stages of dysfunctional decision-making in addiction. Pharmacology Biochemistry and Behavior, 164, 99–105. https://doi.org/10.1016/j.pbb.2017.02.003

Volkow, N. D., & Boyle, M. (2018). Neuroscience of addiction: Relevance to prevention and treatment. American Journal of Psychiatry, 175(8), 729–740. https://doi.org/10.1176/appi.ajp.2018.17101174

Volkow, N. D., Koob, G. F., & McLellan, A. T. (2016). Neurobiologic advances from the brain disease model of addiction. The New England Journal of Medicine, 374(4), 363–371. https://doi.org/10.1056/NEJMra1511480

World Health Organization. (2024). Global status report on alcohol and health and treatment of substance use disorders. Geneva: World Health Organization. ISBN: 978-92-4-009674-5. (World Health Organization)

World Health Organization. (2024). Over 3 million annual deaths due to alcohol and drug use, majority among men. Geneva: World Health Organization. (World Health Organization)

World Health Organization. (2021). Comprehensive mental health action plan 2013–2030. World Health Organization.

World Health Organization, & United Nations Office on Drugs and Crime. (2020). International Standards for the Treatment of Drug Use Disorders. Geneva: World Health Organization.

World Medical Association. (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310(20), 2191–2194.

Yanuarti, T., Daud, M. N. M., Mohamed, N. H., Atil, A., & Triaswati, R. (2025). The relationship between self-efficacy, resilience and social support with relapse tendency in substance use disorder in Indonesia. Jurnal Keperawatan Komprehensif, 11(2), 234–243. https://doi.org/10.33755/jkk.v11i2.851