Why Executive Function Matters in Addiction Recovery
Substance use disorder is associated with biological, psychological, and social consequences. Beyond repeated substance use, people with SUD may experience difficulties with impulse control, decision-making, cognitive flexibility, planning, problem-solving, and self-regulation.
These abilities are particularly important during rehabilitation. Patients may encounter cravings, emotional distress, substance-related cues, or other high-risk situations that require them to control automatic responses and apply coping strategies. The article notes that relapse is influenced by multiple cognitive and emotional processes rather than simply a lack of motivation.
Cognitive rehabilitation and executive-function training have therefore attracted increasing attention as components of addiction treatment. Mindfulness-based relapse prevention provides another approach by helping individuals recognize thoughts, emotions, physical sensations, and cravings without automatically responding to them through substance use.
Five Components Combined in One Rehabilitation Program
Yuliati developed the Brain–Mind Integrated Neurorehabilitation Intervention (BM-INRI) as a structured nursing intervention that combines five components:
- Neurorehabilitation
- Cognitive rehabilitation
- Executive-function training
- Mindfulness-based relapse prevention
- Relapse-prevention strategies
The intervention was designed to bring these approaches together within a hospital-based rehabilitation program rather than applying them separately. According to the article, the combination is intended to address cognitive functioning, emotional regulation, awareness of cravings, and coping with situations associated with relapse vulnerability.
The research involved 24 patients participating in a substance-use rehabilitation program at Manah Shanti Mahottama Mental Hospital in Bali. All participants were male because the rehabilitation unit involved in the study provided care for male patients.
BM-INRI was delivered over eight weeks, with two sessions each week, giving every participant a total of 16 intervention sessions. Participants were assessed before the program and again after completing all sessions.
The researchers used the Frontal Assessment Battery (FAB) to measure executive function. The assessment covers areas including mental flexibility, inhibitory control, conceptualization, motor programming, sensitivity to interference, and environmental autonomy. Relapse tendency was measured using a scale adapted from an earlier instrument. Importantly, the relapse measure assessed a person's tendency toward relapse rather than predicting whether an actual relapse would occur.
Executive Function Scores Rose Sharply
The study found a substantial increase in participants' executive-function scores following BM-INRI.
Before the intervention, the average FAB score was 5.04. After eight weeks, the average score increased to 16.33, representing an average improvement of 11.29 points.
The statistical analysis found that the change was significant, with a p value below 0.001. The reported within-group effect size, measured using Cohen's dz, was 5.39.
The results suggest that participants demonstrated considerably stronger performance on the executive-function assessment after completing the intervention. The article links this change to the cognitive and executive-function components of BM-INRI, which provide structured opportunities to practice skills related to inhibition, flexibility, problem-solving, and adaptive decision-making.
Relapse Tendency Fell by Nearly 29 Points
The second major finding concerned relapse tendency.
Participants had an average relapse-tendency score of 52.38 before the intervention. After completing BM-INRI, the average score fell to 23.50, representing a reduction of 28.88 points.
Because higher scores represented greater relapse tendency, the decrease was interpreted as a favorable change. The statistical analysis reported a p value below 0.001 and a Cohen's dz of 4.47.
Yuliati's discussion suggests that mindfulness may have contributed to this change by encouraging participants to observe cravings, emotions, thoughts, and physical sensations without automatically responding through substance use. The relapse-prevention component also encouraged participants to identify triggers, anticipate high-risk situations, and develop coping strategies.
“BM-INRI offers a structured framework that potentially allows nurses to participate more actively in interventions targeting executive functioning, emotional regulation, and relapse prevention,” the article states in its discussion of nursing implications.
This insight is attributed to Ida Ayu Eka Yuliati of Manah Shanti Mahottama Mental Hospital, Bali, whose research positions BM-INRI as a potentially useful addition to existing rehabilitation programs rather than a replacement for standard addiction treatment.
Potential Implications for Addiction Rehabilitation
The findings may have practical implications for hospitals and healthcare professionals working with people with substance use disorder. Incorporating assessments of executive function could help clinicians identify patients who may need additional neurocognitive rehabilitation.
The study also suggests that rehabilitation programs could combine cognitive exercises with emotional-regulation and relapse-prevention strategies. Nurses may have an important role because of their frequent contact with patients during hospital-based rehabilitation.
However, the researchers emphasize that BM-INRI should currently be viewed as a promising complementary intervention, not as an established replacement for standard addiction treatment. The study did not include a control group, meaning the observed improvements cannot be attributed exclusively to BM-INRI. Other factors during rehabilitation could also have contributed to the changes.
The study also had a relatively small sample of 24 participants, all of whom were male. Participants used different substances, with methamphetamine or shabu reported most frequently among the group. These characteristics limit how broadly the findings can be generalized.
Another important limitation is that the researchers measured relapse tendency rather than actual relapse events. The study also assessed outcomes immediately after the intervention and did not establish whether the improvements would persist over a longer period.
Future research should therefore include larger and more diverse populations, control or randomized designs, longer follow-up periods, and measurements of actual relapse, abstinence duration, treatment adherence, quality of life, and social functioning.
Author Profile
Ida Ayu Eka Yuliati is the author of the study and is affiliated with Manah Shanti Mahottama Mental Hospital, Bali, Indonesia. Her published research focuses on BM-INRI and its application to executive function and relapse tendency among patients with substance use disorder. The article does not specify an academic degree or a separate formal field-of-expertise profile, so those details are not added here.
Research Source
Article title: Effectiveness of Brain–Mind Integrated Neurorehabilitation Intervention (BM-INRI) on Executive Function and Relapse Tendency among Patients with Substance Use Disorder
Author: Ida Ayu Eka Yuliati
Journal: Formosa Journal of Multidisciplinary Research (FJMR)
Publication year: 2026
Volume and issue: Volume 5, No. 9
Pages: 3023–3034
DOI: 10.55927/fjmr.v5i9.201
Official journal: Formosa Journal of Multidisciplinary Research
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