The impact of neuropsychological impairment on drink refusal skill acquisition and treatment outcome was examined in 33 male alcoholic inpatients. Subjects stratified by Abstraction scores on the Shipley Institute of Living Scale (SILS) performed differentially on drink refusal components of the Situational Competency Test (SCT) following a skills-based drink refusal intervention. Higher abstraction subjects tended to respond more rapidly on the SCT at post-training, had significantly higher scores on a quiz about effective drink refusal at baseline, and tended to improve more on the quiz following training than subjects with lower conceptual functioning. Aftercare attendance was significantly greater among the higher neuropsychological functioning group. When subjects were categorized by Brain Age Quotient no differences were found in skill acquisition nor in aftercare attendance. Subjects who showed the most learning on the California Verbal Learning Test demonstrated significantly better performance on the drink refusal quiz at post-training. Implications for alcoholism treatment are discussed.