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Cocaine dependence linked to impaired self-awareness

Cocaine dependence can lead to impaired awareness in users resulting from abnormal activity in the rostral anterior cingulate cortex, according to study results published in JAMA Psychiatry.

Researchers included 33 cocaine-dependent patients and 20 controls. Of the cocaine users, 28 were considered currently dependent on cocaine, three participants’ use was sustained, and two participants’ use was in remission. Study participants completed a probabilistic learning choice task to determine awareness of their addictive behavior. They also completed an event-related functional magnetic resonance imaging Stroop color-word task three times.

Researchers found that cocaine users with impaired insight had lower error-induced rostral anterior cingulate cortex activity and less gray matter within that region compared with other study participants. Cocaine users with impaired insight scored lower on the Levels of Emotional Awareness Scale. Study results showed a correlation between lower rostral anterior cingulate cortex activity and more frequent cocaine use. Because study participants’ cocaine use did not significantly differ, this correlation may be related to effects of addiction rather than cocaine use.

“Our results extend prior research on compromised error awareness and processing and gray matter abnormalities in drug addiction, offering the intriguing suggestion that impaired insight may drive some of the effects observed in prior studies. Our results also raise the possibility that a specific [cocaine use disorder] subgroup (those with impaired self awareness) might benefit from therapeutic interventions directed at enhancing the neuropsychological mechanisms underlying insight and self-awareness,” study researcher Scott J. Moeller, PhD, of the Icahn School of Medicine, and colleagues concluded.

Disclosure: The researchers report no relevant financial disclosures.