Metacognitive impairment in active cocaine use disorder is associated with individual differences in brain structure

Scott J. Moeller, Stephen M. Fleming, Gabriela Gan, Anna Zilverstand, Pias Malaker, Federico d'Oleire Uquillas, Kristin E. Schneider, Rebecca N. Preston-Campbell, Muhammad A. Parvaz, Thomas Maloney, Nelly Alia-Klein, Rita Z. Goldstein

Research output: Contribution to journalArticlepeer-review

38 Scopus citations


Dysfunctional self-awareness has been posited as a key feature of drug addiction, contributing to compromised control over addictive behaviors. In the present investigation, we showed that, compared with healthy controls (n=13) and even individuals with remitted cocaine use disorder (n=14), individuals with active cocaine use disorder (n=8) exhibited deficits in basic metacognition, defined as a weaker link between objective performance and self-reported confidence of performance on a visuo-perceptual accuracy task. This metacognitive deficit was accompanied by gray matter volume decreases, also most pronounced in individuals with active cocaine use disorder, in the rostral anterior cingulate cortex, a region necessary for this function in health. Our results thus provide a direct unbiased measurement - not relying on long-term memory or multifaceted choice behavior - of metacognition deficits in drug addiction, which are further mapped onto structural deficits in a brain region that subserves metacognitive accuracy in health and self-awareness in drug addiction. Impairments of metacognition could provide a basic mechanism underlying the higher-order self-awareness deficits in addiction, particularly among recent, active users.

Original languageEnglish
Pages (from-to)653-662
Number of pages10
JournalEuropean Neuropsychopharmacology
Issue number4
StatePublished - 1 Apr 2016


  • Anterior cingulate cortex
  • Drug addiction
  • Magnetic resonance imaging
  • Metacognition
  • Self-awareness
  • Voxel-based morphometry


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