Metacognitive impairment in cocaine use disorder: confirmatory evidence for the effects of recent drug use

Emerging work indicates that individuals with drug addiction, especially those with recent drug use, have impairments in task-based metacognition. However, studies to date have been limited to small samples. Here, we aggregated data across several protocols to test for group differences on behavioral metacognition using a well-validated task in the largest sample to date to address this question. We compared metacognition task performance among individuals with cocaine use disorder testing positive for cocaine in urine (CUD + : N = 27), individuals with cocaine use disorder testing negative for cocaine in urine (CUD-: N = 36), and healthy controls (HC: N = 41). A secondary goal was to inspect initial relationships between the metacognition task metrics and another measure that taps into self-confidence and self-awareness: Self-Concept problems using the Conners’ Adult ADHD Rating Scales (CAARS). Trial-by-trial analyses revealed metacognition impairments (operationalized as a disconnect between cognitive judgments and confidence in those judgments) in actively-using CUD+ as compared with both HC and CUD- (though CUD- exhibited the most variance). We did not observe effects on the classical metacognitive metric of meta d’/d’. Correlational analyses revealed a pattern of association in CUD+ between metacognition and Self-Concept problems that diverged from the patterns of association seen in HC and CUD-. These collective data align with prior work reporting metacognition deficits in addiction that are largely driven by active drug users. A relationship between metacognition and CAARS further supports confidence-related impairments in CUD + , but this association needs to be confirmed with larger samples and corroborated with other task-based self-awareness measures. Overall, our findings support the emerging idea that metacognition is an important deficit and emerging therapeutic target in addiction.