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.
Bibliographical noteFunding Information:
This work was supported by Grants from the National Institute on Drug Abuse ( K01DA037452 and R21DA040046 to SJM; F32DA033088 to MAP; R21DA034954 to RZG) and the National Institute of Mental Health ( R01MH090134 to NAK). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Additional support came from: a Sir Henry Wellcome Fellowship from the Wellcome Trust ( WT096185 to SMF); and seed funds from the Icahn School of Medicine at Mount Sinai and the Mount Sinai Brain Imaging Center (to SJM, NAK, and RZG). None of these entities had a further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.
- Anterior cingulate cortex
- Drug addiction
- Magnetic resonance imaging
- Voxel-based morphometry