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

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

Bibliographical note

Funding 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.

Publisher Copyright:
© 2016 Elsevier B.V. and ECNP.


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


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