title: Metacognitive impairment in active cocaine use disorder is associated with individual differences in brain structure.
abstract: 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.
authors.affiliation: Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Moeller
authors.affiliation: Wellcome Trust Centre for Neuroimaging, University College London, United Kingdom.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Fleming
authors.affiliation: Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Gan
authors.affiliation: Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
authors.forename: Anna
authors.initials: A
authors.lastname: Zilverstand
authors.affiliation: Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
authors.forename: Pias
authors.initials: P
authors.lastname: Malaker
authors.affiliation: Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
authors.forename: Federico
authors.initials: F
authors.lastname: d'Oleire Uquillas
authors.affiliation: Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
authors.forename: Kristin E
authors.initials: KE
authors.lastname: Schneider
authors.affiliation: Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
authors.forename: Rebecca N
authors.initials: RN
authors.lastname: Preston-Campbell
authors.affiliation: Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
authors.forename: Muhammad A
authors.initials: MA
authors.lastname: Parvaz
authors.affiliation: Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
authors.forename: Thomas
authors.initials: T
authors.lastname: Maloney
authors.affiliation: Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
authors.forename: Nelly
authors.initials: N
authors.lastname: Alia-Klein
authors.affiliation: Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
authors.forename: Rita Z
authors.initials: RZ
authors.lastname: Goldstein
mesh_terms: D000328:Adult; D001284:Atrophy / Q000473:pathology; D016022:Case-Control Studies; D019970:Cocaine-Related Disorders / Q000150:complications / Q000473:pathology* / Q000523:psychology*; D003072:Cognition Disorders / Q000150:complications / Q000473:pathology* / Q000523:psychology; D005260:Female; D066128:Gray Matter / Q000473:pathology; D006179:Gyrus Cinguli / Q000473:pathology*; D006801:Humans; D007206:Individuality; D008279:Magnetic Resonance Imaging; D008297:Male; D000067489:Metacognition; D008875:Middle Aged; D059906:Neuroimaging; D009483:Neuropsychological Tests; D011597:Psychomotor Performance
keywords: Anterior cingulate cortex; Drug addiction; Magnetic resonance imaging; Metacognition; Self-awareness; Voxel-based morphometry