Current Behavioral Neuroscience Reports

, Volume 5, Issue 4, pp 232–237 | Cite as

New Insights on Neurocognition in Cocaine Use Disorder

  • Antonio Verdejo-GarciaEmail author
Addictions (M Potenza and M Brand, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Addictions


Purpose of Review

This review aims to provide an update of neurocognition in cocaine use disorder (CUD), focusing on new developments and areas of growth. It starts with a discussion of novel findings on the neurobiological underpinnings of CUD, including cognitive-genetic research and advanced functional neuroimaging tools and models. This is followed by an overview of progress in the area of CUD-related cognitive deficits, with a special focus on social cognition and meta-cognition. Finally, the review covers recent developments on the relationship between neurocognitive deficits and treatment outcomes and new trials of cognitive training for CUD.

Recent Findings

The studies reviewed support the notion that CUD is underpinned by neural alterations in cortico-striatal-thalamic circuits implicated in executive functions, and ventromedial prefrontal cortex and anterior cingulate cortex regions implicated in social cognition and meta-cognition. Neurocognitive alterations are linked to individual variations in the function of chatecolamines, serotonin and glutamate systems. Brain and cognitive deficits can compromise treatment motivation, abstinence and recovery of social capital in CUD individuals.


New findings highlight the need to test new holistic neuroscience-based interventions for CUD that include rehabilitation of executive functions, self-awareness and social valuation and social cognition, as well as novel glutamatergic, serotonergic and noradrenergic drugs.


Cocaine use disorder Cognition Neurobiology Neuroimaging Treatment Rehabilitation 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.
    Müller CP, Homberg JR. The role of serotonin in drug use and addiction. Behav Brain Res. 2015;277:146–92.CrossRefGoogle Scholar
  2. 2.
    Spencer S, Scofield M, Kalivas PW. The good and bad news about glutamate in drug addiction. J Psychopharmacol. 2016;30(11):1095–8.CrossRefGoogle Scholar
  3. 3.
    Association AP. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub; 2013.Google Scholar
  4. 4.
    Spronk DB, Verkes RJ, Cools R, Franke B, Van Wel JH, Ramaekers JG, et al. Opposite effects of cannabis and cocaine on performance monitoring. Eur Neuropsychopharmacol. 2016;26(7):1127–39.CrossRefGoogle Scholar
  5. 5.
    Verdejo-García A. The neuropsychologist working in addiction: what to know? Ten questions and answers. Revista Iberoamericana de Neuropsicologia. 2018;1(2):170–9.Google Scholar
  6. 6.
    Potvin S, Stavro K, Rizkallah É, Pelletier J. Cocaine and cognition: a systematic quantitative review. J Addict Med. 2014;8(5):368–76.CrossRefGoogle Scholar
  7. 7.
    Vonmoos M, Hulka LM, Preller KH, Minder F, Baumgartner MR, Quednow BB. Cognitive impairment in cocaine users is drug-induced but partially reversible: evidence from a longitudinal study. Neuropsychopharmacology. 2014;39(9):2200–10.CrossRefGoogle Scholar
  8. 8.
    Domínguez-Salas S, Díaz-Batanero C, Lozano-Rojas OM, Verdejo-García A. Impact of general cognition and executive function deficits on addiction treatment outcomes: systematic review and discussion of neurocognitive pathways. Neurosci Biobehav Rev. 2016;71:772–801.CrossRefGoogle Scholar
  9. 9.
    Stevens L, Verdejo-García A, Goudriaan AE, Roeyers H, Dom G, Vanderplasschen W. Impulsivity as a vulnerability factor for poor addiction treatment outcomes: a review of neurocognitive findings among individuals with substance use disorders. J Subst Abus Treat. 2014;47(1):58–72.CrossRefGoogle Scholar
  10. 10.
    Stevens L, Goudriaan A, Verdejo-García A, Dom G, Roeyers H, Vanderplasschen W. Impulsive choice predicts short-term relapse in substance-dependent individuals attending an in-patient detoxification programme. Psychol Med. 2015;45(10):2083–93.CrossRefGoogle Scholar
  11. 11.
    Verdejo-García A, Albein-Urios N, Martinez-Gonzalez JM, Civit E, De la Torre R, Lozano O. Decision-making impairment predicts 3-month hair-indexed cocaine relapse. Psychopharmacology. 2014;231(21):4179–87.CrossRefGoogle Scholar
  12. 12.
    Rezapour T, DeVito EE, Sofuoglu M, Ekhtiari H. Perspectives on neurocognitive rehabilitation as an adjunct treatment for addictive disorders: from cognitive improvement to relapse prevention. Prog Brain Res Elsevier; 2016. p. 345–69.Google Scholar
  13. 13.
    •• Verdejo-García A. Cognitive training for substance use disorders: neuroscientific mechanisms. Neurosci Biobehav Rev. 2016;68:270–81. This review summarises pilot and randomised clinical trials testing the efficacy of cognitive training and rehabilitation among people with substance use disorders, and discusses the mechanisms of interventions’ effects. Provides a guideline for the design of novel neuroscience-informed interventions for substance use disorders, including CUD. CrossRefPubMedGoogle Scholar
  14. 14.
    Verdejo-García A, Alcázar-Córcoles M, Albein-Urios N. Neuropsychological interventions for decision-making in addiction. Neuropsychol Rev 2018: in press.Google Scholar
  15. 15.
    Bickel WK, Yi R, Landes RD, Hill PF, Baxter C. Remember the future: working memory training decreases delay discounting among stimulant addicts. Biol Psychiatry. 2011;69(3):260–5.CrossRefGoogle Scholar
  16. 16.
    Valls-Serrano C, Caracuel A, Verdejo-García A. Goal management training and mindfulness meditation improve executive functions and transfer to ecological tasks of daily life in polysubstance users enrolled in therapeutic community treatment. Drug Alcohol Depend. 2016;165:9–14.CrossRefGoogle Scholar
  17. 17.
    Belcher AM, Volkow ND, Moeller FG, Ferré S. Personality traits and vulnerability or resilience to substance use disorders. Trends Cogn Sci. 2014;18(4):211–7.CrossRefGoogle Scholar
  18. 18.
    Havranek MM, Vonmoos M, Müller CP, Büetiger JR, Tasiudi E, Hulka LM, et al. Serotonin transporter and tryptophan hydroxylase gene variations mediate working memory deficits of cocaine users. Neuropsychopharmacology. 2015;40(13):2929–37.CrossRefGoogle Scholar
  19. 19.
    •• Havranek MM, Hulka LM, Tasiudi E, Eisenegger C, Vonmoos M, Preller KH, et al. α2A-adrenergic receptor polymorphisms and mRNA expression levels are associated with delay discounting in cocaine users. Addict Biol. 2017;22(2):561–9 Consistent evidence shows that CUD is associated with steeper delay discounting, which predicts poor treatment retention and relapse. This pharmacogenetic study shows that this link is underpinned by a noradrenergic mechanism. Findings can inform novel medications for impulsivity among people with CUD. CrossRefGoogle Scholar
  20. 20.
    Verdejo-Garcia A, Clark L, Verdejo-Román J, Albein-Urios N, Martinez-Gonzalez JM, Gutierrez B, et al. Neural substrates of cognitive flexibility in cocaine and gambling addictions. Br J Psychiatry. 2015;207(2):158–64.CrossRefGoogle Scholar
  21. 21.
    Jacobs G, Van der Grond J, Teeuwisse W, Langeveld T, Van Pelt J, Verhagen J, et al. Hypothalamic glutamate levels following serotonergic stimulation: a pilot study using 7-tesla magnetic resonance spectroscopy in healthy volunteers. Prog Neuro-Psychopharmacol Biol Psychiatry. 2010;34(3):486–91.CrossRefGoogle Scholar
  22. 22.
    Crocker CE, Purdon SE, Hanstock CC, Lakusta B, Seres P, Tibbo PG. Enduring changes in brain metabolites and executive functioning in abstinent cocaine users. Drug Alcohol Depend. 2017;178:435–42.CrossRefGoogle Scholar
  23. 23.
    Everitt BJ, Robbins TW. Drug addiction: updating actions to habits to compulsions ten years on. Annu Rev Psychol. 2016;67:23–50.CrossRefGoogle Scholar
  24. 24.
    •• Zhang S, Hu S, Sinha R, Potenza MN, Malison RT, Chiang-shan RL. Cocaine dependence and thalamic functional connectivity: a multivariate pattern analysis. NeuroImage: Clin. 2016;12:348–58 Illustrates how data-driven and machine learning classifier techniques can be applied to identify cortico-thalamic networks implicated in executive dysfunction in CUD. Findings suggest that reduced connectivity between the thalamus and frontal and parietal “control” regions, and heightened connectivity between the thalamus and the DMN underpin CUD related response inhibition deficits. CrossRefGoogle Scholar
  25. 25.
    Zhang Y, Zhang S, Ide JS, Hu S, Zhornitsky S, Wang W, et al. Dynamic network dysfunction in cocaine dependence: graph theoretical metrics and stop signal reaction time. NeuroImage: Clin. 2018;18:793–801.CrossRefGoogle Scholar
  26. 26.
    Verdejo-García A, López-Torrecillas F, Giménez CO, Pérez-García M. Clinical implications and methodological challenges in the study of the neuropsychological correlates of cannabis, stimulant, and opioid abuse. Neuropsychol Rev. 2004;14(1):1–41.CrossRefGoogle Scholar
  27. 27.
    Verdejo-García A, Chong TT-J, Stout JC, Yücel M, London ED. Stages of dysfunctional decision-making in addiction. Pharmacol Biochem Behav. 2018;164:99–105.CrossRefGoogle Scholar
  28. 28.
    Hiser J, Koenigs M. The multifaceted role of ventromedial prefrontal cortex in emotion, decision-making, social cognition, and psychopathology. Biol Psychiatry 2017.Google Scholar
  29. 29.
    Castellano F, Bartoli F, Crocamo C, Gamba G, Tremolada M, Santambrogio J, et al. Facial emotion recognition in alcohol and substance use disorders: a meta-analysis. Neurosci Biobehav Rev. 2015;59:147–54.CrossRefGoogle Scholar
  30. 30.
    Preller KH, Herdener M, Schilbach L, Stämpfli P, Hulka LM, Vonmoos M, et al. Functional changes of the reward system underlie blunted response to social gaze in cocaine users. Proc Natl Acad Sci. 2014;111(7):2842–7.CrossRefGoogle Scholar
  31. 31.
    •• Tobler PN, Preller KH, Campbell-Meiklejohn DK, Kirschner M, Kraehenmann R, Stämpfli P, et al. Shared neural basis of social and non-social reward deficits in chronic cocaine users. Soc Cogn Affect Neurosci. 2016;11(6):1017–25 This fMRI study shows that people with CUD have reduced ventromedial PFC activation in response to both social and non-social rewards (social feedback and prizes, respectively). This finding illustrates that the same ventromedial PFC system implicated in general reward processing alterations also underpins social valuation deficits. CrossRefGoogle Scholar
  32. 32.
    Verdejo-Garcia A, Contreras-Rodríguez O, Fonseca F, Cuenca A, Soriano-Mas C, Rodriguez J, et al. Functional alteration in frontolimbic systems relevant to moral judgment in cocaine-dependent subjects. Addict Biol. 2014;19(2):272–81.CrossRefGoogle Scholar
  33. 33.
    Caldwell BM, Harenski CL, Harenski KA, Fede SJ, Steele VR, Koenigs MR, et al. Abnormal frontostriatal activity in recently abstinent cocaine users during implicit moral processing. Front Hum Neurosci. 2015;9:565.CrossRefGoogle Scholar
  34. 34.
    Moeller SJ, Goldstein RZ. Impaired self-awareness in human addiction: deficient attribution of personal relevance. Trends Cogn Sci. 2014;18(12):635–41.CrossRefGoogle Scholar
  35. 35.
    Moeller SJ, Konova AB, Parvaz MA, Tomasi D, Lane RD, Fort C, et al. Functional, structural, and emotional correlates of impaired insight in cocaine addiction. JAMA psychiatry. 2014;71(1):61–70.CrossRefGoogle Scholar
  36. 36.
    Moeller SJ, Fleming SM, Gan G, Zilverstand A, Malaker P, Schneider KE, et al. Metacognitive impairment in active cocaine use disorder is associated with individual differences in brain structure. Eur Neuropsychopharmacol. 2016;26(4):653–62.CrossRefGoogle Scholar
  37. 37.
    Moreno-López L, Albein-Urios N, Martínez-González JM, Soriano-Mas C, Verdejo-García A. Neural correlates of impaired self-awareness of apathy, disinhibition and dysexecutive deficits in cocaine-dependent individuals. Addict Biol. 2017;22(5):1438–48.CrossRefGoogle Scholar
  38. 38.
    Vergara-Moragues E, Verdejo-García A, Lozano OM, Santiago-Ramajo S, González-Saiz F, Espinosa PB, et al. Association between executive function and outcome measure of treatment in therapeutic community among cocaine dependent individuals. J Subst Abus Treat. 2017;78:48–55.CrossRefGoogle Scholar
  39. 39.
    Wittwer A, Hulka LM, Heinimann HR, Vonmoos M, Quednow BB. Risky decisions in a lottery task are associated with an increase of cocaine use. Front Psychol. 2016;7:640.CrossRefGoogle Scholar
  40. 40.
    Contreras-Rodríguez O, Albein-Urios N, Perales JC, Martínez-Gonzalez JM, Vilar-López R, Fernández-Serrano MJ, et al. Cocaine-specific neuroplasticity in the ventral striatum network is linked to delay discounting and drug relapse. Addiction. 2015;110(12):1953–62.CrossRefGoogle Scholar
  41. 41.
    McHugh MJ, Gu H, Yang Y, Adinoff B, Stein EA. Executive control network connectivity strength protects against relapse to cocaine use. Addict Biol. 2017;22(6):1790–801.CrossRefGoogle Scholar
  42. 42.
    Gladwin TE, Wiers CE, Wiers RW. Cognitive neuroscience of cognitive retraining for addiction medicine: from mediating mechanisms to questions of efficacy. Prog Brain Res Elsevier; 2016. p. 323–44.Google Scholar
  43. 43.
    Alcorn IIIJL, Pike E, Stoops WS, Lile JA. Rush CR. A pilot investigation of acute inhibitory control training in cocaine users. Drug Alcohol Depend. 2017;174:145–9.CrossRefGoogle Scholar
  44. 44.
    Fox H, Sofuoglu M, Sinha R. Guanfacine enhances inhibitory control and attentional shifting in early abstinent cocaine-dependent individuals. J Psychopharmacol. 2015;29(3):312–23.CrossRefGoogle Scholar
  45. 45.
    Moeller SJ, Honorio J, Tomasi D, Parvaz MA, Woicik PA, Volkow ND, et al. Methylphenidate enhances executive function and optimizes prefrontal function in both health and cocaine addiction. Cereb Cortex. 2014;24(3):643–53. Scholar
  46. 46.
    Nocito Echevarria MA, Andrade Reis T, Ruffo Capatti G, Siciliano Soares V, da Silveira DX, Fidalgo TM. N-acetylcysteine for treating cocaine addiction – a systematic review. Psychiatry Res. 2017;251:197–203.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Monash Institute of Cognitive and Clinical NeurosciencesMonash UniversityMelbourneAustralia

Personalised recommendations