Cognitive dysfunction in cocaine abuse: Evidence for impairments in impulse control and decision-making

Cocaine is one of the most widely abused psychoactive substances in the United States, with an estimated 1.3 million Americans using the drug on a regular (at least monthly) basis. Even occasional cocaine use can result in serious medical complications, such as cardiac damage, vascular ischemia, respiratory failure, and persistent alterations in neural function. In this chapter, we will examine the most recent research on impulsivity and decision-making in cocaine use. First, we will present a brief overview of the cognitive processes affected by cocaine use. Next, we will review the relevant literature detailing the status of inhibitory control and decision-making in cocaine users, as well as their proposed neuroanatomical correlates. Finally, we will attempt to integrate these findings with the current view of cocaine addiction and relapse, with an emphasis on the role of impulsivity and decision-making in continued cocaine use despite the elevated risk of negative consequences.