Cognitive deficits in people with stimulant use disorders

Amphetamines and cocaine are the most used illicit stimulants globally. Repeated use of cocaine and amphetamines (particularly the strongest, most harmful form “methamphetamine”) can result in stimulant use disorder and long-term neuroadaptations in frontal-striatal circuits. This chapter reviews the cognitive deficits associated with stimulant use disorders (i.e., cocaine and methamphetamine), including long-term cognitive effects and links between cognitive function and treatment outcomes. People with cocaine use disorder, compared with healthy controls, have moderate cognitive deficits in attention, verbal memory, working memory, and impulsivity. People with methamphetamine use disorder, compared with controls, have moderate cognitive deficits in verbal memory, working memory, impulsivity/executive functions, and social cognition. Longitudinal evidence suggests that attention and memory deficits recover to normal levels after long-term abstinence. Conversely, executive dysfunction seems to be more stable across intermediate and long-term abstinence. There is strong evidence of specific domains of cognition predicting treatment outcomes in individuals with stimulant use disorders, particularly between attention and outcomes of psychological treatments (e.g., cognitive behavioral therapy) and between impulsivity and decision-making deficits and drug relapse. The cognitive assessment of people with stimulant use disorders should focus on the domains of attention, verbal memory, working memory and executive functions, and impulsivity/decision-making. Assessment of attention, verbal memory, working memory, and executive functions can be particularly useful for characterizing long-term cognitive deficits, whereas assessment of working memory, executive functions, and impulsivity/decision-making can be particularly useful for predicting clinical outcomes.