Neuropsychology of cocaine use and cognitive impairment

Dr. Rafael A. Salas Muriel reviews the effects of cocaine on the brain, the main cognitive impairments associated with its use and the effects of neuropsychological intervention.

Introduction

Cocaine use constitutes a clinical and social challenge due to its potent stimulant effect and high addictive potential. It is one of the most widely used illicit drugs in the world, with consequences at both individual and collective levels. From a neuropsychological perspective, cocaine is associated with significant alterations in multiple cognitive, emotional and behavioral domains, which affects the academic, occupational and social performance of those who use it.

In this article we will explore what cocaine is, how it acts in the brain, what the main cognitive impairments associated with its use are and how neuropsychological assessment and intervention can contribute to the rehabilitation and improvement of patients’ quality of life.

What is cocaine and how does it affect the brain?

Cocaine is a stimulant alkaloid extracted from the leaves of the plant Erythroxylum coca. Its main mechanism of action consists in blocking the reuptake of dopamine, noradrenaline and serotonin in the synaptic cleft, which causes an accumulation of these neurotransmitters and produces a state of euphoria, energy and intense alertness (Volkow et al., 2003).

This potent positive reinforcement favors dependence, but in the long term produces neuroadaptations in dopaminergic and frontostriatal circuits, which contribute both to the loss of control over use and to marked cognitive and emotional impairment (Goldstein & Volkow, 2011).

Neuropsychological alterations associated with cocaine use

The cognitive impairment associated with cocaine use affects various cognitive domains:

1. Memory impairment

Cocaine affects working memory and episodic memory, making it difficult to retain and manipulate information. This negatively impacts learning and decision-making (Vonmoos et al., 2013).

2. Attention deficits

Difficulties are observed in maintaining sustained attention, dividing it among multiple tasks and filtering irrelevant stimuli (Spronk et al., 2013), which affects academic and work performance.

3. Executive dysfunction

The executive functions, such as planning, inhibition of impulsive responses and decision-making, are among the most impaired. This is related to alterations in the prefrontal cortex and contributes to the compulsion to use (Bechara, 2005).

4. Emotional and motivational alterations

Chronic users present anxiety, irritability, depression and anhedonia, due to dysregulation of dopaminergic circuits (Koob and Volkow, 2016). These symptoms reinforce the cycle of use as a self-medication strategy.

5. Thought and perception disorders

Repeated use can induce paranoia, persecutory delusions and tactile or visual hallucinations (for example, the ‘sensation of insects on the skin’). In some cases, these psychotic symptoms can persist beyond the acute intoxication.

6. Reduced processing speed

Information processing slows down, affecting the ability to react quickly and accurately, with consequences in risky activities such as driving (Bolla et al., 1998).

Neuropsychological tests to assess cognitive impairment from cocaine

Neuropsychological assessment is essential to identify and quantify the cognitive deficits associated with cocaine use. It includes:

1. Detailed clinical interview, with history of use and functional impact.
2. Standardized neuropsychological tests, some examples are: 
   1. Stroop Test: measures inhibitory control and selective attention.
   2. Trail Making Test (A and B): assesses processing speed and cognitive flexibility.
   3. Wisconsin Card Sorting Test (WCST): evaluates planning and the ability to shift strategy, as well as other executive functions. 
   4. Spain-Complutense Verbal Learning Test (TAVEC): analyzes verbal memory and learning.
   5. WAIS-IV (Digit Span and Coding subtests): measures working memory and processing speed. 

The resulting profile allows designing personalized intervention plans, tailored to each patient’s cognitive and emotional needs.

Comprehensive approach to cocaine use

The treatment of cocaine use requires a multidisciplinary approach, where neuropsychological intervention plays a central role.

1. Cognitive rehabilitation: Use of structured programs (e.g., NeuronUP) to train memory, attention and executive functions through repetitive and adapted exercises.
2. Cognitive-behavioral therapy (CBT): Strategies to manage the craving, control impulses and prevent relapses.
3. Psychoeducation: Information for the patient and their environment about the effects of cocaine on the brain, promoting awareness and motivation to change.
4. Family intervention: Involving the family fosters a supportive environment, improves communication and strengthens relapse prevention strategies.

Conclusion

Current empirical evidence points towards personalized treatments based on each patient’s neurocognitive profile. The use of various technologies (virtual reality, non-invasive brain stimulation, digital platforms for cognitive training) promises to improve rehabilitation outcomes.

What is clear is that the neuropsychology of cocaine use must be addressed comprehensively, combining the latest scientific evidence with individualized clinical interventions, with the goal of improving patients’ mental health and health-related quality of life.

Ultimately, knowledge of the neuropsychological impact of cocaine use not only allows the design of more effective intervention programs, but also promotes prevention policies and social awareness that reduce risks and foster sustainable recovery. The future of rehabilitation in this field will depend on the ability to integrate science, technology and appropriate policies for the benefit of affected individuals and families.

References

• Bechara A. (2005). Decision making, impulse control and loss of willpower to resist drugs: a neurocognitive perspective. Nature neuroscience, 8(11), 1458–1463. https://doi.org/10.1038/nn1584
• Bolla, K. I., Cadet, J. L., & London, E. D. (1998). The neuropsychiatry of chronic cocaine abuse. The Journal of neuropsychiatry and clinical neurosciences, 10(3), 280–289. https://doi.org/10.1176/jnp.10.3.280
• Goldstein, R. Z., & Volkow, N. D. (2011). Dysfunction of the prefrontal cortex in addiction: neuroimaging findings and clinical implications. Nature reviews. Neuroscience, 12(11), 652–669. https://doi.org/10.1038/nrn3119
• Koob, G. F., & Volkow, N. D. (2016). Neurobiology of addiction: a neurocircuitry analysis. The lancet. Psychiatry, 3(8), 760–773. https://doi.org/10.1016/S2215-0366(16)00104-8
• Spronk, D. B., van Wel, J. H., Ramaekers, J. G., & Verkes, R. J. (2013). Characterizing the cognitive effects of cocaine: a comprehensive review. Neuroscience and biobehavioral reviews, 37(8), 1838–1859. https://doi.org/10.1016/j.neubiorev.2013.07.003
• Volkow, N. D., Fowler, J. S., & Wang, G. J. (2003). The addicted human brain: insights from imaging studies. The Journal of clinical investigation, 111(10), 1444–1451. https://doi.org/10.1172/JCI18533
• Vonmoos, M., Hulka, L. M., Preller, K. H., Jenni, D., Baumgartner, M. R., Stohler, R., Bolla, K. I., & Quednow, B. B. (2013). Cognitive dysfunctions in recreational and dependent cocaine users: role of attention-deficit hyperactivity disorder, craving and early age at onset. The British journal of psychiatry: the journal of mental science, 203(1), 35–43. https://doi.org/10.1192/bjp.bp.112.118091

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“This article has been translated. Link to the original article in Spanish:”
Neuropsicología del consumo de cocaína y deterioro cognitivo