Several studies have provided evidence for a dissociation between self-perception and actual behaviour in addiction. For example, in healthy controls the speed and accuracy of responses for a high monetary condition compared to a neutral cue in a monetarily remunerated forced-choice sustained attention task was correlated with self-reported engagement in the task; by contrast, cocaine subjects’ reports of task engagement were disconnected from their actual task performance, indicating discordance between self-reported motivation and goal-driven behaviour70. Using a recently developed task in which participants selected their preferred pictures from four types of pictures and then reported what they thought was their most selected picture type91, the discordance between self-report and actual choice — indicating impaired insight into one’s own choice behaviour — was most severe in current cocaine users, although it was also discernible in abstinent users, in whom it was correlated with frequency of recent cocaine use92.
