To summarize, alcoholism is common in cocaine abusers (Carroll et al., 1993). In samples of individuals identified on the basis of cocaine use, there is consistent evidence of elevated impulsivity and impaired decision-making. These cognitive deficits are associated with poor treatment outcome and alteration in brain function and structure as identified using fMRI and DTI. There is also preliminary evidence that at least some of the white matter changes are directly related to chronic cocaine use. Future studies on the neurobiology of impulsivity in cocaine dependence should determine whether treatments can protect against, or reduce, neuronal changes and the associated cognitive impairments in cocaine users and lead to improved clinical outcome in these individuals.
