Cocaine dependence also seems to involve impaired decision-making. Decision-making involves the outcome of cognitive processes leading to a choice between alternative courses of action. Poor decision-making has been described as “deciding against one’s best interests and inability to learn from previous mistakes, with repeated decisions leading to negative consequences” (Bechara and Damasio, 2005). A widely used, and neurologically sensitive, measure of decision-making is the Iowa Gambling Task (IGT) (Bechara et al., 1994). The IGT was developed by Bechara and colleagues to measure decision-making in patients with focal brain injury, who made poor choices, leading to negative consequences in spite of having otherwise intact intellectual function. Patients with focal ventromedial prefrontal cortical injuries made consistently poor choices on the IGT, which paralleled their real life, postlesion functional problems (Bechara et al., 2000).
