The long-term effects of cocaine use on cognitive functioning: A systematic critical review

•Evidence for the deleterious effects of cocaine use on cognitive functioning was limited to executive function and working memory domains.•The majority of researchers using brain imaging techniques reported differences between cocaine users and non-using controls.•Statistically significant differences in cognitive performance were observed on a minority of measures.•Researchers made conclusions about behavior without including cognitive tests in their studies.•The vast majority of researchers did not compare findings against normative data. The predominant view of chronic cocaine use maintains that it causes a broad range of cognitive deficits. However, concerns about the possibly deleterious impact of cocaine on cognitive functioning have yet to be thoroughly vetted. This review addresses the impact of cocaine use on such cognitive domains as executive function, memory, language, and psychomotor speed. Additionally, relevant neuroimaging data is considered to understand the neural basis underlying cocaine-related effects on cognitive functioning. We searched PubMed, Google Scholar, and Embase using the search terms “cocaine and cognition,” “cocaine and cognitive functioning,” and “cocaine and cognitive deficits or impairment.” To meet inclusion criteria we evaluated only cognitive and neuroimaging studies describing the long-term effects of cocaine on cognitive functioning published from 1999 to 2016. The majority of studies reported statistically significant differences between cocaine users and non-drug-using controls in brain structures, blood-oxygen-level dependent signals, and brain metabolism. However, differences in cognitive performance were observed on a minority of measures. Additionally, the majority of studies were not compared against normative data. The current evidence does not support the view that chronic cocaine use is associated with broad cognitive deficits. The view that cocaine users have broad cognitive deficits is inaccurate based upon current evidence, and the perpetuation of this view may have negative implications for treatment programs and development of public policies.