The inability of cocaine addicts to modify their behavior in the face of adverse consequences and their poor risk assessment resemble the impaired judgment observed in patients with lesions of the ventromedial prefrontal cortex (VmPFC) (Damasio 1985; Bechara et al. 1994; Grant et al. 1997). Patients with VmPFC lesions demonstrate specific deficits involving the inability to make advantageous decisions that involve balancing reward against risk when taking into account future consequences (Damasio 1985). A Gambling Task was developed to quantify this VmPFC deficit (Bechara et al. 1994). A recent study reported that polydrug abusers perform significantly worse on the Gambling Task when compared to controls drawn from the same community (Grant et al. 1997).

On a pilot basis, we evaluated the performance on the Gambling Task in six recently abstinent (more than 4 days) versus six nonabstinent cocaine-dependent (CD) males. All the subjects were outpatients recruited from treatment and research clinics of a metropolitan Department of Veterans Affairs Medical Center. Written informed consent was obtained from all subjects before study participation. Inclusion criteria were: DSM-IV diagnosis for CD, age 33 to 55, history of CD longer than 1 year, and use of cocaine of at least $50/week, primarily by smoking. Subjects were excluded for presence of other psychiatric disorders, dependence on other substances (except nicotine and alcohol), and significant medical or brain diseases. Length of abstinence was assessed by self-report, further validated by urinalysis testing three times per week. The two groups did not statistically differ in age, education, race, and length of exposure to cocaine (p >.55).

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