Neuropsychological impairments associated with the relation between cocaine abuse and violence: neurological facilitation mechanisms.

INTRODUCTION: Cocaine abuse, as well as prenatal exposure to cocaine, could be key factors in the expression of violent behaviour. Neuropsychological impairments, sex differences and the concurrent abuse of cocaine and alcohol have been suggested as facilitation mechanisms. AIMS: To review and recapitulate the results obtained on the relationship between neuropsychological deficits due to cocaine abuse and/or prenatal exposure and the expression of violence. Furthermore, we analyze the roles of sex, concurrent alcohol abuse and possible brain damage as risk markers in this relationship. DEVELOPMENT: The scientific literature was reviewed using Google Scholar, PsycINFO, PubMed, Medline and ISI Web of Knowledge.
CONCLUSIONS: Cocaine facilitates the expression of violence due to neuropsychological deficits in emotional decoding, abstract reasoning and inhibitory control, as well as in mnemonic and verbal skills, and such impairments might also explain problems in decision-making. Both the deficits and the expression of violence appear to be more pronounced in men than in women. However, despite the fact that the combination of cocaine and alcohol use may increase the risk of violent reactions, the deficits would not be greater than those resulting from the separate use of each substance. The impairments might be caused by functional abnormalities of certain regions of the frontal (especially the prefrontal) and parietal lobes and some subcortical structures, such as the amygdala. All of this would provide a basis for the development of intervention strategies focusing on these cognitive domains.