Experimental and observational evidence on substance use and metacognition among adults: a systematic review.
Sarret Seng, Chizimuzo T C Okoli, Lovoria B Williams, Shanna Babalonis, Kristin B Ashford
Addictive Behaviors August 1, 2026 DOI: 10.1016/j.addbeh.2026.108670 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Randomized Longitudinal Cross-sectional Peer reviewed |
|---|---|
| Sample size | 2,852 |
| Population | Adults (≥18 years) from experimental and observational studies |
| Topics | Addiction |
| Keywords | Cognitive insight Metacognition Metacognitive accuracy Metacognitive monitoring Metacognitive regulation Substance use |
| Key findings | Substance use is generally associated with poorer metacognitive functioning, with substance-specific acute alterations in experimental studies and consistent associations with maladaptive metacognitive beliefs and reduced monitoring accuracy in observational studies. |
Abstract
Metacognition - the capacity to monitor, interpret, and regulate cognitive processes - is essential for adaptive behavioral regulation. Evidence on how substance use relates to metacognitive functioning remains heterogeneous across substances and study designs. This systematic review synthesized evidence examining the relationship between substance use and metacognition among adults. Following PRISMA 2020 guidelines, we searched PubMed, PsycINFO, CINAHL, and Web of Science from inception through March 2026. Eligible studies included experimental and observational designs enrolling adults (≥18 years) and reporting metacognitive outcomes. Studies not assessing metacognition, involving non-adult samples, or non-empirical publications were excluded. Risk of bias was assessed using Joanna Briggs Institute appraisal tools. Findings were synthesized narratively. Thirty-six studies (N = 2,852 participants) were included: randomized controlled trials (n = 16), quasi-experimental (n = 3), cross-sectional (n = 7), and case-control studies (n = 10). Experimental evidence showed substance-specific effects: alcohol findings were mixed across paradigms; cannabinoids generally impaired metacognitive accuracy and calibration; benzodiazepines impaired metacognitive awareness of performance and error detection; methamphetamine demonstrated dose-dependent effects on agency judgments; and nicotine replacement did not restore accuracy following abstinence. Craving states (nicotine, caffeine, methamphetamine) were associated with poorer monitoring and calibration. Observational studies indicated that cocaine, nicotine, opioid, cannabis, alcohol, and polysubstance use were generally associated with poorer metacognitive functioning, including greater maladaptive metacognitive beliefs and reduced monitoring accuracy, though some clinical comparisons showed domain-specific or relatively preserved functioning. Experimental studies suggest acute substance-related alterations in metacognitive functioning, while observational studies indicate that substance use is generally associated with poorer metacognitive functioning. Greater standardization and longitudinal research are needed to clarify mechanisms and inform interventions.
Comparable studies
Other systematic reviews and meta-analyses on addiction, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Ketamine use: a review Ketamine users | 2011 | Systematic review | |
| Mindfulness Meditation for Substance Use Disorders: A Systematic Review Individuals with substance use disorders | 2009 | Systematic review | |
| Mindfulness-Based Interventions for the Treatment of Substance and Behavioral Addictions: A Systematic Review | 2018 | Systematic review | |
| Ketamine for the treatment of mental health and substance use disorders: comprehensive systematic review | 2021 | Systematic review | |
| Therapeutic Use of LSD in Psychiatry: A Systematic Review of Randomized-Controlled Clinical Trials Patients with psychiatric disorders, primarily alcoholism | 2020 | Systematic review | n = 567 |
Citations in the library
Cites 6
- Cognitive Impairment Induced by Delta9-tetrahydrocannabinol Occurs through Heteromers between Cannabinoid CB1 and Serotonin 5-HT2A Receptors PLoS Biology July 9, 2015
- Δ9-Tetrahydrocannabinol (THC) impairs visual working memory performance: a randomized crossover trial. Neuropsychopharmacology October 1, 2020
- Can inhaled cannabis users accurately evaluate impaired driving ability? A randomized controlled trial. Frontiers in Public Health 2023
- Metacognition, social cognition, and mentalizing in psychosis: are these distinct constructs when it comes to subjective experience or are we just splitting hairs? BMC Psychiatry July 2, 2021
- Acute and Chronic Effects of Cannabinoids on Human Cognition-A Systematic Review. Biological Psychiatry April 1, 2016
and 1 more in the library