Exploring metacognitive function in patients with opioid use disorder: A pilot study

Despite recognised cognitive deficits related to substance use, as well as high mortality and treatment attrition rates, metacognition has never been studied in patients with opioid use disorder (OUD) undergoing opioid maintenance treatment (OMT).

This exploratory pilot study used a quantitative longitudinal design to assess metacognition in patients with opioid use disorder at treatment initiation and at a one-year follow-up and to explore its association with executive functioning.

Forty-eight adults initiating OMT were enrolled in the study. All participants completed the Indiana Psychiatric Illness Interview (IPII), and recorded transcripts were analysed with the metacognition assessment scale (MAS-A). Additionally, measures of executive function, as well as sociodemographic, psychiatric comorbidity and substance use, were obtained within two weeks of OMT initiation. IPII and MAS-A were repeated at a one-year follow-up.

Participants displayed widespread performance of metacognition in the four subscales self-reflectivity, understanding others' minds, decentration and notably, low levels of mastery. Self-reflectivity and mastery were significantly positively correlated with verbal fluency. Higher levels of decentration were associated with fewer self-reported executive function difficulties. No significant changes in metacognition were detected at the one-year follow-up.

This longitudinal pilot study provides the first evidence of metacognitive functioning in OMT patients. Metacognitive performance was characterised by low levels of mastery, limited correlation with executive function and no improvement observed over the one-year follow-up period. The preliminary findings are interpreted and discussed with caution, emphasising the relevance of metacognition for future research and clinical interventions in OUD populations.