Objective: This study investigates the Theory of Mind performance of female cocaine-dependent users (CDUs) and possible associations between theory of mind performance and features of cocaine use.

Method: Sixty women controlled for age, education, individual income, and IQ participated in this study: 30 in the CDU group and 30 in the healthy control group. Participants were assessed for theory of mind with the Reading the Mind in the Eyes Test (RMET), a test of understanding of first-order and second-order false beliefs, and the Hinting task. Drug use parameters, clinical symptoms, and neuropsychological functioning were also assessed.

Results: Analyses of covariance indicated Theory of Mind impairments in negative mental states within the RMET and second-order false-belief understanding of Theory of Mind stories. In addition, Theory of Mind impairment was associated with drug use characteristics, including craving and number of hospitalizations.

Conclusions: High-demand Theory of Mind is suggested to be impaired in CDU women, and the deficits appear to be related to drug addiction severity. We found associations between Theory of Mind deficits and worse clinical and social outcomes.