Newswise — Alcohol dependence is associated with impairments in social cognition – for example, the ability to identify the emotional state of others – that persist despite abstinence from alcohol during inpatient treatment, according to new study findings. Cognitive deficits are common in alcohol use disorder (AUD), and often involve difficulties with working memory, flexible thinking, and self-control; however, it has become clear that social cognition, including the ability to recognize facial emotion, can also be affected. Poor social cognition contributes to interpersonal difficulties and conflicts. It may also have an important clinical impact, in that poorer recognition of facial emotion has been linked to poorer outcomes of treatment for alcohol dependence and a greater risk of relapse. However, research on social cognition is lacking, and it was not known if social cognitive deficits persist or might naturally improve with abstinence from alcohol. The study at the Medical University of Innsbruck in Austria, reported in Alcoholism: Clinical and Experimental Research, assessed this among alcohol-dependent inpatients undergoing long-term (eight week) abstinence-based treatment.

Data were analyzed from 42 inpatients during a comprehensive treatment program for alcohol dependence, following an initial alcohol detoxification phase. Patients underwent a first (baseline) neuropsychological assessment after being abstinent from alcohol for at least 2 weeks; a follow-up assessment was performed within the last 2 weeks of treatment. Only data from patients who remained abstinent over this timeframe were included. 35 healthy controls, who were comparable to the inpatients in age, gender, education and smoking, were also recruited, and were assessed at equivalent time intervals. Assessments at both timepoints included three computerized social cognition tasks. First, in an ‘emotion recognition’ task, participants were asked to identify either a basic emotion (happiness, sadness, anger, fear, or disgust) or neutral expression shown on 36 faces. Second, during a ‘perspective taking’ task, they inferred the emotional expression of a masked face based on the social context depicted in a further 36 images. Third, in an ‘affective responsiveness’ task, participants imagined how they would feel if they experienced each of 36 situations that were described in short sentences.  

At the baseline assessment, alcohol-dependent patients had been abstinent from alcohol for almost two months on average, extending to up to six months of abstinence at the follow-up assessment. At baseline, the alcohol-dependent patients scored significantly lower than the control participants in all three social cognition tasks. Although the AUD patients showed some improvement in social cognition scores at follow-up, the healthy controls showed a similar level of improvement, indicating that the gains were a result of ‘practice effects’ (familiarity with the tests) rather than a real improvement in cognitive functioning.

People with AUD may therefore have persistent deficits in social cognition that do not improve with abstinence during inpatient treatment for alcohol dependence. Novel interventions, such as neurocognitive rehabilitation therapies focused on social cognition, may be needed to address these impairments alongside standard treatment for alcohol dependence – similar to add-on therapies currently used for other neurocognitive deficits in AUD, such as working memory impairments. Because of the link between impaired emotion recognition and alcohol relapse, such therapies could enhance treatment outcomes among people with alcohol dependence, as well as improving their social functioning. The researchers note the limitations of the study, including the small sample size, and that the findings may not be generalizable to other AUD populations or to earlier or later phases of abstinence. The study also does not address the question of whether impaired social cognition is a consequence, and/or a cause, of excessive drinking and alcohol dependence.

Do social cognition deficits recover in alcohol-dependent patients with abstinence? C.I. Rupp, D. Junker, G. Kemmler, B Mangweth-Matzek, B. Derntl (pages xxx).