Aims: To (1) measure the aggregated effect size of empathy deficits in individuals with alcohol use disorder (AUD) compared with healthy controls, (2) measure the aggregated effect sizes for associations between lower empathy and heavier alcohol consumption and more alcohol problems in non-clinical samples and (3) identify potential moderators on the variability of effect sizes across studies in these meta-analyses.Method: PsycINFO, PubMed and Google Scholar were searched following a preregistered International Prospective Register of Systematic Reviews (PROSPERO) protocol (CRD42021225392) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. We meta-analyzed (using random-effects models) mean differences in empathy between individuals with AUD compared with healthy controls and associations between empathy and alcohol consumption and alcohol problems in non-clinical samples. A total of 714 participants were included in the meta-analysis on clinical samples; 3955 were included in the meta-analyses on non-clinical samples.Results: Individuals with AUD reported significantly lower empathy than healthy controls [Hedges' g = −0.53, 95% confidence interval (CI) = −0.91, -0.16, k = 9, P < 0.01, Q = 40.09, I 2 = 80.04]. Study quality [Q = 1.88, degrees of freedom (d.f.) = 1, P = 0.17] and gender (β = −0.006, Z = −0.60, P = 0.55) were not moderators. Increases in age corresponded to an increase in effect size (β = 0.095, Z = 3.34, P < 0.001). Individuals with AUD (versus healthy controls) had significantly lower cognitive (Hedges' g = −0.44, CI = −0.79, -0.10, P < 0.05), but not affective empathy (Hedges' g = −0.19, CI = −0.51, 0.14, P = 0.27), and the difference between these was significant (Z = 2.34, k = 6, P < 0.01). In non-clinical samples, individuals with lower (versus higher) empathy reported heavier alcohol consumption (r = −0.12, CI = −0.15, -0.09, k = 11, P < 0.001, Q = 9.68, I 2 = 0.00) and more alcohol problems (r = −0.08, CI = −0.14, -0.01, k = 7, P = 0.021, Q = 6.55, I 2 = 8.34). There was no significant heterogeneity across studies. Conclusion:Individuals with alcohol use disorder appear to show deficits in empathy compared with healthy controls. Deficits are particularly pronounced for older individuals and for cognitive (versus affective) empathy. In non-clinical samples, lower empathy appears to be associated with heavier alcohol consumption and more alcohol problems.

Background Deficits in theory of mind (ToM) found in individuals with alcohol use disorder (AUD) are often thought to result from prolonged heavy alcohol use. However, links between deficits in ToM and greater alcohol problems are often also present in non‐clinical samples (e.g., adolescents and young adults) who may not have a similar long‐lasting history of alcohol consumption as individuals with AUD. The current study is the first to systematically review and meta‐analyze results from studies examining associations between lower ToM and greater alcohol problems in non‐clinical samples. Evidence of reliable associations in these non‐clinical samples would support the idea that deficits in ToM might also precede the emergence of AUD. Methods PsycINFO, PubMed, and Google Scholar were searched according to our preregistered International Prospective Register of Systematic Reviews (PROSPERO) protocol (CRD42021225392) and following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) methodology. We systematically reviewed sample characteristics and ToM measures in identified articles. We then meta‐analyzed the findings of association between ToM and alcohol problems in non‐clinical samples using random effects models. Results Nearly all studies used a measure of ToM that assessed the ability to infer the mental states of others based on eye region cues. Meta‐analytic results demonstrated that lower ToM was associated with more alcohol problems (r = −0.16, k = 6, CI = [−0.26, −0.04], p < 0.01, Q = 15.55, I2 = 67.85), and there was significant heterogeneity across studies. Gender (ß = 0.0003, CI = [−0.006, 0.007], z = 0.09, p = 0.93), age (ß = −0.008, CI = [−0.03, 0.01], z = −0.82, p = 0.42), and study quality (ß = −0.10, CI = [−0.35, 0.15], z = −0.82, p = 0.41) did not explain the heterogeneity. Conclusion In non‐clinical samples, lower ToM is associated with more alcohol problems, indicative of a small effect size. Future longitudinal studies are needed to explore whether socio‐cognitive deficits may also serve as a risk factor for alcohol misuse.

Background: A growing literature documents associations between lower trait empathy and heavier alcohol use and more alcohol problems in adolescent and young adult samples. Prior work linking empathy and alcohol use/problems in these populations has thus far focused on trait rather than state empathy, and researchers often do not differentiate between cognitive and affective empathy. Further, no prior studies have examined associations between daily fluctuations in state empathy and alcohol use. The goal of the current study is to advance knowledge about the associations between state (vs. trait) and cognitive (vs. affective) empathy and alcohol use.Methods: Adult alcohol drinkers (n = 492; M age = 22.89, SD = 5.53; 53.70% female) participated in ecological momentary assessment studies for 7 to 10 days (day n = 4683). Multilevel hurdle models were used to investigate associations between day-level state empathy and daily alcohol use at the within-person level, and associations between individual differences in trait empathy and alcohol use across days at the between-person level.Results: Higher day-level state affective empathy was not associated with the likelihood of drinking on a particular day, but it was significantly associated with a greater number of drinks consumed on alcohol-consuming days, with the latter associations remaining after controlling for day-level positive affect (PA) and negative affect (NA).No associations were found for day-level state cognitive empathy, or trait affective or cognitive empathy.Conclusions: On drinking days, when individuals reported more affective empathy than is typical for them, they were more likely to consume a greater number of alcoholic drinks, results that remained when controlling for levels of PA and NA. Daily shifts in affective empathy may be important to consider in efforts to understand alcohol use.

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