Improvement of Emotional Empathy and Cluster B Personality Disorder Symptoms Associated With Decreased Cocaine Use Severity

Abstract

Aims: Chronic cocaine users display impaired social cognitive abilities, reduced prosocial behavior, and pronounced cluster B personality disorder (PD) symptoms all contributing to their social dysfunctions in daily life. These social dysfunctions have been proposed as a major factor for maintenance and relapse of stimulant use disorders in general. However, little is known about the reversibility of social cognitive deficits and socially problematic personality facets when stimulant use is reduced or ceased. Therefore, we examined the relation between changing intensity of cocaine use and the development of sociocognitive functioning and cluster B PD symptomatology over the course of 1 year. Methods: Social cognition, social decision-making, and cluster B PD symptoms were assessed in 38 cocaine users (19 with increased and 19 with decreased use) and 48 stimulant-naive healthy controls at baseline and at 1-year follow-up. Cocaine use severity was objectively determined by quantitative 6-month hair analyses. The categorization of the two cocaine user groups was based on a combination of absolute (± 0.5 ng/mg) and relative (± 10%) changes in the cocaine hair concentration between baseline and the 1-year follow-up. Social cognition was assessed using the Multifaceted Empathy Test (MET) and the Movie for the Assessment of Social Cognition (MASC). A combined Distribution/Dictator Game was applied for assessing social decision-making. Cluster B PD symptoms were measured by a Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) PD questionnaire according to Diagnostic and Statistical Manual of Mental Disorders , 4th edition (DSM-IV). Results: Increased cocaine use was linked to worsened empathy, while decreased cocaine use went along with improved emotional empathy. Moreover, whereas decreased cocaine use was associated with reduced severity of self-reported cluster B PD symptoms, these symptoms remained largely stable in increasers . In contrast to a significant reduction of prosocial behavior at baseline in the combined cocaine user group, specifically decreasers were not statistically distinguishable from controls at the follow-up. Conclusions: Sociocognitive deficits and cluster B PD symptoms of chronic cocaine users are adaptable over time as they covary with the increase or decrease in cocaine use. Hence, abstinence orientation and training of social cognition and interaction might improve social functioning, and should therefore be important therapeutic elements in cocaine addiction treatment.

Social and Non-Social Cognitive Enhancement in Cocaine Users—A Closer Look on Enhancement Motives for Cocaine Consumption

“…This might explain a lack of findings regarding emotional empathy. Emotional empathy deficits seem to be at least partially drug-induced (16). However, this does not seem to be the case for cognitive empathy and socially motivated CU.…”

“…The sample of 48 stimulant-naïve healthy controls and 42 chronic CU derives from the follow-up assessment of the longitudinal Zurich Cocaine Cognition Study (ZuCo 2 St) in which 132 individuals participated (for details please see Supplementary Methods). Data of this sample has already been reported in other publications from our group but with different outcome measures or research questions (13,15,16,27). General inclusion criteria at the first assessment were: age between 18 and 60 years, German language proficiency, no current or previous severe medical diseases, neurological disorders or head injuries, no family history of Axis I disorders, no current intake of medication affecting the central nervous system and no regular cannabis consumption.…”

“…However, the effect for CE in the MET persisted even after exclusion of subjects with ADHD. Furthermore, to exclude the possibility that our findings were driven by more cumulated lifetime cocaine consumption (2,15,16) in the SoM group, we repeated the ANCOVAs adjusted for age and verbal IQ for the domain, the MET, and the MASC scores only comparing CU groups and additionally included ln-transformed cumulated lifetime dose of cocaine. This did not change the results.…”

“…Finally, CU demonstrated reduced prosocial behavior in social interaction tasks (3) and were less rewarded by social feedback (14). Notably, longitudinal data recently suggested that both cognitive and social cognitive impairments are partially drug-induced and can be improved to a certain extent with decreasing cocaine consumption (15,16).…”

“…Given these relatively broad cognitive deficits and the potential of cocaine to boost cognitive functions acutely (17), one might assume that at least some CU instrumentalize cocaine to self-medicate cognitive impairments that can be either preexisting or induced by chronic cocaine consumption (15,16,18). However, the association between cognitive impairment and pharmacological cognitive enhancement (PCE) with cocaine in CU has not been investigated yet.…”