Systematic review and meta‐analysis on the association between theory of mind and alcohol problems in non‐clinical samples

Abstract

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.

Associations between alcohol consumption and empathy in a non-clinical sample: drinking motives as a moderator

“…In line with findings in AUD populations, one meta-analysis that examined non-clinical samples found an association between lower ToM and more alcohol related problems 30 . Additionally, experimental studies in non-AUD individuals have found that drinking alcohol can have acute negative effects on social cognition processes such as facial emotion recognition, empathy and ToM (for a review, see 31 ).…”

Associations of state and trait empathy with daily alcohol use

“…The results indicated a positive association between state affective empathy and number of standard drinks consumed. These findings add to a growing body of work highlighting the importance of social factors in alcohol use and misuse (e.g., Creswell, 2021;Fairbairn & Sayette, 2014;Fairbairn et al, 2015;Goodwin & Sayette, 2022;Kumar et al, 2022aKumar et al, , 2022b. Future research is needed to replicate these findings and explore possible mechanisms for the link between higher state affective empathy and increased alcohol use, as well as individual difference factors (e.g., drinking refusal self-efficacy, impulsivity; Creswell et al, 2019;Laghi et al, 2019) that might moderate the association between state affective empathy and alcohol use.…”

A systematic review of the acute effects of alcohol on emotion recognition of facial expressions

“…We systematically reviewed alcohol administration studies and found no consistent effects of any dosage of alcohol on recognition of any emotion. Further research is needed to clarify the underlying mechanisms explaining alcohol's effects on positive and negative social behaviours (e.g., changes in empathy and/or theory of mind) 46 , 81,82 …”

“…Further research is needed to clarify the underlying mechanisms explaining alcohol's effects on positive and negative social behaviours (e.g., changes in empathy and/or theory of mind). 46,81,82…”