The Impact of Social Cognition and Emotional Processing on Alcohol Use Disorder

Alcohol Use Disorder (AUD) is a major contributor to worldwide disability, mortality, and morbidity. Evidence suggests that individuals with impaired emotion and social cognitive processing capacities a) consume more alcohol, b) experience more social and interpersonal difficulties, and c) are more likely to deny or minimise the negative impact of their excessive alcohol use, as compared to those with intact capacities. Even though AUD is widely considered to be a disorder of impaired self-regulation characterised by poor emotional and social functioning, and despite the inclusion of impaired social cognition as a core requirement for a diagnosis of mild neurovegetative disorder according to the Diagnostic and Statistical Manual of Mental Disorders Volume 5 (DSM-5), the potential importance of deficient emotion processing and social cognition in AUD remains largely unresearched. Hence, the extent to which deficient social cognition and emotion processing contribute to reduced functionality in AUD, and potentially impact on the development and maintenance of AUD, is largely unknown. The present program of research explores impaired emotion processing and social cognition in AUD and makes a case for an emotion processing/socio-cognitive perspective to understanding AUD. This thesis also highlights the importance of accounting for emotion processing and social cognition in the management of alcohol-related disorders. More specifically, a series of studies provide evidence of deficits in social cognition (Theory of Mind, or ToM) and emotion processing (alexithymia) in individuals with AUD. The concept of ToM involves perceiving and identifying the emotions and cognitive states of others. ToM is a subdomain of social cognition that is conceptualised as the individual’s ability to accurately interpret and decode the intentions, abstract beliefs, mental states, and emotions of others. Alexithymia, a multifaceted cognitive-affective construct, is characterised by a lack of emotional awareness and difficulty identifying, describing, and verbalising one’s own feelings or emotions. Alexithymia is also characterised by an externally-orientated thinking style. Findings of this thesis inform this field of research and illuminate the putative links between alcohol use, deficient emotion processing, and social cognition. Two tentative inter-related models are offered, a theoretical model and an assessment/treatment model of AUD, in an attempt to explicate the relationships between these factors and problematic alcohol use. This body of work is unique in that, although various studies have examined the relative roles of social cognition and emotion processing in AUD individually, few, if any, studies have explored these factors in AUD jointly. The first chapter presents an introduction and overview of the main objectives and areas of the current program of research (Chapter One). The second chapter builds on the first by presenting a review of alcohol and its impact on the brain’s various regions, as well as the impact of other psychoactive substances on the brain and the brain correlates of emotional processing and social cognition. The third and fourth chapters present a collection of studies that examine relationships between impaired emotion processing (alexithymia) and social cognition (ToM) in AUD. The fifth and sixth chapters investigate the possible roles of depression, intelligence, and stress within these putative relationships. The relationships between AUD, alexithymia, and physiological indices of emotional reactivity are examined in the seventh chapter. The eighth chapter investigates whether the relationship between alexithymia and deficient ToM is sufficiently consistent to encourage confidence in the findings. The two final chapters synthesise the findings and offer two tentative inter-related models, the impaired emotion processing and socio-cognitive diathesis-stress model and the Onuoha impaired emotional processing and socio-cognitive assessment and treatment model for AUD, in an attempt to explain the relationships between the earlier described factors and AUD. The results of these studies demonstrate that AUD is significantly associated with impaired emotion processing (alexithymia) and impaired socio-cognitive function (deficient ToM). The findings also suggest a unique role of intelligence. This program of research reveals that deficits in both emotion processing (alexithymia) and social cognition (ToM) appear to perform crucial roles in the behavioural and psychological processes observed in AUD. Therefore, improved understanding of these factors could potentially inform knowledge and clinical practice regarding the AUD population. The present program of research further highlights the need for research and clinical practice to address impaired emotion processing (e.g., alexithymia) and deficient social cognition (e.g., ToM) in the management of alcohol-related dysfunction. This could be achieved through proper assessment and selection of treatment approaches to remediate these capacities where impairments are observed in AUD. The findings have policy, clinical care, and management implications. A research strategy to address gaps in the literature is also outlined