Alcohol use disorder and emotional processing patterns: Insights from a systematic review

Alcohol use and misuse represent a significant public health issue associated with physical, psychological, emotional, and neurological risks. This systematic review aims to explore emotional processing in individuals with alcohol use disorder (AUD) through both a gender-informed perspective and an intersectional approach, to identify potential targets for intervention.

This systematic review was conducted following the Cochrane Collaboration guidelines and reported based on the PRISMA guidelines. The review protocol was previously registered in PROSPERO. The literature search was carried out across the PubMed, Scopus, and Web of Science databases, resulting in the inclusion of 11 studies after the screening process.

Individuals with AUD consistently exhibit impairments in social and emotional cognition, particularly in tasks involving emotional facial recognition. These deficits extend to broader neuropsychological domains, such as working memory and spatial frequency processing. They demonstrate attentional biases, including difficulties disengaging from alcohol-related cues and reduced accuracy in interpreting emotional facial expressions. Theory of Mind (ToM) -especially its affective components- and empathy are significantly impaired in individuals with AUD, with the duration of problematic alcohol use being the strongest predictor of impaired ToM reasoning. Neuroimaging studies corroborate these findings, revealing decreased fusiform gyrus activity in response to emotional faces, increased pallidum activation to alcohol-related cues, reduced hippocampal network efficiency, lower occipito-temporal sensitivity to emotional stimuli, heightened striatal reactivity to alcohol cues, and diminished activation in the inferior frontal gyrus. Although gender-specific neural differences in the processing of emotional facial expressions in individuals with AUD have been reported, there is a lack of studies in this field, and social and cultural variable are often overlooked in the analysis.

Deficits in social and emotional processing among individuals with AUD may present significant barriers to achieving and maintaining abstinence, ultimately diminishing the effectiveness of therapeutic interventions. These findings underscore the need for comprehensive treatment approaches that address social and emotional cognitive impairments as integral components of recovery, incorporating both a gender perspective and an intersectional framework.