Social Cognition in people with substance use disorders

Introduction: Substance use disorders (SUD) have been consistently associated with changes in different neuropsychological processes such as attention, memory, executive functions and social cognition (CS), with a significant impact on the daily functioning. Specifically, CS dysfunctions play a relevant role in the etiopathogenesis, clinical evolution and response to treatment, what justifies the delivery of specific rehabilitation programs. Thus, regarding treatment, CS should be considered in diagnostic and therapeutic procedures, such as the detection of neuropsychological dysfunctions and the delivery of concrete treatments which can help improve the therapeutic response of patients with substance use disorders.

Objective: To evaluate possible changes in the CS subdomains: theory of mind, attributional styles, empathy and emotional recognition, in a sample of patients with SUD.

Methodology: Multicenter experimental design, with a total of 57 patients with SUD. The sample was selected from three care units in Portugal: CRI Porto Ocidental/Dicad of ARS Norte, Centro Hospitalar e Universitário de Coimbra and Centro Hospitalar Psiquiátrico de Lisboa, using inclusion and exclusion criteria. This project was implemented between 2022 and 2023.

Results: Scores on the Ekman 60 Faces Test (FEEST), indicate below-average performance in the emotions Happiness (Z= -1.04), Surprise (Z=-0.39), Fear (Z=-1.87), Sadness (Z=-1.60), Disgust (Z=-2.18), Anger (Z=-1.12) and Total Score (Z=-2.52). The results in the Interpersonal Reactivity Index (IRI) reflect an average performance in Perspective Taking (Z=+0.23), Fantasy (Z=-0.65), Empathic Concern (Z=-0.45) and Personal Distress (Z=+0.53). The scores obtained on the Ambiguous Intentions Hostility Questionnaire (AIHQ), are indicative of a below-average performance in the hostility bias (Z=+1.68) and an average performance in the score Intentionality (Z=0.85), Anger (Z=0.08), Guilt (Z=0.37) and Aggressiveness Bias (Z=0.77).

Conclusions: The results suggest deficits in the subdomain of emotional recognition of facial expressions, in the 6 emotions evaluated and in the total score, as well in the subdomain of attributional style, more specifically in the hostility bias. A normative functioning was observed in the sub-domains of empathy, both in the emotional and cognitive components, and in the theory of mind. This study demonstrates the importance of carrying out neuropsychological assessments in the field of CS, in order to enhance specific lines of intervention to rehabilitate deficits that patients with SUD present.