Unmasking addictions: exploring the role of attributional styles

Background: Individuals with substance use disorder (SUD) often face challenges in their social and clinical functioning, which are linked to deterioration in different aspects of social cognition (SC). One important aspect is Attributional Styles (AS), which play a significant role in the development, progression, and prognosis of this long-term brain condition. Understanding how individuals explain the causes of social events is crucial for clinicians to comprehend their cognitive style and how they process social situations, to develop therapeutic interventions tailored to the specific challenges expressed by the individual. One of the treatment main goals is to address social cognitive impairments by assessing and intervening in dysfunctional AS, which can lead to improvements in real-life social outcomes and reduce the risk of drop-outs and relapses. Research on AS in individuals with SUD in Portugal is limited and there is a need for more comprehensive studies in this area, which could provide valuable insights into effective prevention strategies, improved therapeutic approaches, and better overall outcomes. This exploratory study aims to evaluate AS in a sample of SUD patients undergoing treatment at CRI Porto Ocidental, Portugal.
Methods: The Interpersonal Reactivity Index (IRI) and Facial Expressions of Emotion: Stimuli and tests (FEEST) were administrated to an intentional sample of 19 patients (N=19) in order to diagnose deficits in SC. From this sample, we identified 11 patients and administrated The Ambiguous Intentions Hostility Questionnaire (AIHQ). This preliminary and exploratory study is part of a comprehensive research, in partnership with Galicia Spain, and was approved by the Health Ethics Committee of Northern Health Administration.
Results: The results concern to the 11 patients sample identified with SC deficits. They showed statistically significant values compared to normative values for the non-clinical population in the following areas: Hostility Bias (M=29.82; SD=±7.94; p<0.001*), Aggressiveness Bias (M=30.36; SD=±9.07; p<0.010*), and Score Intentionality (M=49.09; SD=±9.16; p<0.007*). They achieved normative results in the Guilt (M=43.82; SD=±10.01; p<0.116) and Anger (M=41.09; SD=±8.89; p<0.406) scores.
Conclusions: This study demonstrates that individuals with SUD exhibit altered attributional styles, tending to interpret others' behavior as hostile and respond aggressively to negative social situations, compared to non-clinical samples. The Intentionality score suggests a social-cognitive bias in perceiving others' actions during unpleasant social situations as deliberately malicious. These difficulties in interpretating and response to social situations, can contribute to treatment drop-out or relapse. This study highlights the importance of considering AS in diagnosing cognitive styles in SUD patients and emphasizes its clinical relevance as a prognostic variable for treatment impact and rehabilitation outcomes.