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Cox SS, Reichel CM. The intersection of empathy and addiction. Pharmacol Biochem Behav 2023; 222:173509. [PMID: 36565789 PMCID: PMC10518853 DOI: 10.1016/j.pbb.2022.173509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/28/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
Empathy, the ability to perceive the affective state of another, is a complex process that is integral to many of the prosocial behaviors expressed in humans and across the animal kingdom. Research into the behavioral and neurobiological underpinnings of empathic behaviors has increased in recent years. Growing evidence suggests changes in empathy may contribute to a myriad of psychiatric illnesses, including substance use disorder (SUD). Indeed, both clinical and preclinical research in SUD demonstrates a strong relationship between drug taking or relapse events and changes to empathic behavior. Further, there is significant overlap in the underlying neural substrates of these complex behaviors, including the insula, paraventricular nucleus of thalamus (PVT), and the paraventricular nucleus of the hypothalamus (PVN). In this review, we will discuss our current understanding of the interplay between empathic behaviors and SUD. We will also examine the underlying neurobiology that may regulate this interaction, focusing specifically on the insula, PVT, and PVN. Finally, we discuss the biologic and therapeutic importance of taking empathic processes into consideration when discussing SUD.
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Affiliation(s)
- Stewart S Cox
- Medical University of South Carolina, Dept. of Neurosciences, United States of America.
| | - Carmela M Reichel
- Medical University of South Carolina, Dept. of Neurosciences, United States of America.
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Carlyle M, Rowley M, Stevens T, Karl A, Morgan CJA. Impaired empathy and increased anger following social exclusion in non-intoxicated opioid users. Psychopharmacology (Berl) 2020; 237:419-430. [PMID: 31686176 PMCID: PMC7018792 DOI: 10.1007/s00213-019-05378-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/05/2019] [Indexed: 12/25/2022]
Abstract
RATIONALE Social functioning is modulated by the endogenous opioid system. In opioid use disorder, social functioning appears disrupted, but little research has delineated the nature of these deficits and their relationship to acute opioid use. OBJECTIVES The current study aimed to assess both emotional and cognitive empathy, along with subjective and physiological responses to social exclusion in opioid users who were either acutely intoxicated or non-intoxicated from using opioids. METHODS Individuals on an opioid substitution medication (OSM) were divided into 'intoxicated users' (had taken their OSM the same day as testing, n = 20) and 'non-intoxicated users' (had taken their OSM > 12 h ago, n = 20) and compared with opioid-naïve controls (n = 24). Empathy was assessed using the multifaceted empathy test and self-report questionnaire. Participants also underwent a period of social exclusion (Cyberball Game) and completed measures of mood and physiological responses (salivary cortisol and heart rate). RESULTS Non-intoxicated users had significantly lower emotional empathy (the ability to experience others' emotions), as well as greater anger after social exclusion when compared with the intoxicated users and controls. Anger did not change with social exclusion in the intoxicated user group and cortisol levels were lower overall. CONCLUSIONS Reduced ability to spontaneously share the emotions of others was reported in non-intoxicated users, particularly regarding positive emotions. There was some support for the idea of hyperalgesia to social pain, but this was restricted to an enhanced anger response in non-intoxicated users. Equivalent rates of empathy between the intoxicated users and controls could indicate some remediating effects of acute opioids.
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Affiliation(s)
- Molly Carlyle
- Psychopharmacology and Addiction Research Centre (PARC), University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG, UK.
| | - Megan Rowley
- Psychopharmacology and Addiction Research Centre (PARC), University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG, UK
| | - Tobias Stevens
- Psychopharmacology and Addiction Research Centre (PARC), University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG, UK
| | - Anke Karl
- Psychopharmacology and Addiction Research Centre (PARC), University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG, UK
| | - Celia J A Morgan
- Psychopharmacology and Addiction Research Centre (PARC), University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG, UK
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Eddy CM. What Do You Have in Mind? Measures to Assess Mental State Reasoning in Neuropsychiatric Populations. Front Psychiatry 2019; 10:425. [PMID: 31354534 PMCID: PMC6636467 DOI: 10.3389/fpsyt.2019.00425] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/29/2019] [Indexed: 12/12/2022] Open
Abstract
Social interaction is closely associated with both functional capacity and well-being. Previous research has not only revealed evidence of social dysfunction in individuals with a wide range of psychiatric and neurological disorders but also generated an abundance of potential measures for assessing social cognition. This review explores the most popular measures used within neuropsychiatric populations to investigate the ability to recognize or reason about the mental states of others. Measures are also critically analyzed in terms of strengths and limitations to aid task selection in future clinical studies. The most frequently applied assessment tools use verbal, visual or audiovisual forms of presentation and assess recognition of mental states from facial features, self-rated empathy, the understanding of other's cognitive mental states such as beliefs and intentions, or the ability to combine knowledge of other's thoughts and emotions in order to understand subtle communications or socially inappropriate behavior. Key weaknesses of previous research include limited investigation of relationships with clinical symptoms, and underutilization of measures of everyday social functioning that offer a useful counterpart to traditional "lab" tasks. Future studies should aim to carefully select measures not only based on the range of skills to be assessed but also taking into account potential difficulties with interpretation and the need to gain insight into the application of social cognitive skills as well as ability per se. Some of the best measures include those with well-matched control trials (e.g., Yoni Task) or those that restrict the influence of verbal deficits (e.g., intentions comic strip task), elicit spontaneous mentalizing (e.g., Animations Task), and possess greater ecological validity (e.g., Movie for the Assessment of Social Cognition). Social cognitive research within psychiatric populations will be further enhanced through the development of more closely matched control tasks, and the exploration of relationships between task performance, medication, strategy use, and broader emotional and motor functions.
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Affiliation(s)
- Clare M. Eddy
- Research and Innovation, BSMHFT National Centre for Mental Health, Birmingham, United Kingdom
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Kroll SL, Nikolic E, Bieri F, Soyka M, Baumgartner MR, Quednow BB. Cognitive and socio-cognitive functioning of chronic non-medical prescription opioid users. Psychopharmacology (Berl) 2018; 235:3451-3464. [PMID: 30310961 DOI: 10.1007/s00213-018-5060-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/02/2018] [Indexed: 12/20/2022]
Abstract
RATIONALE Non-medical prescription opioid use (NMPOU) has become a major public health issue in the USA and is also increasing in Europe. However, little is known about neuropsychological associations of NMPOU-specifically regarding social cognition, which is essential for social functioning and treatability of opioid dependence. Previous studies with heroin users and opioid-substituted patients reported deficits in various cognitive functions, but these results are likely confounded by comorbid physical and psychiatric diseases, overdose-associated hypoxia, and adulteration of street heroin. Therefore, the purpose of the present study was to investigate social and non-social cognition in a relatively pure NMPOU sample taking opioid analgesics or antitussives. METHODS We assessed 23 individuals with NMPOU objectively confirmed by hair analyses and 29 opioid-naïve, healthy controls, employing a comprehensive neuropsychological test battery. RESULTS Significant impairments were found between NMPOU individuals and controls regarding the cognitive domains of attention (p < .01, Hedge's g = .85), declarative memory (p < .05, g = .66), and global cognitive empathy (p < .01, g = 0.99)-the latter included problems with emotion recognition from faces, voices, and complex scenes. Opioid hair concentrations transformed to morphine equivalents were negatively correlated with global cognitive empathy (r = - 0.52, p < .01), suggesting dose-dependent deficits. CONCLUSION In contrast to stimulant users primarily displaying deficits in emotional empathy, opioid users showed relatively selective impairments in measures of cognitive empathy, with dose-dependent effects suggesting potential opioid-induced deficits and involvement of the opioid-system in processes of cognitive empathy. These results have important implications for future interventions of opioid dependence targeting social functioning and consequently enhancing therapy outcome and preventing relapse.
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Affiliation(s)
- Sara L Kroll
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital of the University of Zurich, Lenggstrasse 31, PO Box 1931, 8008, Zurich, Switzerland.
| | - Emilija Nikolic
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital of the University of Zurich, Lenggstrasse 31, PO Box 1931, 8008, Zurich, Switzerland
| | - Franziska Bieri
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital of the University of Zurich, Lenggstrasse 31, PO Box 1931, 8008, Zurich, Switzerland
| | - Michael Soyka
- Psychiatric Hospital of the University of Munich, Nussbaumstrasse 7, 80336, Munich, Germany.,Medical Park Chiemseeblick, Rasthaustrasse 25, 83233, Bernau am Chiemsee, Germany
| | - Markus R Baumgartner
- Center for Forensic Hair Analysis, Institute of Forensic Medicine, University of Zurich, Kurvenstrasse 17, 8006, Zurich, Switzerland
| | - Boris B Quednow
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital of the University of Zurich, Lenggstrasse 31, PO Box 1931, 8008, Zurich, Switzerland. .,Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.
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