A systematic review of the acute effects of alcohol on emotion recognition of facial expressions.

Alcohol has been linked to both positive (e.g., sociability) and negative (e.g., aggression) social outcomes, and researchers have proposed that alcohol-induced changes in emotion recognition may partially explain these effects. Here, we systematically review alcohol administration studies to clarify the acute effects of alcohol on emotion recognition. We also investigate various moderator variables (i.e., sex, study quality, study design, alcohol dosage, emotion recognition task and outcome measure). PsycINFO, PubMed and Google Scholar were searched following a pre-registered PROSPERO protocol (CRD42021225392) and PRISMA methodology. Analyses focused on differences in emotion recognition between participants consuming alcoholic and/or non-alcoholic (i.e., placebo or no-alcohol control) beverages. Nineteen unique samples (N = 1271 participants) were derived from 17 articles (two articles included two studies, each conducted on a unique sample). Data were extracted for sample characteristics, alcohol administration methods and emotion recognition tasks and outcomes. All studies compared an alcoholic beverage to a placebo beverage and used tasks that asked participants to identify emotions from images or videos of facial expressions. Otherwise, methodologies varied substantially across studies, including the alcohol dosage(s) tested, the specific emotion recognition task(s) used and the outcome variable(s) assessed. No consistent effects of alcohol on emotion recognition emerged for any emotion. None of the moderator variables affected the findings, except for some indication that alcohol may affect males' emotion recognition abilities more so than females. Alcohol does not appear to consistently affect positive or negative emotion recognition of facial expressions, at least with the tasks currently used in the field.

Lack of Belonging Predicts Depressive Symptomatology in College Students.

Feeling a sense of belonging is a central human motivation that has consequences for mental health and well-being, yet surprisingly little research has examined how belonging shapes mental health among young adults. In three data sets from two universities (exploratory study: N = 157; Confirmatory Study 1: N = 121; Confirmatory Study 2: n = 188 in winter term, n = 172 in spring term), we found that lower levels of daily-assessed feelings of belonging early and across the academic term predicted higher depressive symptoms at the end of the term. Furthermore, these relationships held when models controlled for baseline depressive symptoms, sense of social fit, and other social factors (loneliness and frequency of social interactions). These results highlight the relationship between feelings of belonging and depressive symptoms over and above other social factors. This work underscores the importance of daily-assessed feelings of belonging in predicting subsequent depressive symptoms and has implications for early detection and mental health interventions among young adults.

How laboratory studies of cigarette craving can inform the experimental alcohol craving literature.

Interest in alcohol and other drug craving has flourished over the past two decades, and evidence has accumulated showing that craving can be meaningfully linked to both drug use and relapse. Considerable human experimental alcohol craving research since 2000 has focused on craving as a clinical phenomenon. Self-reported craving to drink typically has served as a catch-all for the craving construct in these studies, whereas few studies have considered craving as a process (or hypothetical construct) that interacts with other phenomena to affect use. In contrast to alcohol, we believe that recently there has been more mechanistic work targeting cigarette craving-related processes. Here, we briefly present a narrative review of studies of acute alcohol craving in humans that have been conducted during the past two decades. We then specify important ways in which alcohol and tobacco differ (e.g., the role of withdrawal), and we note the unique challenges in inducing robust alcohol craving states in the laboratory. Finally, we offer recommendations for how the alcohol field might advance its conceptual understanding of craving by adopting ideas and methods drawn from the smoking research literature. Specifically, we suggest that researchers extend their studies to not only examine the link between alcohol craving and relapse but also to focus on why and, in some instances, how alcohol cravings matter clinically, and the circumstances under which craving especially matters. We propose research to investigate the shifts in alcohol-related cognitive and affective processing that occur during alcohol craving states. Furthermore, we highlight the value of research examining the level of insight that individuals with varying levels of alcohol involvement possess about their own craving-related processing shifts. We believe that laboratory studies can provide rich opportunities to examine conceptual questions about alcohol craving that are central to addiction.

Systematic review and meta-analysis on the association between theory of mind and alcohol problems in non-clinical samples.

BACKGROUND: Deficits in theory of mind (ToM) found in individuals with alcohol use disorder (AUD) are often thought to result from prolonged heavy alcohol use. However, links between deficits in ToM and greater alcohol problems are often also present in non-clinical samples (e.g., adolescents and young adults) who may not have a similar long-lasting history of alcohol consumption as individuals with AUD. The current study is the first to systematically review and meta-analyze results from studies examining associations between lower ToM and greater alcohol problems in non-clinical samples. Evidence of reliable associations in these non-clinical samples would support the idea that deficits in ToM might also precede the emergence of AUD. METHODS: PsycINFO, PubMed, and Google Scholar were searched according to our preregistered International Prospective Register of Systematic Reviews (PROSPERO) protocol (CRD42021225392) and following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. We systematically reviewed sample characteristics and ToM measures in identified articles. We then meta-analyzed the findings of association between ToM and alcohol problems in non-clinical samples using random effects models. RESULTS: Nearly all studies used a measure of ToM that assessed the ability to infer the mental states of others based on eye region cues. Meta-analytic results demonstrated that lower ToM was associated with more alcohol problems (r = -0.16, k = 6, CI = [-0.26, -0.04], p < 0.01, Q = 15.55, I2  = 67.85), and there was significant heterogeneity across studies. Gender (ß = 0.0003, CI = [-0.006, 0.007], z = 0.09, p = 0.93), age (ß = -0.008, CI = [-0.03, 0.01], z = -0.82, p = 0.42), and study quality (ß = -0.10, CI = [-0.35, 0.15], z = -0.82, p = 0.41) did not explain the heterogeneity. CONCLUSION: In non-clinical samples, lower ToM is associated with more alcohol problems, indicative of a small effect size. Future longitudinal studies are needed to explore whether socio-cognitive deficits may also serve as a risk factor for alcohol misuse.

The Influence of Smoking Motivation on the Associations Among Cigarette Craving, Attentional Bias to Smoking Cues, and Smoking Behavior.

INTRODUCTION: Theory and data suggest that attentional bias (AB) to drug-related cues should be associated with craving when smoking motivation is high, and that AB should be predictive of drug use when immediate use is possible. The current study is the first to test these propositions in smokers in a controlled laboratory environment. AIMS AND METHODS: Ninety daily smokers were randomly assigned to a high smoking motivation (nicotine-deprived and/or smoking cue exposure) or low smoking motivation (non-deprived and/or control cue exposure) condition. Participants engaged in an AB task in which they viewed smoking and matched control pictures while their eye movements were continuously monitored. Participants were then given the option to smoke, and latency to first puff and number of puffs were coded. RESULTS: High motivation smokers had significantly higher urges to smoke (p < .001) and shorter latencies to smoke (p = .001) than low motivation smokers, but AB measures (ie, dwell time and initial fixation bias scores) and number of puffs did not differ across groups (ps > .45). As predicted, the association between dwell time bias scores and urge to smoke was stronger in the high (r = .47) than low (r = .18) smoking motivation condition, but this difference failed to reach significance (p = .068). Contrary to predictions, neither AB measure was significantly associated with smoking behavior (SB). Internal reliability was excellent for dwell time bias scores (alpha = .90) but very low for initial fixation bias scores (alpha = .20). CONCLUSIONS: Maintenance of attention on drug-related cues may be a valid index of incentive motivation. Importantly, however, these dwell time bias scores were not predictive of actual SB. IMPLICATIONS: This study tested key predictions made by theoretical accounts of addiction that emphasize AB to drug-related cues as fundamental components of the development and maintenance of drug use. Namely, this is the first experimental study in smokers to test whether AB to smoking-related cues is associated with craving when smoking motivation is high and whether AB predicts SB assessed immediately after the AB task. As predicted, the association between AB and craving was stronger in smokers randomly assigned to a high rather than a low smoking motivation condition. Contrary to predictions, AB did not predict SB.

Neurobiological Functioning and the Personality-Trait Hierarchy: Central Serotonergic Responsivity and the Stability Metatrait.

Trait domains of the five-factor model are not orthogonal, and two metatraits have often been estimated from their covariation. Here, we focus on the stability metatrait, which reflects shared variance in conscientiousness, agreeableness, and (inversely) neuroticism. It has been hypothesized that stability manifests, in part, because of individual differences in central serotonergic functioning. We explored this possibility in a community sample (N = 441) using a multiverse analysis of (a) multi-informant five-factor-model traits and (b) stability as a predictor of individual differences in central serotonergic functioning. Differences in serotonergic functioning were assessed by indexing change in serum prolactin concentration following intravenous infusion of citalopram, a selective serotonin reuptake inhibitor. Results were mixed, showing that trait neuroticism, agreeableness, and conscientiousness, as well as the stability metatrait, were significantly associated with prolactin response but that these findings were contingent on a number of modeling decisions. Specifically, these effects were nonlinear, emerging most strongly for participants with the highest levels (or lowest, for neuroticism) of the component traits.

Multidimensional assessment of impulsivity-related measures in relation to externalizing behaviors.

BACKGROUND: Trait impulsivity is thought to play a key role in predicting behaviors on the externalizing spectrum, such as drug and alcohol use and aggression. Research suggests that impulsivity may not be a unitary construct, but rather multidimensional in nature with dimensions varying across self-report assessments and laboratory behavioral tasks. Few studies with large samples have included a range of impulsivity-related measures and assessed several externalizing behaviors to clarify the predictive validity of these assessments on important life outcomes. METHODS: Community adults (N = 1295) between the ages of 30 and 54 completed a multidimensional assessment of impulsivity-related traits (including 54 self-report scales of personality traits implicated in impulsive behaviors, and four behavioral tasks purporting to assess a construct similar to impulsivity) and reported on five externalizing behavioral outcomes (i.e. drug, alcohol, and cigarette use, and physical and verbal aggression). We ran an exploratory factor analysis on the trait scales, and then a structural equation model predicting the externalizing behaviors from the three higher-order personality factors (i.e. Disinhibition v. Constraint/Conscientiousness, Neuroticism/Negative Emotionality, and Extraversion/Positive Emotionality) and the four behavioral tasks. RESULTS: Relations between the self-report factors and behavioral tasks were small or nonexistent. Associations between the self-report factors and the externalizing outcomes were generally medium to large, but relationships between the behavioral tasks and externalizing outcomes were either nonexistent or small. CONCLUSIONS: These results partially replicate and extend recent meta-analytic findings reported by Sharma et al. (2014) to further clarify the predictive validity of impulsivity-related trait scales and laboratory behavioral tasks on externalizing behaviors.

Do graphic health warning labels on cigarette packages deter purchases at point-of-sale? An experiment with adult smokers.

This experiment tested whether the presence of graphic health warning labels on cigarette packages deterred adult smokers from purchasing cigarettes at retail point-of-sale (POS), and whether individual difference variables moderated this relationship. The study was conducted in the RAND StoreLab (RSL), a life-sized replica of a convenience store that was developed to evaluate how changing POS tobacco advertising influences tobacco use outcomes during simulated shopping experiences. Adult smokers (n = 294; 65% female; 59% African-American; 35% White) were assigned randomly to shop in the RSL under one of two experimental conditions: graphic health warning labels present on cigarette packages versus absent on cigarette packages. Cigarette packages in both conditions were displayed on a tobacco power wall, which was located behind the RSL cashier counter. Results revealed that the presence of graphic health warning labels did not influence participants' purchase of cigarettes as a main effect. However, nicotine dependence acted as a significant moderator of experimental condition. Graphic health warning labels reduced the chances of cigarette purchases for smokers lower in nicotine dependence but had no effect on smokers higher in dependence.

Course of alcohol symptoms and social anxiety disorder from adolescence to young adulthood.

BACKGROUND: There is limited knowledge of the course of social anxiety disorder (SAD) from adolescence into adulthood, and how SAD and alcohol use disorder (AUD) symptoms change together over time. The current study examined how persistent and adolescent-limited SAD relate to alcohol symptom trajectories across adolescence and into adulthood, as well as gender differences in the course of SAD and AUD symptoms. METHODS: Participants were 788 youth (ages 12 to 18 at the baseline assessment; 46.2% female; 80.5% White) recruited from the community (n = 220) and from clinical programs (n = 568). Youth completed clinical interviews on their lifetime history of AUD symptoms and SAD at baseline and were followed through age 25. Multivariate polynomial growth mixture modeling was used to estimate developmental trajectories for SAD and AUD symptoms separately, then together in a dual trajectory model. Gender differences were examined using a classify-analyze approach. RESULTS: Three SAD trajectory classes were identified: adolescent-limited (15%), persistent (6%), and no SAD (79%). For AUD symptoms, 5 trajectories were identified: severe (10%), moderate (22%), remitting (18%), young adult onset (22%), and stable low (28%). Those with a history of SAD were about twice as likely to be in the severe AUD symptom class compared to those without a history of SAD. Compared to those with persisting SAD, those in the adolescent-limited SAD class were more likely to belong to the stable low AUD trajectory. Compared to males with SAD, females with SAD were less likely to be in the moderate AUD symptom class and were more likely to be in stable low and young adult onset AUD symptom classes. CONCLUSIONS: A history of SAD was associated with membership in the severe AUD trajectory group. The association of gender with SAD and AUD differed depending on developmental period. Future research should examine whether treating SAD in early adolescence may prevent subsequent AUD symptoms.

A test of the stress-buffering model of social support in smoking cessation: is the relationship between social support and time to relapse mediated by reduced withdrawal symptoms?

INTRODUCTION: Social support has been linked to quitting smoking, but the mechanisms by which social support affects cessation are poorly understood. The current study tested a stress-buffering model of social support, which posits that social support protects or "buffers" individuals from stress related to quitting smoking. We hypothesized that social support would be negatively associated with risk of relapse, and that this effect would be mediated by reduced withdrawal and depressive symptoms (i.e., cessation-related stress) over time. Further, we predicted that trait neuroticism would moderate this mediational effect, such that individuals high in negative affectivity would show the greatest stress-buffering effects of social support. METHODS: Participants were weight-concerned women (n = 349) ages 18-65 enrolled in a randomized, double-blind, placebo-controlled smoking cessation trial of bupropion and cognitive behavioral therapy. Social support was assessed at baseline, and biochemically-verified abstinence, withdrawal-related symptoms, and depressive symptoms were assessed at 1-, 3-, 6-, and 12-months follow-up. RESULTS: Social support was negatively related to risk of relapse in survival models and negatively related to withdrawal symptoms and depression in mixed effects models. These relationships held after controlling for the effects of pre-quit day negative affect and depression symptoms, assignment to treatment condition, and number of cigarettes smoked per day. A temporal mediation model showed that the effect of social support on risk of relapse was mediated by reductions in withdrawal symptoms over time but not by depression over time. Contrary to hypotheses, we did not find that neuroticism moderated this mediation effect. CONCLUSIONS: Increased social support may buffer women from the harmful effects of cessation-related withdrawal symptoms, which in turn improve cessation outcomes.

The impact of alcohol consumption on implicit racial bias.

OBJECTIVE: Researchers and theorists studying intergroup relations have been interested in the impact of alcohol on interracial responding. Theories predict that alcohol will exacerbate expressions of racial bias by increasing reliance on stereotypes and/or by decreasing controlled processing and self-monitoring. Prior studies testing these theories have often examined alcohol's effects on implicit (i.e., indirect) measures of racial bias with inconsistent results. However, previous research in this area has suffered from several methodological limitations, including small sample sizes and doses of alcohol that may have been too low to induce substantial intoxication. METHOD: Here, in more than triple the number of alcohol participants than the largest prior study, we tested whether an intoxicating dose of alcohol (target breath alcohol concentration of .08%) exacerbated implicit racial bias. Young adults who identified as races other than Black or African American (N = 207) were randomly assigned to consume an alcoholic or placebo beverage and completed the race-based Implicit Association Test (race IAT) testing implicit preference for White (vs. Black) individuals [or, conversely, bias against Black (vs. White) individuals]. RESULTS: All participants demonstrated an implicit racial bias (i.e., linking traditionally Black names with negative/unpleasant words), with no difference in this implicit racial bias across beverage conditions. Specifically, there were no differences between alcohol participants' race IAT D scores (M = 0.55, SD = 0.39), and placebo participants' race IAT D scores (M = 0.59, SD = 0.35), b = 0.05, 95%CI [-0.07, 0.18], p = .422. CONCLUSIONS: These findings challenge theories and prior studies suggesting that alcohol increases implicit racial bias. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Solitary-specific drinking to cope motives explain unique variance in solitary drinking behavior but not alcohol problems compared to general drinking to cope motives.

OBJECTIVE: Adolescent and young adult solitary drinking is prospectively associated with alcohol problems, and it is thus important to understand why individuals engage in this risky drinking behavior. There is substantial evidence that individuals drink alone to cope with negative affect, but all prior studies have assessed motives for alcohol use without specifying the context of such use. Here, we directly compared solitary-specific drinking to cope motives with general drinking to cope motives in their ability to predict solitary drinking behavior and alcohol problems. We hypothesized that solitary-specific drinking motives would provide additional predictive utility in each case. METHODS: Current underage drinkers (N = 307; 90% female; ages 18-20) recruited from a TurkPrime panel March-May 2016 completed online surveys querying solitary alcohol use, general and solitary-specific coping motives, and alcohol problems. RESULTS: Both solitary-specific and general coping motives were positively associated with a greater percentage of total drinking time spent alone in separate models, after controlling for solitary-specific and general enhancement motives, respectively. However, the model with solitary-specific motives accounted for greater variance than the general motives model based on adjusted R2 values (0.8 versus 0.3, respectively). Additionally, both general and solitary-specific coping motives were positively associated with alcohol problems, again controlling for enhancement motives, but the model including general motives accounted for greater variance (0.49) than the solitary-specific motives model (0.40). CONCLUSION: These findings provide evidence that solitary-specific coping motives explain unique variance in solitary drinking behavior but not alcohol problems. The methodological and clinical implications of these findings are discussed.

Associations of state and trait empathy with daily alcohol use.

BACKGROUND: A growing literature documents associations between lower trait empathy and heavier alcohol use and more alcohol problems in adolescent and young adult samples. Prior work linking empathy and alcohol use/problems in these populations has thus far focused on trait rather than state empathy, and researchers often do not differentiate between cognitive and affective empathy. Further, no prior studies have examined associations between daily fluctuations in state empathy and alcohol use. The goal of the current study is to advance knowledge about the associations between state (vs. trait) and cognitive (vs. affective) empathy and alcohol use. METHODS: Adult alcohol drinkers (n = 492; Mage = 22.89, SD = 5.53; 53.70% female) participated in ecological momentary assessment studies for 7 to 10 days (day n = 4683). Multilevel hurdle models were used to investigate associations between day-level state empathy and daily alcohol use at the within-person level, and associations between individual differences in trait empathy and alcohol use across days at the between-person level. RESULTS: Higher day-level state affective empathy was not associated with the likelihood of drinking on a particular day, but it was significantly associated with a greater number of drinks consumed on alcohol-consuming days, with the latter associations remaining after controlling for day-level positive affect (PA) and negative affect (NA). No associations were found for day-level state cognitive empathy, or trait affective or cognitive empathy. CONCLUSIONS: On drinking days, when individuals reported more affective empathy than is typical for them, they were more likely to consume a greater number of alcoholic drinks, results that remained when controlling for levels of PA and NA. Daily shifts in affective empathy may be important to consider in efforts to understand alcohol use.

Indirect effects of personality on high-intensity drinking: The role of drinking motives.

BACKGROUND: Researchers have long been interested in identifying risk factors for binge drinking behavior (4+/5+ drinks/occasion for females/males), but many studies have demonstrated that a substantial proportion of young adults are drinking at levels far beyond (often 2 to 3 times) the standard binge threshold. The consumption of such large quantities of alcohol, typically referred to as high-intensity drinking (HID), can cause severe alcohol-related problems, such as blackouts, unintended sexual experiences, and death. This study is the first to investigate whether personality is indirectly associated with the likelihood of HID via drinking motives in a large (N = 999) sample of underage young adult drinkers. We hypothesized that trait neuroticism would be indirectly associated with the likelihood of HID via coping motives and that extraversion would be indirectly associated with the likelihood of HID via social and enhancement motives. METHODS: To investigate these hypotheses, we used two archival data sets that recruited current underage (18- to 20-year-old) adult drinkers residing in the United States from online panel services. Participants completed self-report survey items assessing constructs of interest. To investigate the role of drinking motives in the association between personality and HID, both the direct and indirect effects were calculated via three path analyses. RESULTS: Findings revealed that neuroticism was partially indirectly associated with the likelihood of HID via coping motives (b = 0.02, SE = 0.004, p < 0.01). In addition, extraversion was indirectly associated with the likelihood of HID via social (b = 0.031, SE = 0.002, p < 0.01) and enhancement motives (b = 0.01, SE = 0.002, p = 0.01). CONCLUSIONS: These findings are an initial step in examining the interplay among personality traits, drinking motives, and HID in underage drinkers and point to the need for longitudinal studies assessing these associations.

A Reexamination of Drinking Motives in Young Adults: The Development and Initial Validation of the Young Adult Alcohol Motives Scale.

This study reexamined the factor structure of drinking motives using 205 unique items from 18 drinking motives scales with the inclusion of social tension reduction motives, which have been largely neglected in the literature. A new scale was created and compared with the Drinking Motives Questionnaire-Revised (DMQ-R) to predict alcohol use/problems. Young adults (N = 1,049) completed questionnaires assessing drinking motives and alcohol use/problems. A subset (N = 368) of participants completed a 6-month follow-up. Hierarchical factor analyses informed the creation of a four-factor (i.e., coping, social, enhancement, and social tension reduction) scale (i.e., the Young Adult Alcohol Motives Scale [YAAMS]). In general, the YAAMS performed similarly to the DMQ-R in predicting concurrent and prospective alcohol consumption (i.e., typical drinking quantity and frequency) and alcohol problems (i.e., Alcohol Use Disorder Identification Test [AUDIT] and Brief Young Adult Alcohol Consequences Questionnaire [B-YAACQ] scores), but there were some notable differences, including that the novel social tension reduction scale of the YAAMS was particularly relevant in predicting drinking frequency in those with social anxiety. Results suggest that drinking motives can be described by multiple factor structures and predict alcohol-related outcomes.

The daily association between affect and alcohol use: A meta-analysis of individual participant data.

Influential psychological theories hypothesize that people consume alcohol in response to the experience of both negative and positive emotions. Despite two decades of daily diary and ecological momentary assessment research, it remains unclear whether people consume more alcohol on days they experience higher negative and positive affect in everyday life. In this preregistered meta-analysis, we synthesized the evidence for these daily associations between affect and alcohol use. We included individual participant data from 69 studies (N = 12,394), which used daily and momentary surveys to assess affect and the number of alcoholic drinks consumed. Results indicate that people are not more likely to drink on days they experience high negative affect, but are more likely to drink and drink heavily on days high in positive affect. People self-reporting a motivational tendency to drink-to-cope and drink-to-enhance consumed more alcohol, but not on days they experienced higher negative and positive affect. Results were robust across different operationalizations of affect, study designs, study populations, and individual characteristics. These findings challenge the long-held belief that people drink more alcohol following increases in negative affect. Integrating these findings under different theoretical models and limitations of this field of research, we collectively propose an agenda for future research to explore open questions surrounding affect and alcohol use.

Alcohol and group formation: a multimodal investigation of the effects of alcohol on emotion and social bonding.

We integrated research on emotion and on small groups to address a fundamental and enduring question facing alcohol researchers: What are the specific mechanisms that underlie the reinforcing effects of drinking? In one of the largest alcohol-administration studies yet conducted, we employed a novel group-formation paradigm to evaluate the socioemotional effects of alcohol. Seven hundred twenty social drinkers (360 male, 360 female) were assembled into groups of 3 unacquainted persons each and given a moderate dose of an alcoholic, placebo, or control beverage, which they consumed over 36 min. These groups' social interactions were video recorded, and the duration and sequence of interaction partners' facial and speech behaviors were systematically coded (e.g., using the facial action coding system). Alcohol consumption enhanced individual- and group-level behaviors associated with positive affect, reduced individual-level behaviors associated with negative affect, and elevated self-reported bonding. Our results indicate that alcohol facilitates bonding during group formation. Assessing nonverbal responses in social contexts offers new directions for evaluating the effects of alcohol.

Meta-analysis of associations between empathy and alcohol use and problems in clinical and non-clinical samples.

AIMS: To (1) measure the aggregated effect size of empathy deficits in individuals with alcohol use disorder (AUD) compared with healthy controls, (2) measure the aggregated effect sizes for associations between lower empathy and heavier alcohol consumption and more alcohol problems in non-clinical samples and (3) identify potential moderators on the variability of effect sizes across studies in these meta-analyses. METHOD: PsycINFO, PubMed and Google Scholar were searched following a pre-registered International Prospective Register of Systematic Reviews (PROSPERO) protocol (CRD42021225392) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. We meta-analyzed (using random-effects models) mean differences in empathy between individuals with AUD compared with healthy controls and associations between empathy and alcohol consumption and alcohol problems in non-clinical samples. A total of 714 participants were included in the meta-analysis on clinical samples; 3955 were included in the meta-analyses on non-clinical samples. RESULTS: Individuals with AUD reported significantly lower empathy than healthy controls [Hedges' g = -0.53, 95% confidence interval (CI) = -0.91, -0.16, k = 9, P < 0.01, Q = 40.09, I2 = 80.04]. Study quality [Q = 1.88, degrees of freedom (d.f.) = 1, P = 0.17] and gender (ß = -0.006, Z = -0.60, P = 0.55) were not moderators. Increases in age corresponded to an increase in effect size (ß = 0.095, Z = 3.34, P < 0.001). Individuals with AUD (versus healthy controls) had significantly lower cognitive (Hedges' g = -0.44, CI = -0.79, -0.10, P < 0.05), but not affective empathy (Hedges' g = -0.19, CI = -0.51, 0.14, P = 0.27), and the difference between these was significant (Z = 2.34, k = 6, P < 0.01). In non-clinical samples, individuals with lower (versus higher) empathy reported heavier alcohol consumption (r = -0.12, CI = -0.15, -0.09, k = 11, P < 0.001, Q = 9.68, I2 = 0.00) and more alcohol problems (r = -0.08, CI = -0.14, -0.01, k = 7, P = 0.021, Q = 6.55, I2 = 8.34). There was no significant heterogeneity across studies. CONCLUSION: Individuals with alcohol use disorder appear to show deficits in empathy compared with healthy controls. Deficits are particularly pronounced for older individuals and for cognitive (versus affective) empathy. In non-clinical samples, lower empathy appears to be associated with heavier alcohol consumption and more alcohol problems.