Psilocybin-assisted therapy for severe alcohol use disorder: protocol for a double-blind, randomized, placebo-controlled, 7-month parallel-group phase II superiority trial.

BACKGROUND: A significant number of individuals with alcohol use disorder remain unresponsive to currently available treatments, which calls for the development of new alternatives. In parallel, psilocybin-assisted therapy for alcohol use disorder has recently yielded promising preliminary results. Building on extant findings, the proposed study is set to evaluate the feasibility and preliminary clinical efficacy of psilocybin-assisted therapy when incorporated as an auxiliary intervention during inpatient rehabilitation for severe alcohol use disorder. Moreover, it intends to pinpoint the modifications in the two core neurocognitive systems underscored by dual-process models of addiction. METHODS: In this double-blind, randomized, placebo-controlled, 7-month parallel-group phase II superiority trial, 62 participants aged 21-64 years will be enrolled to undergo psilocybin-assisted therapy as part of a 4-week inpatient rehabilitation for severe alcohol use disorder. The experimental group will receive a high dose of psilocybin (30 mg), whereas the control group will receive an active placebo dose of psilocybin (5 mg), both within the context of a brief standardized psychotherapeutic intervention drawing from key elements of acceptance and commitment therapy. The primary clinical outcome is the between-group difference regarding the change in percentage of heavy drinking days from baseline to four weeks posthospital discharge, while safety and feasibility metrics will also be reported as primary outcomes. Key secondary assessments include between-group differences in terms of changes in (1) drinking behavior parameters up to six months posthospital discharge, (2) symptoms of depression, anxiety, trauma, and global functioning, (3) neuroplasticity and key neurocognitive mechanisms associated with addiction, and (4) psychological processes and alcohol-related parameters. DISCUSSION: The discussion outlines issues that might arise from our design. TRIAL REGISTRATION: EudraCT 2022-002369-14 and NCT06160232.

The Role of the Posterior Cerebellum in Dysfunctional Social Sequencing.

Recent advances in social neuroscience have highlighted the critical role of the cerebellum in social cognition, and especially the posterior cerebellum. Studies have supported the view that the posterior cerebellum builds internal action models of our social interactions to predict how other people's actions will be executed and what our most likely responses are to these actions. This mechanism allows to better anticipate action sequences during social interactions in an automatic and intuitive way and to fine-tune these anticipations, making it easier to understand other's social behaviors and mental states (e.g., beliefs, intentions, traits). In this paper, we argue that the central role of the posterior cerebellum in identifying and automatizing social action sequencing provides a fruitful starting point for investigating social dysfunctions in a variety of clinical pathologies, such as autism, obsessive-compulsive and bipolar disorder, depression, and addiction. Our key hypothesis is that dysfunctions of the posterior cerebellum lead to under- or overuse of inflexible social routines and lack of plasticity for learning new, more adaptive, social automatisms. We briefly review past research supporting this view and propose a program of research to test our hypothesis. This approach might alleviate a variety of mental problems of individuals who suffer from inflexible automatizations that stand in the way of adjustable and intuitive social behavior, by increasing posterior cerebellar plasticity using noninvasive neurostimulation or neuro-guided training programs.

Distinct Whole-Body Movements in Response to Alcohol and Sexual Content in Alcohol Use Disorder.

BACKGROUND: Spontaneous motor responses of approach and avoidance toward stimuli are important in characterizing psychopathological conditions, including alcohol use disorder (AUD). However, divergent results have been reported, possibly due to confounded parameters (e.g., using a symbolic vs. a sensorimotor task, implementation of approach-avoidance as a measure vs. a manipulation). METHODS: We studied whole-body/posturometric changes by using a sensorimotor measure relying on embodied cognition principles to assess forward (approach) and backward (avoidance) spontaneous leaning movements. Over a 12-second period, 51 male patients with AUD and 29 male control participants were instructed to stand still in response to both alcohol and sexual visual content. Patients with AUD were then divided into "abstainers" and "relapsers," depending on their continuous abstinence at 2 weeks postdischarge (obtained via a telephone follow-up interview). The effects of the group, the stimulus type, the experimental period, and their interactions on the posturometric changes were tested using mixed Analyses of variance (ANOVAs), with a significance threshold set at 0.05. RESULTS: Contrary to our expectations, patients and controls did not show significant difference in their forward/backward micromovements while passively viewing alcohol or sexual content (p > 0.1). However, in line with our hypothesis, patients who relapsed several weeks following discharge from the rehabilitation program were significantly more reactive and more likely to lean back during the first seconds of viewing alcohol cues (p = 0.002). Further, "relapsers" were more likely to lean forward during exposure to sexual content than participants who remained abstinent (p < 0.001). CONCLUSIONS: Among individuals with AUD, there are distinct pattern of spontaneous movements that differentiate "abstainers" and "relapsers," findings that can be understood in light of existing data and theories on action tendencies.

Electrophysiological correlates of emotional crossmodal processing in binge drinking.

Emotional crossmodal integration (i.e., multisensorial decoding of emotions) is a crucial process that ensures adaptive social behaviors and responses to the environment. Recent evidence suggests that in binge drinking-an excessive alcohol consumption pattern associated with psychological and cerebral deficits-crossmodal integration is preserved at the behavioral level. Although some studies have suggested brain modifications during affective processing in binge drinking, nothing is known about the cerebral correlates of crossmodal integration. In the current study, we asked 53 university students (17 binge drinkers, 17 moderate drinkers, 19 nondrinkers) to perform an emotional crossmodal task while their behavioral and neurophysiological responses were recorded. Participants had to identify happiness and anger in three conditions (unimodal, crossmodal congruent, crossmodal incongruent) and two modalities (face and/or voice). Binge drinkers did not significantly differ from moderate drinkers and nondrinkers at the behavioral level. However, widespread cerebral modifications were found at perceptual (N100) and mainly at decisional (P3b) stages in binge drinkers, indexed by slower brain processing and stronger activity. These cerebral modifications were mostly related to anger processing and crossmodal integration. This study highlights higher electrophysiological activity in the absence of behavioral deficits, which could index a potential compensation process in binge drinkers. In line with results found in severe alcohol-use disorders, these electrophysiological findings show modified anger processing, which might have a deleterious impact on social functioning. Moreover, this study suggests impaired crossmodal integration at early stages of alcohol-related disorders.

Binge drinking in adolescents: a review of neurophysiological and neuroimaging research.

AIMS: While the relationship between chronic exposure to alcohol and neurobiological damage is well established, deleterious brain effects of binge drinking in youths have only recently been studied. METHODS: Narrative review of studies of brain disturbances associated with binge drinking as assessed by neuroimaging (EEG and IRMf techniques in particular) in adolescent drinkers. RESULTS: Some major points still deserved to be investigated; directions for future research are suggested. CONCLUSIONS: Information and prevention programs should emphasize that binge drinking is not just inoffensive social fun, but if carried on, may contribute to the onset of cerebral disturbances possibly leading to alcohol dependence later in life.

Understanding the Pathophysiology of Mental Diseases and Early Diagnosis Thanks to Electrophysiological Tools: Some Insights and Empirical Facts.

Objective. Neurophysiological tools remain indispensable instruments in the assessment of psychiatric disorders. These techniques are widely available, inexpensive and well tolerated, providing access to the assessment of brain functional alterations. In the clinical psychiatric context, electrophysiological techniques are required to provide important information on brain function. While there is an immediate benefit in the clinical application of these techniques in the daily routine (emergency assessments, exclusion of organic brain alterations), these tools are also useful in monitoring the progress of psychiatric disorders or the effects of therapy. There is increasing evidence and convincing literature to confirm that electroencephalography and related techniques can contribute to the diagnostic workup, to the identification of subgroups of disease categories, to the assessment of long-term causes and to facilitate response predictions. Methods and Results. In this report we focus on 3 different novel developments of the use of neurophysiological techniques in 3 highly prevalent psychiatric disorders: (1) the value of EEG recordings and machine learning analyses (deep learning) in order to improve the diagnosis of dementia subtypes; (2) the use of mismatch negativity in the early diagnosis of schizophrenia; and (3) the monitoring of addiction and the prevention of relapse using cognitive event-related potentials. Empirical evidence was presented. Conclusion. Such information emphasized the important role of neurophysiological tools in the identification of useful biological markers leading to a more efficient care management. The potential of the implementation of machine learning approaches together with the conduction of large cross-sectional and longitudinal studies was also discussed.

Intentional interruptions during compression only CPR: A scoping review.

Introduction: Out of hospital cardiac arrest (OHCA) remains one of the main causes of death among industrialized countries. The initiation of cardiopulmonary resuscitation (CPR) by laypeople before the arrival of emergency medical services improves survival. Mouth-to-mouth ventilation may constitute a hindering factor to start bystander CPR, while during continuous chest compressions (CCC) CPR quality decreases rapidly. The aim of this scoping review is to examine the existing literature on strategies that investigate the inclusion of intentional pauses during compression-only resuscitation (CO-CPR) to improve the performance in the context of single lay rescuer OHCA. Methods: The protocol of this Scoping review was prospectively registered in Open Science Framework (https://osf.io/rvn8j). A systematic search of PubMed, Scopus, EMBASE, CINAHL was performed. Results: Six articles were included. All studies were carried out on simulation manikins and involved a total of 1214 subjects. One study had a multicenter design. Three studies were randomized controlled simulation trials, the rest were prospective randomized crossover studies. The tested protocols were heterogeneous and compared CCC to CO-CPR with intentional interruptions of various length. The most common primary outcome was compressions depth. Compression rate, rescuers' perceived exertion and composite outcomes were also evaluated. Compressions depth and perceived exertion improved in most study groups while compression rate and chest compression fraction remained within guidelines indications. Conclusions: In simulation studies, the inclusion of intentional interruptions during CO-CPR within the specific scenario of single rescuer bystander CPR during OHCA may improve the rate of compressions with correct depth and lower rate of perceived exertion. Further high-quality research and feasibility and safety of protocols incorporating intentional interruptions during CO-CPR may be justified.

BOLD response to deviant face detection informed by P300 event-related potential parameters: a simultaneous ERP-fMRI study.

INTRODUCTION: Faces are multi-dimensional stimuli conveying parallel information about identity and emotion. Although event-related potential (ERP) studies have disclosed a P300 component in oddball responses to both deviant identity and emotional target faces, it is hypothesized that partially different neural processes should subtend emotion vs. identity within the core network of face processing. In the present study, we used simultaneous ERP-fMRI recordings and ERP-informed analysis of functional magnetic resonance imaging (fMRI) data to evidence the specific neural networks underlying P300 generation in response to different deviant emotional vs. identity faces. METHOD: 18 participants were scanned during a visual oddball task in which they had to detect 3 types of deviant faces representing a change in emotion-fear or happiness-or in identity, within a series of frequent neutral ones. Amplitude and latency parameters of the P300 component, recorded for each type of deviant faces, were used to constrain fMRI analyses. RESULTS: Analysis of fMRI data informed by single-trial parameters of the P300 component disclosed specific activation patterns for fearful, happy and identity deviant faces. For fearful faces, P300 amplitudes were associated with BOLD changes in the left fusiform gyrus whereas latencies were linked to left superior orbito-frontal and right fusiform activations. P300 amplitude modulations for happy deviant faces involved the left posterior cingulate gyrus and right parahippocampal regions whereas P300 latencies related to the right insula and left caudate regions. Finally, identity deviant faces were associated with widespread activities involving cortical and subcortical regions when P300 amplitudes were considered, and P300 latencies were associated with activity in right hippocampal/parahippocampal regions. DISCUSSION: Our results suggest the existence of differential cerebral functional processes involved in the responses to deviant face stimuli, depending on the quality of the deviance (fear vs. happiness vs. identity).

Decoding of emotional components in complex communicative situations (irony) and its relation to empathic abilities in male chronic alcoholics: an issue for treatment.

BACKGROUND: Previous research has shown that deficits in the domain of emotions strongly characterize alcoholism. Patients diagnosed with alcoholism show impairments in emotional mimic recognition, as well as in the domain of emotional prosody. These data suggest that male alcoholics might suffer from a generalized emotional impairment associated with dysfunctions in empathy. Taken altogether, those deficits might influence alcoholics' relational domain and their performance in complex communicative situations such as ironic interactions. The present study investigates the ability of chronic male alcoholics to recognize the emotional component of ironic contexts and its relation to the comprehension of ironic meaning as a function of their empathic abilities. METHODS: Forty-four male subjects participated in a story comprehension task. They were asked to read stories with either an ironic or a nonironic ending. Participants were asked to fill in a questionnaire about communicative intentions and the emotional states of the stories' characters. Moreover, the correct comprehension of the ironic meaning was assessed through a self-reported questionnaire and related to the empathy quotient (EQ) which was measured in a preexperimental phase. RESULTS: Alcoholic subjects showed a lower EQ in comparison to healthy subjects and recognized significant fewer ironic endings. Social skills results were particularly impaired. The correlation between EQ and ironic endings recognition was significant. Moreover, alcoholics showed a tendency to attribute positive emotions to both ironic and nonironic contexts, showing an opposite pattern in comparison with control subjects who tended to associate negative emotions to ironic contexts. CONCLUSIONS: The present study indicates that emotional recognition deficits that have been previously observed in chronic alcoholics extend to complex interactive contexts. This deficit is associated with a more general impairment of empathy, especially in its social skill component. Clinical implications of the present results are discussed.

Fear of negative evaluation and attentional bias for facial expressions: an event-related study.

Numerous studies have shown an exacerbation of attentional bias towards threat in anxiety states. However, the cognitive mechanisms responsible for these attentional biases remain largely unknown. Further, the authors outline the need to consider the nature of the attentional processes in operation (hypervigilance, avoidance, or disengagement). We adapted a dot-probe paradigm to record behavioral and electrophysiological responses in 26 participants reporting high or low fear of evaluation, a major component of social anxiety. Pairs of faces including a neutral and an emotional face (displaying anger, fear, disgust, or happiness) were presented during 200 ms and then replaced by a neutral target to discriminate. Results show that anxious participants were characterized by an increased P1 in response to pairs of faces, irrespective of the emotional expression included in the pair. They also showed an increased P2 in response to angry-neutral pairs selectively. Finally, in anxious participants, the P1 response to targets was enhanced when replacing emotional faces, whereas non-anxious subjects showed no difference between the two conditions. These results indicate an early hypervigilance to face stimuli in social anxiety, coupled with difficulty in disengaging from threat and sustained attention to emotional stimuli. They are discussed within the framework of current models of anxiety and psychopathology.

A Comparative Event-Related Potentials Study between Alcohol Use Disorder, Gambling Disorder and Healthy Control Subjects through a Contextual Go/NoGo Task.

(1) Background: Inhibitory and rewarding processes that mediate attentional biases to addiction-related cues may slightly differ between patients suffering from alcohol use (AUD) or gambling (GD) disorder. (2) Methods: 23 AUD inpatients, 19 GD patients, and 22 healthy controls performed four separate Go/NoGo tasks, in, respectively, an alcohol, gambling, food, and neutral long-lasting cueing context during the recording of event-related potentials (ERPs). (3) Results: AUD patients showed a poorer inhibitory performance than controls (slower response latencies, lower N2d, and delayed P3d components). In addition, AUD patients showed a preserved inhibitory performance in the alcohol-related context (but a more disrupted one in the food-related context), while GD patients showed a specific inhibitory deficit in the game-related context, both indexed by N2d amplitude modulations. (4) Conclusions: Despite sharing common addiction-related mechanisms, AUD and GD patients showed different patterns of response to (non-)rewarding cues that should be taken into account in the therapeutic context.

Rhabdomyolysis as cause, consequence, or mimicker of myocardial infarction: A case report.

Key Clinical Message: A timely diagnosis is essential to start appropriate therapy and to reduce risks of life-threatening complications of rhabdomyolysis. Some cases can undergo differential diagnosis with other clinical conditions, e.g., myocardial infarction. Abstract: We present the case of a 65-years-old male who was admitted to the emergency department with a clinical presentation related to myocardial infarction. The patient underwent coronary angioplasty and was then admitted to ICU due to hemodynamical instability, elevated potassium levels, and anuria. Further investigations revealed rhabdomyolysis. The patient received vasopressors, oxygenation support and renal replacement therapy. Outcomes at ICU discharge were favorable. The temporal association between rhabdomyolysis and myocardial infarction, together with an unclear pathophysiological relationship, made differential diagnosis difficult. We discuss this uncertainty in light of published literature.

Cognitive training and remediation interventions for substance use disorders: a Delphi consensus study.

AIMS: Substance use disorders (SUD) are associated with cognitive deficits that are not always addressed in current treatments, and this hampers recovery. Cognitive training and remediation interventions are well suited to fill the gap for managing cognitive deficits in SUD. We aimed to reach consensus on recommendations for developing and applying these interventions. DESIGN, SETTING AND PARTICIPANTS: We used a Delphi approach with two sequential phases: survey development and iterative surveying of experts. This was an on-line study. During survey development, we engaged a group of 15 experts from a working group of the International Society of Addiction Medicine (Steering Committee). During the surveying process, we engaged a larger pool of experts (n = 54) identified via recommendations from the Steering Committee and a systematic review. MEASUREMENTS: Survey with 67 items covering four key areas of intervention development: targets, intervention approaches, active ingredients and modes of delivery. FINDINGS: Across two iterative rounds (98% retention rate), the experts reached a consensus on 50 items including: (i) implicit biases, positive affect, arousal, executive functions and social processing as key targets of interventions; (ii) cognitive bias modification, contingency management, emotion regulation training and cognitive remediation as preferred approaches; (iii) practice, feedback, difficulty-titration, bias modification, goal-setting, strategy learning and meta-awareness as active ingredients; and (iv) both addiction treatment work-force and specialized neuropsychologists facilitating delivery, together with novel digital-based delivery modalities. CONCLUSIONS: Expert recommendations on cognitive training and remediation for substance use disorders highlight the relevance of targeting implicit biases, reward, emotion regulation and higher-order cognitive skills via well-validated intervention approaches qualified with mechanistic techniques and flexible delivery options.

Sex differences on emotional processing are modulated by subclinical levels of alexithymia and depression: a preliminary assessment using event-related potentials.

Several studies have suggested that women are more sensitive than men to emotions in general. Event-related potential (ERP) studies have demonstrated N2 and P3b modulations, suggesting that women allocate more attentional resources to emotions than men do. However, the exact origin of this emotional modulation by sex is still a matter of debate. We wondered whether these sex differences might be due to some specific personality traits of women and men. Thirty participants (15 males and 15 females) were selected so that there were no sex differences on alexithymia, or depression and anxiety scales. The participants were asked to complete a "modified emotional" oddball task, in which they had to detect deviant stimuli among frequent neutral ones as quickly as possible. Behavioral performance, N2 and P3b ERP data were analyzed. When personality factors were controlled for, the sex differences on N2 and P3b components of the ERPs disappeared. Moreover, linear regression analyses showed that alexithymia was much better than sex at predicting the N2 latencies, while depression was the best factor for predicting the P3b latency. These results suggest that personality factors should be taken into account when sex differences on emotional processing are investigated.

Comparison of Neural Correlates of Reactive Inhibition in Cocaine, Heroin, and Polydrug Users through a Contextual Go/No-Go Task Using Event-Related Potentials.

Recent global data indicates a worldwide increase in polydrug use associated with a shift from recreational to productive habits of consumption. Such non-responsible abuse of substances (alcohol, cocaine, heroin, etc.) is likely to lead to addictive disorders that are characterized by various neuropsychopharmacological effects. A main cognitive function involved in the onset and long-term maintenance of addiction is reactive inhibition, i.e., the ability to withhold a prepotent motor dominant response. In the present study, 63 (poly)drug user patients who were undergoing a detoxification program, in addition to 19 healthy controls matched for gender, age, and education, were subjected to a "contextual Go/No-Go task" with concomitant electroencephalography. Stimuli were superimposed on three contextual backgrounds: control (black screen), drug-unrelated (neutral pictures), or drug-related (pictures related to drug consumption). Of these patients, 23 were cocaine users (CU), 21 were heroin users (HU), and 19 were polydrug users (PDU). The main results showed that (1) at the behavioral level, more commission errors occurred with the PDU patients compared to the healthy controls; (2) at the neurophysiological level, specific alterations were found on classical event-related potentials that index reactive inhibition. Indeed, the higher rate of errors in the PDU group was subtended by both reduced amplitude and latency on the ∆N2 component and increased ∆P3 latency compared to controls. These data clearly suggest a more deleterious impact of polydrug use on inhibitory functions. In addition, our results provide evidence of reduced ERN amplitude in cocaine users, suggesting that impaired performance monitoring and error-processing may support impaired awareness, thereby preventing these patients from changing their behaviors.

Proactive and Reactive Inhibitory Control Strategies: Exploring the Impact of Interindividual Variables on an ERP Continuous Performance Task (AX-CPT).

According to the Dual Mechanisms of Control (DMC) framework, cognitive control can be divided into two strategies: proactive cognitive control, which relies mainly on the active maintenance of contextual information relevant to the ongoing task; and reactive cognitive control, which is a form of transient control triggered by an external cue. Although cognitive control has been studied extensively, little is known about the specificities of inhibition within the framework of the DMC model and the influence of interindividual variables on inhibitory control.Thanks to an inhibitory version of the continuous performance task (CPT), we studied behavioral performances and Event-Related Potentials (ERPs) related to proactive and reactive inhibition, and their links to psychological profile and cognitive performances. One hundred and five young adults underwent the task, along with a short clinical and cognitive evaluation.We were able to observe ERPs related to proactive (cue-N1, cue-N2, cue-P3, and the contingent negative variation) and reactive inhibitory control (target-N2 and target-P3). Our results showed that proactive strategies appeared to be linked with impulsivity, working memory abilities, dominant response inhibition, gender, and the consumption pattern of nicotine. Reactive strategies appeared to be linked with attentional and working memories abilities.Overall, the inhibitory AX-CPT allowed a specific investigation of cognitive control within the framework of the DMC based on behavioral and ERP variables. This provided us an opportunity to investigate the principal ERP components related to proactive and reactive inhibitory control strategies as well as to link them with specific clinical and cognitive variables.

The neural network sustaining the crossmodal processing of human gender from faces and voices: an fMRI study.

The aim of this fMRI study was to investigate the cerebral crossmodal interactions between human faces and voices during a gender categorization task. Twelve healthy male participants took part to the study. They were scanned in 4 runs that contained 3 conditions consisting in the presentation of faces, voices or congruent face-voice pairs. The task consisted in categorizing each trial (visual, auditory or associations) according to its gender (male or female). The subtraction between the bimodal condition and the sum of the unimodal ones showed that categorizing face/voice associations according to their gender produced unimodal activations of the visual (right calcarine sulcus) and auditory regions (bilateral superior temporal gyri), and specific supramodal activations of the left superior parietal gyrus and the right inferior frontal gyrus. Moreover, psychophysiological interaction analyses (PPI) revealed that both unimodal regions were inter-connected and connected to the prefrontal gyrus and the putamen, and that the left parietal gyrus had an enhanced connectivity with a parieto-premotor circuit involved in the crossmodal control of attention. This fMRI study showed that the crossmodal auditory-visual categorization of human gender is sustained by a network of cerebral regions highly similar to those observed in our previous studies examining the crossmodal interactions involved in face/voice recognition (Joassin et al., 2010). This suggests that the crossmodal processing of human stimuli requires the activation of a network of cortical regions, including both unimodal visual and auditory regions and supramodal parietal and frontal regions involved in the integration of both faces and voices and in the crossmodal attentional processes, and activated independently from the task to perform or the cognitive level of processing.

Dissociation between affective and cognitive empathy in alcoholism: a specific deficit for the emotional dimension.

BACKGROUND: Emotional impairments constitute a crucial and widely described dimension of alcoholism, but several affective abilities are still to be thoroughly explored among alcohol-dependent patients. This is particularly true for empathy, which constitutes an essential emotional competence for interpersonal relations and has been shown to be highly impaired in various psychiatric states. The present study aimed at exploring empathic abilities in alcoholism, and notably the hypothesis of a differential deficit between emotional and cognitive empathy. METHODS: Empathy abilities were evaluated among 30 recently detoxified inpatients diagnosed with alcohol dependence and 30 paired healthy controls, using highly validated questionnaires (Interpersonal Reactivity Index [J Pers Soc Psychol44:113] and Empathy Quotient [J Autism Dev Disord34:163]). Correlational analyses were performed to evaluate the links between empathy scores and psychopathological measures (i.e., depression, anxiety, interpersonal problems, and alexithymia). RESULTS: When psychiatric comorbities are controlled for, alcoholism is not associated with a general empathy deficit, but rather with a dissociated pattern combining impaired emotional empathy and preserved cognitive one. Moreover, this emotional empathy deficit is not associated with depression or anxiety scores, but is negatively correlated with alexithymia and the severity of interpersonal problems. CONCLUSIONS: At the theoretical level, this first observation of a specific deficit for emotional empathy in alcoholism, combined with the exact inverse pattern observed in other psychiatric populations, leads to a double-dissociation, which supports the notion that emotional and cognitive empathy are 2 distinct abilities. At the clinical level, this deficit calls for considering emotional empathy rehabilitation as a crucial concern in psychotherapy.