Hostile attributional biases in severe alcohol use disorder: replication, gender specificity, and mechanistic insights.

AIMS: Despite their importance in the emergence and persistence of severe alcohol use disorder (SAUD), social cognition impairments remain understudied in this population. Hostile attributional biases (HAB), a key component of social cognition, may be involved in interpersonal problems and SAUD maintenance. However, current evidence for HAB in SAUD is highly preliminary, as it relies on a single study based on a small sample and on a task that cannot dissociate increased hostile from reduced benign attributions. We therefore used an improved methodology to further characterize this bias and disentangle underlying mechanisms. In addition, we explored potential gender differences. METHOD: A total of 56 patients (28 women) diagnosed with SAUD and 66 (27 women) demographically matched controls completed the Word-Sentence Association Paradigm-Hostility, which provides a valid, spontaneous, and relatively implicit assessment of both hostile and benign social attributions related to ambiguous situations. They also completed self-report measures of psychopathology and interpersonal problems. RESULTS: At the group-level, patients with SAUD presented higher HAB than controls, without group differences for benign attributions. Gender analyses revealed that this effect selectively emerged in men with SAUD. Further, patients' benign attributions did not differ from their hostile attributions. Finally, HAB (not benign attributions) were associated with interpersonal problems and state anxiety in patients. CONCLUSIONS: The association between SAUD and HAB at the group level is genuine and replicable across samples and tasks. This association may further selectively emerge in men. Our results also confirm the functional significance of HAB in SAUD, and point to potential mechanisms and clinical recommendations.

Metadehumanization, fundamental needs and coping strategies: A comparison of drinkers at low versus high risk of alcohol use disorder.

The interpersonal difficulties documented in chronic excessive drinking might foster the progression toward severe alcohol use disorder (SAUD). Characterizing these interpersonal difficulties and their commonalities with patients already presenting a diagnosed SAUD is needed to develop targeted prophylactic interventions. Patients with SAUD present metadehumanization (i.e., the perception of being considered as less than human by others), which is associated with deleterious consequences (e.g., reduced fundamental needs satisfaction, increased negative emotions, reduced self-esteem, disrupted coping strategies) involved in the persistence of this disorder. No study has investigated metadehumanization among individuals not diagnosed with SAUD but at high risk of alcohol use disorder. We measured metadehumanization, emotions, self-esteem, coping strategies, and fundamental needs threat among such high-risk drinkers (N = 86; AUDIT score higher than 15), and matched low-risk drinkers (N = 100, AUDIT score <8). Compared to low-risk drinkers, high-risk drinkers felt more dehumanized and reported increased fundamental needs threat, negative emotions, anxiety, depression, and more frequent use of both adaptive and maladaptive coping strategies, including alcohol use. Mediation analyses controlling for anxiety/depression revealed that the differences in emotions and coping strategies were explained by metadehumanization and fundamental needs threat. Despite not being diagnosed with SAUD and being untreated, high-risk drinkers are more similar to patients with SAUD than to low-risk drinkers. In view of its links with factors favoring SAUD, metadehumanization should be considered in experimental studies among high-risk drinkers and treated by specific interventions.

Altered attentional processing of facial expression features in severe alcohol use disorder: An eye-tracking study.

Social cognition impairments, and notably emotional facial expression (EFE) recognition difficulties, as well as their functional and clinical correlates, are increasingly documented in severe alcohol use disorder (SAUD). However, insights into their underlying mechanisms are lacking. Here, we tested if SAUD was associated with alterations in the attentional processing of EFEs. In a preregistered study, 40 patients with SAUD and 40 healthy controls (HCs) had to identify the emotional expression conveyed by faces while having their gaze recorded by an eye-tracker. We assessed indices of initial (first fixation locations) and later (number of fixations and dwell-time) attention with reference to regions of interest corresponding to the eyes, mouth, and nose, which carry key information for EFE recognition. We centrally found that patients had less first fixations to key facial features in general, as well as less fixations and dwell time to the eyes specifically, relative to the rest of the face, compared to controls. These effects were invariant across emotional expressions. Additional exploratory analyses revealed that patients with SAUD had a less structured viewing pattern than controls. These results offer novel, direct, evidence that patients with SAUD's socioaffective difficulties already emerge at the facial attentional processing stage, along with precisions regarding the nature and generalizability of the effects. Potential implications for the mechanistic conceptualization and treatment of social cognition difficulties in SAUD are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Craving modulates attentional bias towards alcohol in severe alcohol use disorder: An eye-tracking study.

BACKGROUND AND AIMS: Competing models disagree on three theoretical questions regarding alcohol-related attentional bias (AB), a key process in severe alcohol use disorder (SAUD): (1) is AB more of a trait (fixed, associated with alcohol use severity) or state (fluid, associated with momentary craving states) characteristic of SAUD; (2) does AB purely reflect the over-activation of the reflexive/reward system or is it also influenced by the activity of the reflective/control system and (3) does AB rely upon early or later processing stages? We addressed these issues by investigating the time-course of AB and its modulation by subjective craving and cognitive load in SAUD. DESIGN: A free-viewing eye-tracking task, presenting pictures of alcoholic and non-alcoholic beverages, combined with a concurrent cognitive task with three difficulty levels. SETTING: A laboratory setting in the detoxification units of three Belgian hospitals. PARTICIPANTS: We included 30 patients with SAUD self-reporting craving at testing time, 30 patients with SAUD reporting a total absence of craving and 30 controls matched on sex and age. All participants from SAUD groups met the DSM-5 criteria for SAUD. MEASUREMENTS: We assessed AB through early and late eye-tracking indices. We evaluated the modulation of AB by craving (comparison between patients with/without craving) and cognitive load (variation of AB with the difficulty level of the concurrent task). FINDINGS: Dwell time measure indicated that SAUD patients with craving allocated more attention towards alcohol-related stimuli than patients without craving (P < 0.001, d = 1.093), resulting in opposite approach/avoidance AB according to craving presence/absence. SAUD patients without craving showed a stronger avoidance AB than controls (P = 0.003, d = 0.806). AB did not vary according to cognitive load (P = 0.962, η2 p = 0.004). CONCLUSIONS: The direction of alcohol-related attentional bias (approach/avoidance) appears to be determined by patients' subjective craving at testing time and does not function as a stable trait of severe alcohol use disorder. Alcohol-related attentional bias appears to rely on later/controlled attentional stages but is not modulated by the saturation of the reflective/control system.

Rejection sensitivity in severe alcohol use disorder: Increased anxious anticipation of rejection.

Rejection sensitivity (RS) reflects the disposition to anxiously expect, readily perceive, and disproportionately react to rejection. It is linked to interpersonal problems and psychopathological symptoms, which are frequent in severe alcohol use disorder (SAUD) and are known to influence clinical outcomes. Consequently, RS has been put forward as a process of interest in this disorder. However, empirical studies investigating RS in SAUD are scarce and focused on its last two components, leaving the core process of anxious expectations of rejection unexplored. To fil this gap, 105 patients with SAUD and 73 age-and-gender-matched controls completed the validated Adult Rejection Sensitivity Scale. We computed anxious anticipation (AA), and rejection expectancy (RE) scores, corresponding to the affective and cognitive dimensions of anxious expectations of rejection, respectively. Participants also completed measures of interpersonal problems and psychopathological symptoms. We found that patients with SAUD had higher AA (affective dimension) but not RE (cognitive dimension) scores. Moreover, AA was associated with interpersonal problems as well as psychopathological symptoms in the SAUD sample. These findings meaningfully extend the RS and social cognition literatures in SAUD by showing that difficulties already arise at the anticipatory stage of socio-affective information processing. Moreover, they shed light on the affective component of anxious expectations of rejection as a novel, clinically relevant process in this disorder.

Tell me how you feel, I will tell you what you look at: Impact of mood and craving on alcohol attentional bias in binge drinking.

BACKGROUND: Alcohol-related attentional bias (AB) is thought to play a key role in the emergence and maintenance of excessive alcohol use. Recent models suggest that AB, classically considered as a permanent feature in alcohol use disorders, is rather modulated by temporary motivational states. AIMS: We explored the influence of current mood and craving on AB in binge drinking, through a mood induction procedure combined with eye-tracking measures of AB. METHODS: In Experiment 1, we measured AB (visual probe task with eye-tracking measures) among binge drinkers (n = 48) and light drinkers (n = 32) following positive, negative and neutral mood inductions. Participants reported subjective craving and mood before/after induction. In Experiment 2, we measured AB among the same binge drinkers compared with 29 moderate drinkers following alcohol-related negative, non-alcohol-related negative and neutral mood inductions. RESULTS: In Experiment 1, induced negative mood and group positively predicted subjective craving, which was positively associated with AB. We found no effect of induced positive mood nor a direct mood-AB association. In Experiment 2, the relationships AB presented with both induced negative mood and group were again mediated by craving. Inducing alcohol-related negative mood did not modify the mood-craving association. CONCLUSIONS: Alcohol-related AB is not a stable binge drinking characteristic but rather varies according to transient motivational (i.e., craving) and emotional (i.e., negative mood) states. This study provides important insights to better understand AB in subclinical populations and emphasizes the importance of considering motivational and affective states as intercorrelated, to offer multiple ways to reduce excessive alcohol use.

An eye-tracking study of biased attentional processing of emotional faces in severe alcohol use disorder.

BACKGROUND: Social cognition impairments in severe alcohol use disorder (SAUD) are increasingly established. However, fundamental aspects of social cognition, and notably the attentional processing of socio-affective information, remain unexplored, limiting our understanding of underlying mechanisms. Here, we determined whether patients with SAUD show attentional biases to specific socio-affective cues, namely emotional faces. METHOD: In a modified dot-probe paradigm, 30 patients with SAUD and 30 demographically matched healthy controls (HC) were presented with pairs of neutral-emotional (angry, disgusted, happy, sad) faces while having their eye movements recorded. Indices of early/automatic (first fixations, latency to first fixations) and later/controlled (number of fixations, dwell-time) processes were computed. RESULTS: Patients with SAUD did not differ from HC in their attention to angry/disgusted/sad vs. neutral faces. However, patients with SAUD fixated/dwelled less on happy vs. neutral faces in the first block of stimuli than HC, who presented an attentional bias to happy faces. LIMITATIONS: Sample-size was determined to detect medium-to-large effects and subtler ones may have been missed. Further, our cross-sectional design provides no explanation as to whether the evidenced biases precede or are a consequence of SAUD. CONCLUSIONS: These results extend the social cognition literature in SAUD to the attentional domain, by evidencing the absence of a controlled attentional bias toward positive social cues in SAUD. This may reflect reduced sensitivity to social reward and could contribute to higher order social cognition difficulties and social dysfunction.

Tasks and investigated components in social cognition research among adults with alcohol use disorder: A critical scoping review.

OBJECTIVE: Social cognition research in alcohol use disorder (AUD) has accumulated over the past decades and has implications for understanding the interpersonal problems reported in this population and for improving clinical outcomes. However, recent criticism of classically used social cognition tasks calls for an evaluation of social cognition assessments in AUD. Moreover, available literature reviews focus on a restricted subset of social cognition components, leaving the outcomes and significance of studies assessing the remaining components unknown. Hence, to qualify and broaden our understanding of the available evidence and identify research perspectives, we systematically charted and critically appraised the tasks used and social cognition components investigated in AUD. METHOD: We searched databases for studies comparing patients with AUD and healthy controls on behavioral social cognition assessments. We extracted the number of times specific social cognition components were investigated and the tasks assessing them. RESULTS: Of the 74 included records, 58 investigated emotion recognition, 14 investigated theory of mind (ToM), three investigated social perception/knowledge, and two investigated attributional biases. Most emotion recognition tasks required complex categorization, and presented unimodal static and context-free emotional stimuli among verbal labels. ToM was mostly assessed with the reading the mind in the eyes and faux-pas tests. CONCLUSIONS: Emotion recognition and ToM have been extensively investigated yet most tasks are multidetermined, lack ecological validity, or fail to assess the targeted ability. Conversely, social perception/knowledge and attributional biases, despite their clear relevance to AUD, are insufficiently studied. We propose concrete ways to address these issues. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Greater self-oriented and socially prescribed perfectionism in severe alcohol use disorder.

BACKGROUND: Perfectionistic individuals present exaggerated performance standards, generating a constant search for flawlessness and a high tendency to self-criticize. Dominant models distinguish three dimensions of perfectionism: namely, self-oriented, socially prescribed and other-oriented. Perfectionism constitutes a vulnerability factor for psychopathological disorders, but its role in severe alcohol use disorder (SAUD) remains unexplored. METHODS: Sixty-five recently detoxified patients with SAUD and 65 matched controls completed a perfectionism questionnaire (the Hewitt Multidimensional Perfectionism Scale), together with measures of psychopathology. RESULTS: SAUD was associated with greater self-oriented and socially prescribed perfectionism, with no group differences on other-oriented perfectionism. This differential pattern persisted when controlling for depression and anxiety levels, and there was no correlation with alcohol consumption. CONCLUSION: This specific perfectionistic profile is consistent with those of previous studies showing lower self-evaluation (e.g., higher self-blame and reduced self-esteem) and impaired social cognition (e.g., unrealistic social standards and greater social isolation) in SAUD. In view of its potential role in the development and maintenance of SAUD, perfectionism may constitute a valuable treatment target in patients with this disorder.

Longitudinal Assessment of Alcohol Consumption throughout the First COVID-19 Lockdown: Contribution of Age and Pre-Pandemic Drinking Patterns.

INTRODUCTION: The COVID-19 outbreak and the related lockdown measures have raised concerns regarding mental health, including alcohol misuse. Preliminary studies investigated alcohol consumption at the early stages of lockdown, but no longitudinal data regarding its evolution during and after the first lockdown are currently available. METHODS: We investigated changes in alcohol consumption among a convenience sample of 1,693 French-speaking Belgian adults using a 3-stage longitudinal online survey. All participants reported their consumption at different stages of lockdown: before lockdown onset (retrospectively, T0), at 2 different times during lockdown (T1 and T2), and after lockdown offset (T3). We also measured socio-demographic variables and the harmfulness of drinking patterns before lockdown. RESULTS: A mixed model with negative binomial distribution indicated that participants decreased their alcohol consumption after lockdown onset and returned to their initial alcohol consumption after lockdown offset. Younger individuals (18-30 years old) were more likely to decrease their consumption during the lockdown period (T1 and T2) than the periods preceding or following lockdown (T0 and T3), especially if they presented hazardous or problematic drinking patterns before lockdown. We only observed a rebound effect after lockdown offset among young moderate drinkers. All participants kept stable their alcohol consumption during lockdown (T1 and T2). CONCLUSIONS: Lockdown onset and offset constitute key periods for alcohol consumption changes during the COVID-19 crisis, particularly in youth and in individuals with hazardous or problematic drinking patterns.

Social perception and knowledge impairments in severe alcohol use disorder: Group and individual-level findings.

BACKGROUND: Consistent data highlight the presence and clinical significance of social cognition impairments in severe alcohol use disorder (SAUD). However, social perception and knowledge (i.e., the ability to interpret social situations and to identify latent social rules), an important social cognition component, has not yet been explored in this disorder. METHOD: 35 patients with SAUD and 35 healthy controls (HC) completed the Social Perception and Knowledge test (PerSo), an experimental task requiring participants to comprehensively describe social situations and to identify the social rules illustrated in 8 pictures. We performed group and single-case analyses. RESULTS: Patients with SAUD, as a group, spontaneously identified less relevant "where"/"who"/"what" aspects of the social situations (social perception) than HC. They were however able to provide these elements when explicitly asked to. They were also less able to identify the social rules that subtended the situations (social knowledge). Single-case analyses revealed that 23 % of patients were significantly impaired for social perception, and 34 % for social knowledge. DISCUSSION: We provide novel evidence that SAUD is associated with social perception and knowledge impairments at the group level, and that these impairments strongly vary across patients. Such results should lead to the integration of social perception and knowledge impairments in the conceptualization and treatment of socio-affective difficulties in SAUD.

Social decision making in severe alcohol use disorder: Scoping review and experimental perspectives.

BACKGROUND: Patients with severe alcohol use disorder (SAUD) demonstrate multifaceted impairments in social cognition abilities, including emotional decoding or Theory of Mind. Such impairments are associated with real-life interpersonal difficulties, which in turn could contribute to the persistence of SAUD. However, little is known regarding how patients with SAUD make decisions in a social context and this literature has not been comprehensively reviewed. OBJECTIVES: The main aim of this paper was to conduct the first review specifically focusing on social decision-making abilities in SAUD. Following PRISMA guidelines for scoping reviews, we describe existing knowledge regarding the difficulties experienced by patients with SAUD during social interactions. Our second objective was to propose perspectives for future research, based on the shortcomings identified in the available literature. DESIGN: We searched three online databases (PubMed, PsycINFO, and Scopus) and identified 14 papers using behavioral tasks to assess social decision making in patients with SAUD. RESULTS: Included studies assessed social decision making through three paradigms: (1) economic games (four papers), (2) moral dilemmas (four papers), and (3) interpersonal problem-solving (six papers). Results indicated that patients with SAUD behave differently from controls in all three paradigms. CONCLUSIONS: Previous studies suggested large-scale social decision-making impairments or biases in SAUD. However, in light of the limited number of studies available and of the restricted set of processes measured, we call for the extension of this field through more ecologically relevant and model-based paradigms in order to elucidate the underlying mechanisms of these effects.

Alcohol-related attentional biases in recently detoxified inpatients with severe alcohol use disorder: an eye-tracking approach.

BACKGROUND: Dominant theoretical models consider that attentional biases (AB) towards alcohol-related stimuli play a key role in the development and maintenance of alcohol use disorder (AUD). Their assessment has however showed high inconsistencies and has been mostly based on unreliable behavioral measures. This study evaluated the presence and extent of alcohol-related AB in recently detoxified inpatients with severe AUD by combining the visual probe task (VPT) paradigm with eye-tracking measures, known to improve the VPT reliability in subclinical populations. METHODS: We recruited 24 patients and 27 matched healthy controls. They performed the VPT (measuring reaction time when processing visual targets preceded by alcoholic and matched non-alcoholic pictures) combined with eye-tracking measures (dwell time, first fixation direction/duration, second fixation direction) during two sessions. Estimates of internal consistency, split-half reliability, and test-retest reliability were measured. RESULTS: Patients showed shorter dwell time for alcohol cues (p = .004, d=.853) and reduced number of fixations towards alcohol after a first fixation on non-alcohol cues (p = .012, d=.758) compared to controls. These findings suggest the presence of alcohol-related avoidance AB in detoxified patients with severe AUD. The VPT achieved excellent reliability for these eye-tracking measures. Reaction times and first fixation measures did not indicate any AB pattern and showed poor reliability. CONCLUSIONS: The VPT, when combined with dwell time and second fixation direction, constitutes a reliable method for assessing AB in detoxified patients. It showed the presence of an alcohol-related avoidance bias in this clinical population, in contradiction with the approach bias predicted by theoretical models.

Alcohol consumption changes during the first COVID-19 lockdown: an online population survey in a convenience sample of French-speaking Belgian residents.

An online survey among French-speaking Belgians (N=7711) investigated self-reported changes in alcohol consumption during the first COVID-19-related lockdown (March 17th - May 4th 2020). Population-weighted estimates indicated that 31.37% of the population increased consumption during lockdown, 30.32% decreased consumption and 38.31% reported unchanged consumption. The magnitude of change was higher for "decreasers" than "increasers", resulting in a slight reduction in overall consumption. A multiple regression analysis revealed that age, occupational status, number of cohabitants, perceived alcohol accessibility, drinking motivations and previous consumption predicted consumption changes. The lockdown was thus associated with consumption modifications among French-speaking Belgians, without a prevailing direction of change.

Alcohol consumption changes following COVID-19 lockdown among French-speaking Belgian individuals at risk for alcohol use disorder.

We investigated changes in alcohol consumption following the COVID-19 lockdown among French-speaking Belgian individuals at risk for severe alcohol use disorder. Participants (N = 299) at risk for alcohol use disorder (AUD, i.e., score higher than 19 at the Alcohol Use Disorder Identification Test), and 299 moderate drinkers (MOD, i.e., score lower than 8) individually matched for age, gender and education provided self-reports of alcohol consumption changes (i.e., number of alcohol units consumed during a typical week before and during lockdown). AUD were more likely (91.31%) than MOD (71.57%) to modify their consumption following lockdown (p < 0.0001). They were more likely to decrease (65.89% vs. 35.12%, p < 0.0001) and less likely to increase (25.42% vs. 36.45%, p = 0.004) their consumption than MOD. Analyses of post-pre lockdown differences in alcohol consumption showed that AUD presented a stronger decrease than MOD (-13.97 units/week vs. -0.07, p < 0.0001). Among individuals who decreased consumption, AUD decreased more (-27.92 vs. -2.74, p < 0.0001) than MOD. Among those who increased consumption, AUD increased more (17.32 vs. 2.44, p < 0.0001) than MOD. We thus observed sharp consumption increases or conversely abrupt decreases in individuals at high risk of alcohol use disorder, underscoring the need to develop prophylactic interventions for this population during such sanitary crises, to avoid brutal changes of the alcohol consumption pattern. Efforts should be made to mitigate consumption increases but also to favor progressive rather than sudden decreases in order to prevent damaging withdrawal symptoms.

Prior drinking motives predict alcohol consumption during the COVID-19 lockdown: A cross-sectional online survey among Belgian college students.

The global outbreak of coronavirus disease 2019 (COVID-19) and the resulting lockdown measures have raised concerns regarding their effect on alcohol consumption. We investigated alcohol use during lockdown in a population of college students, usually characterized by social and heavy drinking. We also tested the predictive role of pre-lockdown drinking motives on alcohol consumption during lockdown. We collected data from 1951 French-speaking Belgian students during the lockdown period (April 1st - May 3rd, 2020) through a cross-sectional online survey. Participants self-reported their daily alcohol consumption (1) during a typical week in normal circumstances (i.e., before lockdown), and (2) since lockdown onset. We also assessed drinking motives and severity of alcohol use before lockdown. Our findings showed that 68.2% of the sample reported a lower alcohol consumption during lockdown compared to before lockdown, 17.2% conversely reporting a higher consumption. Enhancement, social and coping motives were all associated with heavy drinking before lockdown. Enhancement and social motives predicted lower alcohol consumption during lockdown among heavy drinkers. Conversely, coping motives, as well as social motives among low drinkers, predicted higher consumption during lockdown. Conformity motives, as well as enhancement motives among low and moderate drinkers, did not predict alcohol consumption before or during lockdown. Overall, several pre-lockdown drinking motives reliably predicted alcohol consumption during lockdown and could thus be used to identify at-risk populations and to tailor intervention programs on alcohol misuse during sanitary crises.

Tackling heterogeneity: Individual variability of emotion decoding deficits in severe alcohol use disorder.

BACKGROUND: Severe alcohol use disorder (SAUD) is associated with social cognition deficits. Patients with SAUD are impaired for the recognition of emotional facial expressions, particularly at early stages of abstinence. These deficits damage interpersonal relations and increase relapse risk. However, uncertainties still abound on their variation across emotions and on the heterogeneity of emotional impairments across patients. We addressed these questions by exploring how the deficit varies according to emotions' type/intensity and patients' heterogeneity. METHODS: Sixty-five recently detoxified patients with SAUD and 65 matched healthy controls performed the Facial Emotion Recognition Test, assessing the ability to identify six emotions (anger, contempt, disgust, fear, happiness, sadness) displayed by morphed faces with various intensities. Accuracy scores and detection thresholds were collected for each emotion. Beyond group comparisons, multiple single-case analyses determined the percentage of patients presenting decoding deficits for each emotion. RESULTS: When current depression and anxiety symptoms were controlled for, patients did not present a general emotion decoding deficit, but were rather characterized by specific deficits for disgust/contempt in accuracy, and for disgust in detection threshold scores. Single-case analyses showed that only a third of patients presented a clinically significant emotional deficit. CONCLUSIONS: Patients with SAUD only present emotional decoding deficits for specific interpersonal emotions (disgust/contempt) when subclinical psychopathological states are controlled for, and show no general emotional impairment. This goes against the proposal of a generalized social cognition deficit in this population. This group effect moreover masks a massive heterogeneity across patients, which has implications at experimental and clinical levels.

Hostile attributional bias in severe alcohol use disorder.

Impairments in social cognition have been documented in severe alcohol use disorder (SAUD) over the past two decades. They have been linked with lower social functioning and poor treatment outcomes, illustrating their key role in the disorder. However, studies investigating social cognition in SAUD have largely focused on emotional decoding and theory of mind abilities, neglecting other important processes. We expand this line of research by exploring the association between SAUD and hostile attributional biases (i.e., the tendency to attribute hostile intentions to others), another clinically relevant subcomponent of social cognition. Thirty-five patients with SAUD and thirty-five matched healthy controls completed the short version of the Ambiguous Intentions Hostility Questionnaire, a validated measure assessing participants' perceived hostility, blame attribution and aggression in relation to vignettes depicting social situations with negative outcomes and ambiguous intent. Patients with SAUD attributed more hostile intentions to others than did healthy controls. Moreover, this hostile attributional bias was associated with increased interpersonal problems in SAUD, as measured through the Inventory of Interpersonal Problems. We thus evidence hostile attributional bias in SAUD and extend the growing literature on social cognition impairments in this population. Furthermore, these findings corroborate the recent proposal that patients with SAUD exhibit biases toward socially threatening information. The association between hostile attributional bias and interpersonal problems suggests that targeting this bias in treatment may reduce the relapse risk resulting from interpersonal deficits. Recommendations are made to further explore the clinical relevance of hostile attributional bias in SAUD.

Socio-affective processing biases in severe alcohol use disorders: Experimental and therapeutic perspectives.

Previous literature has consistently reported socio-affective information processing impairments in patients with severe alcohol use disorder (SAUD). Some recent studies have also suggested that these patients might exhibit biases toward stimuli indicating social threat, such as angry or disgusted faces. Such biases have been largely documented in other psychopathological disorders like anxiety, where they play a critical role in the emergence and maintenance of the disorder. A comprehensive understanding of these biases in SAUD would thus deepen the understanding of interpersonal difficulties and relapse-related factors. However, to date, no study has directly explored these biases in SAUD. In order to initiate efforts to address this issue, we first review preliminary evidence supporting the hypothesis of biased processing of social threat in SAUD. Then, we identify possible pathways through which such biases might negatively impact the course of the disorder. Finally, we provide precise recommendations and available materials to develop research in this promising field, and underline the related theoretical and clinical perspectives.