Theory of mind and emotion recognition functions of patients with alcohol and opioid addiction

Background: In recent studies, emotion recognition (ER) functions and theory of mind (ToM) in social cognition have become prominent. It has been shown that ToM and ER are impaired in patients with different addictions. But there are only a few researches that compare degree or forms of social cognition impairment in different addiction groups. Our aim is to compare ToM and ER functions of patients with opioid addiction (OA), patients with alcohol addiction (AA) and healty control (HC) group. Method: 32 OA and 30 AA diagnosed with DSM-IV criteria, and 32 HC were included in the study. Reading the Mind in the Eyes Test (RMET), Pictures Of Facial Affect (POFA), and faux pas were used for measuring ToM functions; Stroop Test and Auditory Consonant Trigrams were used for measuring neurocognitive functions; and Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-1) was used for excluding matched diagnoses. Results: As participants' ages and education levels showed difference between groups, research data were analysed by controlling these variants. OA group's POFA, RMET, faux pas total points were lower when compared with HC; they also had lower scores in all categories, but espacially in 'understanding faux pas', 'understanding an inappropriate state', 'false belief' and 'empathy' categories. Likewise; AA group had lower scores in POFA and RMET when compared to HC, but they showed no significant difference regarding faux pas and its sub-categories. When emotions were evaluted seperately, OA group gave more wrong answers about angry faces than HC group. Also, AA group gave more wrong answers about disgusted faces than HC group. Both OA and AA groups had tendency to answer as 'sad face' for unrecognised faces. OA and AA groups' RMET scores that evaluate ToM decoding and POFA scores showed no significant difference. Yet, when OA group's and AA group's faux pas scores that measures ToM reasoning were compared, OA group showed significantly lower performance in 'false belief' category. Difference between OA and AA groups' total scores of faux pas test, 'understanding inappropriate situation' scores and 'empathy' scores were near the treshold of significancy. OA group showed a significant negative correlation between POFA scores and duration of opioid addiction. OA group also showed a nearly significant negative correlation between RMET scores and opioid doses. After multiple regression analyses, it was seen that opioid doses affected their RMET scores directly. POFA scores and consumed standard alcohol doses of the AA group showed a positive correlation. Both AA and OA groups showed deficits in working memory and response inhibition categories, yet there was no significant relationship between these deficits and deficit in social cognition. Conclusion: In this research; we found that OA group showed extensive deficits in social cognition, especially in ToM and emotion recognition functions. AA group showed more deficits in ToM decoding and emotion recognition functions when compared to HC group, yet ToM reasoning was partly preserved in AA group. Altough there was no significant difference between AA and OA group's ToM decoding and emotion recognition functions, OA group's deficits in ToM reasoning functions were greater than AA group. When evaluating neurocognitive functions, both groups had deficits in working memory and response inhibition functions. There was no significant difference between groups. It was also found that deficits in neurocognitive functions had no direct affects on social cognition deficits. This findings might indicate that these two distinct cognitive areas may be affective through independent neural pathways, and may also be impaired independently. The fact that there is no strong relation between deficits in social cognition and clinical variables may bring to mind that these deficits are indicators of the pre-addiction period, or even properties that predispose to addiction. These results may be interpreted as 'social functioning areas are important to focus on while preventing and treating addictions'.