Many Close Relatives of People with Alcohol Use Disorder Experience Similar Cognitive Weaknesses, Manifesting as Social and Emotional Struggles

Many people with a family history of alcohol use disorder (AUD) struggle with certain cognition issues that often accompany AUD itself, even if they don’t themselves drink dangerously, according to a novel study. The findings suggest that these issues may be markers of vulnerability for the condition. A family history of AUD—having one or more first-degree relatives with the disorder—increases the risk of developing it, owing to genetic and environmental factors. Differences in cognitive functioning, especially in executive function (EF) and social cognition (SC), may predispose people to AUD and be amplified by chronic drinking. EF involves mental flexibility, inhibiting responses, and working memory, among other processes. SC facilitates social interactions through theory of mind (understanding others’ mental states), emotion recognition, and empathy. Research on healthy people with a family history of AUD has identified EF and SC differences in their neural networks, though little is known about SC processes in this population or whether those neural differences also manifest behaviorally. A better understanding of EF and SC as vulnerability markers may help identify people at risk for AUD. For the study in Alcohol: Clinical & Experimental Research, investigators in France explored behavioral SC in people without AUD who have first-degree relatives with the disorder and assessed the cognitive impact of SC and EF difficulties.

Researchers worked with 120 adults, of whom 60 had a father or sibling with AUD but did not themselves drink dangerously. The two groups—with and without a family history of AUD—were matched for age, sex, and education level. The participants were assessed for intellectual functioning, psychiatric conditions, problematic drinking, nicotine dependence, depressive symptoms, anxiety, and childhood trauma. They underwent neuropsychological tasks evaluating their EF and theory of mind (a key component of SC) and self-reported impulsivity, alexithymia (“emotional blindness”), and empathy. The investigators used statistical analysis to compare the EF and SC profiles of participants with and without family histories of AUD as groups and individually.

In tests, the participants with family histories of AUD showed lower resistance to interference—or difficulties suppressing automatic responses and impaired attentional control—EF issues. They also demonstrated weaknesses in theory of mind. (Other differences between groups dissipated after controlling for age, anxiety, and depressive symptoms.) Some participants with AUD relatives had mainly EF difficulties, others predominantly theory of mind. Individual analyses showed EF or SC weaknesses in 53% of people with a family history of AUD; of these, six out of ten struggled with one outcome, the others with more. Those with impaired theory of mind revealed diminished emotional arousal, fantasy, empathy, and perspective-taking. Overall, the findings suggest that EF and SC may drive AUD vulnerability through separate cognitive mechanisms. The participants with close AUD relatives had higher rates of past suicide attempts, anxiety disorders, and childhood trauma than those without such family histories; these mental health symptoms may increase the risk of heavy drinking. The variability in findings was consistent with previous studies suggesting heterogeneous cognitive manifestations in people with AUD as well as in close relatives without the disorder.

This is the first known study to highlight SC difficulties in a behavioral task measuring theory of mind among healthy close relatives of people with AUD and extends our understanding of the breadth of socioemotional issues affecting this population. Cognitive vulnerabilities involving EF or SC appear to represent a continuum. Despite these risk factors, many people with family histories of AUD likely have protective resiliency factors. More research is needed to examine the relative roles of EF and theory of mind in the development of AUD and to identify people with higher clinical and cognitive vulnerability to AUD, facilitating prevention.

Patterns of executive functions and theory of mind in adults with a family history of alcohol use disorder: Combined group and single-case analyses. F. Schmid, A. Henry, F. Benzerouk, S. Barrière, J. Gondrexon, A. Kaladjian, F. Gierski. (pp xxx)

ACER-23-5740.R2