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Greater deficits in emotional facial expression can indicate more severe alcoholism

February 23, 2007

- Recognition of emotional facial expressions (EFEs) is a key form of non-verbal communication that is lacking among alcoholics.

- New findings show continuing EFE decoding deficits among alcoholics even after three months of abstinence.

- Alcoholics with the worst EFE decoding performance at initial assessment not only dropped out of treatment, but all of them later relapsed.

Recognition of emotional facial expressions (EFEs) is a key form of non-verbal communication that has a huge influence on an individual's social-interaction skills. Alcoholics tend to have impaired EFE decoding abilities. A new study has found that not only do EFE decoding deficits continue despite three months of abstinence, but those individuals with the worst deficits also had the worst prognosis for treatment success.

Results are published in the March issue of Alcoholism: Clinical & Experimental Research.

"Satisfying and successful interpersonal relationships are partly determined by the ability to accurately interpret nonverbal signals from interaction partners," said Marie-Line Foisy, a researcher at the Université Libre de Bruxelles and corresponding author for the study. "In our daily life, EFEs are key features of communication since they convey most information on emotional expression and regulation as well as on social motives."

"Humans are a gregarious species, so we survive by living in groups," added Marilee Monnot, clinical associate professor at the University of Oklahoma Health Sciences Center. "Emotional expressions in face, body language, and/or vocal tone inform group members of each other's motivation and potential actions. If an individual cannot decode these honest signals, social-interaction mistakes are inevitable, leading to rejection, loss of essential resources, and poor chances of survival."

Foisy and her colleagues wanted to know if abstinence from alcohol can "repair" EFE decoding deficits. They recruited 49 alcoholics from a long-stay post-detoxification treatment center during the third or fourth week of their detoxification. Of these, 22 maintained abstinence until final assessment two months later; however, 27 dropped out of the treatment program. Researchers also recruited a "control" group of 22 individuals matched on age, gender and educational levels. Both at initial recruitment as well as final assessment, all participants were given an EFE decoding test of 16 photographs depicting "universal" facial expressions of happiness, anger, disgust and sadness.

"Our results corroborate and expand upon previous findings of more errors in accurate labeling, and overestimation of the intensity level of the emotion displayed, among alcoholic participants when compared to control participants," said Foisy. "In addition, there was no improvement after three months of abstinence."

Furthermore, all 27 alcoholics who dropped out of the treatment program were later found to have had the worst EFE decoding performance at baseline assessment.

"All of the 27 participants who dropped out of the long-term detoxification subsequently relapsed," said Foisy. "This means that EFE decoding deficits could have a prognostic value in alcohol dependence."

"This study indicates strongly that chronic alcoholism is associated with neurological damage to the areas of the brain that comprehend emotional expression in others," added Monnot. "Decoding facial emotion cues in others is one of the core skills in social cognition. Although research in social cognition is quite new, this study adds to the knowledge base by showing how the brain processes social signals and responses. Social-interaction ability is now seen as one of the most important skills one can have, and may contribute as much to personal success and group achievement as abstract knowledge."

While the findings do not indicate if EFE decoding deficits existed prior to the development of alcoholism, results do suggest that alcoholics who have fewer EFE decoding deficits would be better candidates for detoxification treatment.

"It may be that alcoholics with more severe difficulties in recognizing EFE also have more difficulties in dealing with the conventional detoxification process," said Foisy. "They may also benefit from specific training programs aimed at improving EFE recognition, or more general interpersonal skills."

Monnot wholeheartedly agrees. "From this data, it appears that alcohol abuse/dependence treatment programs around the world must take into account the deficits in emotion comprehension, and alter therapy regimes substantially," she said. "Patients with alcohol dependence would benefit from learning about their deficit and finding ways of compensating for this problem. For example, people who are color blind must learn to cope in a world of color meanings, such as traffic lights. Thus, individuals who cannot reliably interpret the emotions of others may need to ask explicitly what others are feeling," she emphasized, "rather than guessing incorrectly."

Alcoholism: Clinical & Experimental Research