Emotional facial expression decoding impairment in persons dependent on multiple substances: impact of a history of alcohol dependence

OBJECTIVE: The decoding of emotional facial expressions is impaired in recovering alcoholics and less severely so in opiate-dependent persons without alcohol dependence antecedents. This study addressed two complementary questions: (1) How do these decoding deficits change with long-term abstinence during an institutionalized therapeutic program? and (2) Do alcohol-dependent antecedents constitute a factor impairing a potential recovery? METHOD: Sixty-five participants (54 men and 11 women) were recruited at a long-stay postdetoxification treatment center. They were assigned to one of four groups, depending on (1) whether or not they met alcohol dependence criteria in the past and (2) whether they were at therapeutic Stage 1 or Stage 2. Stage 1 was defined as being in the first 2 months of the therapeutic program, and Stage 2 was defined as being in the long-term therapeutic community (i.e., from 2 to 10 months of a therapeutic program). Participants were given an emotional facial-expression decoding test consisting of 16 photographs portraying happiness, anger, disgust and sadness. Participants were asked to rate the estimated intensity level of each photograph on eight scales labeled as happiness, sadness, fear, anger, disgust, surprise, shame and contempt--all presented successively. A complementary scale assessed the self-estimated difficulty in performing the task. RESULTS: Results show a greater deficit in individuals with substance dependence with past alcoholic dependence, compared with former substance-dependent persons who had never met the alcohol dependence criteria according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. However, there was no effect of long-term abstinence on emotion decoding abilities whatever their past dependence. CONCLUSIONS: Substance dependence is associated with dysfunctions in emotional facial expression decoding processing, with alcohol dependence being linked with more impairments and no improvement after months of abstinence.