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Baltariu IC, Enea V, de Jong PJ, Aan Het Rot M. Associations between alcohol consumption and empathy in a non-clinical sample: drinking motives as a moderator. Sci Rep 2024; 14:10993. [PMID: 38744834 PMCID: PMC11094050 DOI: 10.1038/s41598-024-59233-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/08/2024] [Indexed: 05/16/2024] Open
Abstract
People consume alcohol for multiple reasons. Negative motives are often associated with alcohol-related problems. These problems might be explained by negative effects of high alcohol consumption on empathy. Past studies have associated alcohol use disorder (AUD) with reduced cognitive and affective empathy. Few studies have focused on non-clinical samples and considered behavioral empathy. We examined the links between alcohol consumption and multiple aspects of empathy, and if these links were moderated by negative drinking motives. We collected online data of 520 unselected individuals. All completed the AUD Identification Test (AUDIT) and a Drinking Motives Questionnaire. Affective and cognitive empathy were assessed using the Empathy Quotient. Behavioral empathy was assessed by asking participants how likely they would help the person in each of 24 scenarios involving pain. Helping others in pain was positively predicted by affective and cognitive empathy. Higher AUDIT scores were associated with helping others less, particularly among participants who scored higher on drinking to cope with negative affect. People who drink more and do so to cope with negative affect appear to have less behavioral empathy. This supports the view that negative drinking motives contribute to AUD risk.
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Affiliation(s)
- Isabelle C Baltariu
- Department of Psychology, University of Groningen, Grote Kruisstraat 2/1, Groningen, The Netherlands.
- Department of Psychology, Alexandru Ioan Cuza University of Iași, Iași, Romania.
| | - Violeta Enea
- Department of Psychology, Alexandru Ioan Cuza University of Iași, Iași, Romania
| | - Peter J de Jong
- Department of Psychology, University of Groningen, Grote Kruisstraat 2/1, Groningen, The Netherlands
| | - Marije Aan Het Rot
- Department of Psychology, University of Groningen, Grote Kruisstraat 2/1, Groningen, The Netherlands
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Monk RL, Qureshi AW, Knibb G, McGale L, Nair L, Kelly J, Collins H, Heim D. In people who drink more, facets of theory of mind may be impaired by alcohol stimuli. Drug Alcohol Depend 2023; 245:109811. [PMID: 36871375 DOI: 10.1016/j.drugalcdep.2023.109811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/16/2023] [Accepted: 02/14/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Theory of mind (ToM) - the ability to understand others' beliefs, mental states, and knowledge - is an important part of successful social interaction. There is a growing (albeit mixed) evidence base suggesting that individuals with substance use disorder or who are intoxicated (relative to sober controls) perform worse on a number of ToM tasks. The aim of this study was to explore the hitherto little explored notion that ToM-related capabilities such as the ability to see the world from another person's perspective (termed Visual Perspective Taking; VPT), may be impacted by alcohol-related stimuli. METHOD In this pre-registered study, 108 participants (M age = 25.75, SD age = 5.67) completed a revised version of the director task where they followed the instructions of an avatar to move both alcohol beverages and soft drinks that were mutually visible (target objects) while avoiding those only visible to the participant (distractor items). RESULTS Contrary to predictions, accuracy was lower when the target drink was alcohol and the distractor was a soft drink, although higher AUDIT scores were associated with significantly lower accuracy when alcohol drinks were the distractor items. CONCLUSIONS There may be some contexts when being able to see alcohol beverages makes it harder to take another person's perspective. It also appears that poorer VPT and perhaps ToM capacity may be evident in individuals who consume more alcohol. Future research is warranted to examine how alcohol beverages, alcohol consumption behaviours, and intoxication interact to impact VPT capacity.
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Affiliation(s)
- Rebecca L Monk
- Edge Hill University, UK; Liverpool Centre for Alcohol Research, UK.
| | - Adam W Qureshi
- Edge Hill University, UK; Liverpool Centre for Alcohol Research, UK.
| | - Graeme Knibb
- Edge Hill University, UK; Liverpool Centre for Alcohol Research, UK.
| | - Lauren McGale
- Edge Hill University, UK; Liverpool Centre for Alcohol Research, UK.
| | - Leonie Nair
- Edge Hill University, UK; Liverpool Centre for Alcohol Research, UK
| | - Jordan Kelly
- Edge Hill University, UK; Liverpool Centre for Alcohol Research, UK
| | - Hope Collins
- Edge Hill University, UK; Liverpool Centre for Alcohol Research, UK
| | - Derek Heim
- Edge Hill University, UK; Liverpool Centre for Alcohol Research, UK.
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Kumar L, Zhou A, Sanov B, Beitler S, Skrzynski CJ, Creswell KG. Indirect effects of theory of mind on alcohol use and problems in underage drinkers: The role of peer pressure to drink. Addict Behav Rep 2022; 16:100468. [DOI: 10.1016/j.abrep.2022.100468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/15/2022] [Accepted: 10/30/2022] [Indexed: 11/09/2022] Open
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Kumar L, Skrzynski CJ, Creswell KG. Meta-analysis of associations between empathy and alcohol use and problems in clinical and non-clinical samples. Addiction 2022; 117:2793-2804. [PMID: 35546448 PMCID: PMC9796795 DOI: 10.1111/add.15941] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 04/13/2022] [Indexed: 01/07/2023]
Abstract
AIMS To (1) measure the aggregated effect size of empathy deficits in individuals with alcohol use disorder (AUD) compared with healthy controls, (2) measure the aggregated effect sizes for associations between lower empathy and heavier alcohol consumption and more alcohol problems in non-clinical samples and (3) identify potential moderators on the variability of effect sizes across studies in these meta-analyses. METHOD PsycINFO, PubMed and Google Scholar were searched following a pre-registered International Prospective Register of Systematic Reviews (PROSPERO) protocol (CRD42021225392) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. We meta-analyzed (using random-effects models) mean differences in empathy between individuals with AUD compared with healthy controls and associations between empathy and alcohol consumption and alcohol problems in non-clinical samples. A total of 714 participants were included in the meta-analysis on clinical samples; 3955 were included in the meta-analyses on non-clinical samples. RESULTS Individuals with AUD reported significantly lower empathy than healthy controls [Hedges' g = -0.53, 95% confidence interval (CI) = -0.91, -0.16, k = 9, P < 0.01, Q = 40.09, I2 = 80.04]. Study quality [Q = 1.88, degrees of freedom (d.f.) = 1, P = 0.17] and gender (β = -0.006, Z = -0.60, P = 0.55) were not moderators. Increases in age corresponded to an increase in effect size (β = 0.095, Z = 3.34, P < 0.001). Individuals with AUD (versus healthy controls) had significantly lower cognitive (Hedges' g = -0.44, CI = -0.79, -0.10, P < 0.05), but not affective empathy (Hedges' g = -0.19, CI = -0.51, 0.14, P = 0.27), and the difference between these was significant (Z = 2.34, k = 6, P < 0.01). In non-clinical samples, individuals with lower (versus higher) empathy reported heavier alcohol consumption (r = -0.12, CI = -0.15, -0.09, k = 11, P < 0.001, Q = 9.68, I2 = 0.00) and more alcohol problems (r = -0.08, CI = -0.14, -0.01, k = 7, P = 0.021, Q = 6.55, I2 = 8.34). There was no significant heterogeneity across studies. CONCLUSION Individuals with alcohol use disorder appear to show deficits in empathy compared with healthy controls. Deficits are particularly pronounced for older individuals and for cognitive (versus affective) empathy. In non-clinical samples, lower empathy appears to be associated with heavier alcohol consumption and more alcohol problems.
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Affiliation(s)
- Lakshmi Kumar
- Department of PsychologyCarnegie Mellon UniversityPittsburghPA
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Kumar L, Skrzynski CJ, Creswell KG. Systematic review and meta-analysis on the association between theory of mind and alcohol problems in non-clinical samples. Alcohol Clin Exp Res 2022; 46:1944-1952. [PMID: 36117380 PMCID: PMC9722547 DOI: 10.1111/acer.14943] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/08/2022] [Accepted: 09/12/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Deficits in theory of mind (ToM) found in individuals with alcohol use disorder (AUD) are often thought to result from prolonged heavy alcohol use. However, links between deficits in ToM and greater alcohol problems are often also present in non-clinical samples (e.g., adolescents and young adults) who may not have a similar long-lasting history of alcohol consumption as individuals with AUD. The current study is the first to systematically review and meta-analyze results from studies examining associations between lower ToM and greater alcohol problems in non-clinical samples. Evidence of reliable associations in these non-clinical samples would support the idea that deficits in ToM might also precede the emergence of AUD. METHODS PsycINFO, PubMed, and Google Scholar were searched according to our preregistered International Prospective Register of Systematic Reviews (PROSPERO) protocol (CRD42021225392) and following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. We systematically reviewed sample characteristics and ToM measures in identified articles. We then meta-analyzed the findings of association between ToM and alcohol problems in non-clinical samples using random effects models. RESULTS Nearly all studies used a measure of ToM that assessed the ability to infer the mental states of others based on eye region cues. Meta-analytic results demonstrated that lower ToM was associated with more alcohol problems (r = -0.16, k = 6, CI = [-0.26, -0.04], p < 0.01, Q = 15.55, I2 = 67.85), and there was significant heterogeneity across studies. Gender (ß = 0.0003, CI = [-0.006, 0.007], z = 0.09, p = 0.93), age (ß = -0.008, CI = [-0.03, 0.01], z = -0.82, p = 0.42), and study quality (ß = -0.10, CI = [-0.35, 0.15], z = -0.82, p = 0.41) did not explain the heterogeneity. CONCLUSION In non-clinical samples, lower ToM is associated with more alcohol problems, indicative of a small effect size. Future longitudinal studies are needed to explore whether socio-cognitive deficits may also serve as a risk factor for alcohol misuse.
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Affiliation(s)
- Lakshmi Kumar
- Department of Psychology, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, USA
| | - Carillon J. Skrzynski
- Department of Psychology and Neuroscience, University of Colorado Boulder, 1600 Pleasant St., Boulder, CO, 80309, USA
| | - Kasey G. Creswell
- Department of Psychology, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, USA
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Li G, Chen Y, Le TM, Zhornitsky S, Wang W, Dhingra I, Zhang S, Tang X, Li CSR. Perceived friendship and binge drinking in young adults: A study of the Human Connectome Project data. Drug Alcohol Depend 2021; 224:108731. [PMID: 33915512 PMCID: PMC8641247 DOI: 10.1016/j.drugalcdep.2021.108731] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/26/2021] [Accepted: 03/19/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Peer influences figure prominently in young adult binge drinking. Women have trended to show a level of alcohol use on par with men during the last decades. It would be of interest to investigate the neural processes of social cognition that may underlie binge drinking and the potential sex differences. METHODS Here, we examined the data of the Human Connectome Project where we identified a total of 175 binge drinkers (125 men) and 285 non-binge drinkers (97 men) performing a social cognition task during brain imaging. We analyzed the imaging data with published routines and evaluated the results at a corrected threshold. RESULTS Both male and female binge relative to non-binge drinkers showed higher perceived friendship. Binge relative to non-binge drinkers demonstrated diminished activations in the anterior medial orbitofrontal cortex (amOFC) during perception of social vs. random interaction, with a more prominent effect size in women. Further, whole-brain regression identified activity of the right posterior insula (rPI) in negative correlation with perceived friendship score in non-binge drinking women. Post-hoc analyses showed significant correlation of rPI activity with perceived friendship, amOFC activity, and a summary measure of alcohol use severity identified by principal component analysis, across all subjects. Mediation and path analysis demonstrated a significant model: amOFC activity → rPI activity → perceived friendship → severity of alcohol use. CONCLUSIONS These findings support peer influences on binge drinking and suggest neural correlates that may relate altered social cognitive processing to alcohol misuse in young adults.
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Affiliation(s)
- Guangfei Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States; Department of Biomedical Engineering, School of Life Sciences, Beijing Institute of Technology, Beijing, China
| | - Yu Chen
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Thang M Le
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Simon Zhornitsky
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Wuyi Wang
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Isha Dhingra
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Sheng Zhang
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Xiaoying Tang
- Department of Biomedical Engineering, School of Life Sciences, Beijing Institute of Technology, Beijing, China.
| | - Chiang-Shan R Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States; Department of Neuroscience, Yale University School of Medicine, New Haven, CT, United States; Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, CT, United States.
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Patrick ME, Terry-McElrath YM. Drinking Motives and Drinking Consequences across Days: Differences and Similarities between Moderate, Binge, and High-Intensity Drinking. Alcohol Clin Exp Res 2021; 45:1078-1090. [PMID: 33797768 PMCID: PMC8131261 DOI: 10.1111/acer.14591] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/03/2021] [Accepted: 03/03/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The current study examined the extent to which within-person variation in drinking motives differentiates moderate, binge, and high-intensity drinking; and independent associations of motives and drinking intensity with alcohol use consequences in a sample of young adult drinkers from across the United States. METHODS Participants were past 30-day drinkers in the U.S. nationally representative Monitoring the Future 12th grade sample in 2018, who also reported alcohol use during a 14-day data collection burst 1 year later (N = 484 people, mean age 19.3 [SD 0.40], 43% female; N = 1042 drinking days) as part of the Young Adult Daily Life Study in 2019. Weighted multilevel modeling estimated within- and between-person associations of drinking motives, drinking intensity (i.e., moderate [women 1-3, men 1-4 drinks], binge [women 4-7, men 5-9 drinks], and high-intensity drinking [women 8+, men 10+ drinks]), and number of positive and negative alcohol consequences. RESULTS On days participants reported greater enhancement and social motives, they were more likely to engage in high-intensity (vs. binge) drinking and binge (vs. moderate) drinking and experience more positive alcohol consequences. On days participants reported greater enhancement and coping motives, they experienced more negative alcohol consequences. Binge (vs. moderate) drinking on a given day was associated with more positive and negative alcohol consequences; high-intensity (vs. binge) drinking on a given day was associated with more negative alcohol consequences that day. Moderation analyses indicated that social motives were associated with high-intensity (vs. binge) drinking only among college students. CONCLUSIONS Stronger drinking motives on a given day were associated with drinking intensity (enhancement and social motives) and negative consequences (enhancement and coping). High-intensity (vs. binge or moderate) drinking was associated with more negative consequences but not more positive consequences. These results underscore that high-intensity drinking and consequences vary across days and time-varying, occasion-specific risks such as current motivational context are appropriate targets for intervention.
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A biological framework for emotional dysregulation in alcohol misuse: from gut to brain. Mol Psychiatry 2021; 26:1098-1118. [PMID: 33288871 DOI: 10.1038/s41380-020-00970-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 10/21/2020] [Accepted: 11/20/2020] [Indexed: 02/08/2023]
Abstract
Alcohol use disorder (AUD) has been associated with impairments in social and emotional cognition that play a crucial role in the development and maintenance of addiction. Repeated alcohol intoxications trigger inflammatory processes and sensitise the immune system. In addition, emerging data point to perturbations in the gut microbiome as a key regulator of the inflammatory cascade in AUD. Inflammation and social cognition are potent modulators of one another. At the same time, accumulating evidence implicates the gut microbiome in shaping emotional and social cognition, suggesting the possibility of a common underlying loop of crucial importance for addiction. Here we propose an integrative microbiome neuro-immuno-affective framework of how emotional dysregulation and alcohol-related microbiome dysbiosis could accelerate the cycle of addiction. We outline the overlapping effects of chronic alcohol use, inflammation and microbiome alterations on the fronto-limbic circuitry as a convergence hub for emotional dysregulation. We discuss the interdependent relationship of social cognition, immunity and the microbiome in relation to alcohol misuse- from binge drinking to addiction. In addition, we emphasise adolescence as a sensitive period for the confluence of alcohol harmful effects and emotional dysregulation in the developing gut-brain axis.
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Laghi F, Pompili S, Bianchi D, Lonigro A, Baiocco R. Drunkorexia: An Examination of the Role of Theory of Mind and Emotional Awareness among Adolescents. Dev Neuropsychol 2020; 46:70-81. [PMID: 33372552 DOI: 10.1080/87565641.2020.1869743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study aimed to investigate Theory of Mind (ToM) and emotional awareness in drunkorexia, an emerging behavior characterized by calorie restriction when drinking alcohol is planned. A sample of 246 adolescents (148 females, 98 males; range 17-20) completed self-reported measures assessing drunkorexia, ToM and lack of emotional awareness. Drunkorexia was negatively correlated with ToM abilities, with reading neutral emotions, and positively with lack of emotional awareness. ToM and lack of emotional awareness were also found to predict drunkorexia. Findings highlighted that adolescents who engage in drunkorexia may have difficulties in reading others' mental states and being aware of their emotions.
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Affiliation(s)
- Fiorenzo Laghi
- Department of Developmental and Social Psychology, Sapienza University of Rome , Rome, Italy
| | - Sara Pompili
- Department of Developmental and Social Psychology, Sapienza University of Rome , Rome, Italy
| | - Dora Bianchi
- Department of Developmental and Social Psychology, Sapienza University of Rome , Rome, Italy
| | - Antonia Lonigro
- Department of Human Sciences, European University of Rome , Rome, Italy
| | - Roberto Baiocco
- Department of Developmental and Social Psychology, Sapienza University of Rome , Rome, Italy
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Lannoy S, Gilles F, Benzerouk F, Henry A, Oker A, Raucher-Chéné D, Besche-Richard C, Gierski F. Disentangling the role of social cognition processes at early steps of alcohol abuse: The influence of affective theory of mind. Addict Behav 2020; 102:106187. [PMID: 31863967 DOI: 10.1016/j.addbeh.2019.106187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/04/2019] [Accepted: 10/19/2019] [Indexed: 01/25/2023]
Abstract
Excessive alcohol use among adolescents has become a pressing challenge among Western societies. Accordingly, one of the current research objectives is to identify the processes associated with this harmful habit. Although numerous studies have underlined the role of executive and motivational processes, few have explored emotional and interpersonal abilities at early steps of alcohol abuse. The present study evaluated the role of two social cognition processes, namely theory of mind (ability to infer others' mental states at cognitive and affective levels) and empathy (ability to understand others' feelings at cognitive and affective levels) in adolescents' alcohol consumption. Two hundred and two adolescents (13-20 years old) performed a behavioral task evaluating theory of mind and filled in questionnaires measuring personal data, empathy, alcohol consumption (alcohol abuse and specific binge drinking), as well as depressive and anxiety symptoms. Findings showed that cognitive and affective empathy were negatively associated with alcohol consumption in youth whereas affective theory of mind was related to specific binge drinking. Importantly, affective theory of mind predicted binge drinking in adolescents, even after controlling for age, gender, and education level. These results emphasized the role of social cognition in early alcohol abuse and showed that, beyond inhibition, interpersonal abilities might precipitate excessive drinking in youth.
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Affiliation(s)
- Séverine Lannoy
- Cognition Health and Society Laboratory (EA 6291), Université de Reims Champagne-Ardenne, 57 rue Pierre Taittinger, 51571 Reims, France; Laboratory for Experimental Psychopathology (LEP), Psychological Science Research Institute, Université catholique de Louvain, 10 Place Cardinal Mercier, Louvain-la-Neuve, Belgium.
| | - Fanny Gilles
- Cognition Health and Society Laboratory (EA 6291), Université de Reims Champagne-Ardenne, 57 rue Pierre Taittinger, 51571 Reims, France
| | - Farid Benzerouk
- Cognition Health and Society Laboratory (EA 6291), Université de Reims Champagne-Ardenne, 57 rue Pierre Taittinger, 51571 Reims, France; Pôle Universitaire de Psychiatrie, EPSM Marne, 8 Rue Roger Aubry, Reims, France.
| | - Audrey Henry
- Cognition Health and Society Laboratory (EA 6291), Université de Reims Champagne-Ardenne, 57 rue Pierre Taittinger, 51571 Reims, France; Pôle Universitaire de Psychiatrie, EPSM Marne, 8 Rue Roger Aubry, Reims, France.
| | - Ali Oker
- Cognition Health and Society Laboratory (EA 6291), Université de Reims Champagne-Ardenne, 57 rue Pierre Taittinger, 51571 Reims, France.
| | - Delphine Raucher-Chéné
- Cognition Health and Society Laboratory (EA 6291), Université de Reims Champagne-Ardenne, 57 rue Pierre Taittinger, 51571 Reims, France; Pôle Universitaire de Psychiatrie, EPSM Marne, 8 Rue Roger Aubry, Reims, France.
| | - Chrystel Besche-Richard
- Cognition Health and Society Laboratory (EA 6291), Université de Reims Champagne-Ardenne, 57 rue Pierre Taittinger, 51571 Reims, France.
| | - Fabien Gierski
- Cognition Health and Society Laboratory (EA 6291), Université de Reims Champagne-Ardenne, 57 rue Pierre Taittinger, 51571 Reims, France; Pôle Universitaire de Psychiatrie, EPSM Marne, 8 Rue Roger Aubry, Reims, France; INSERM U1247 GRAP, Research Group on Alcohol and Drugs, Université de Picardie Jules Verne, Chemin du Thil, Amiens, France.
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