Social cognition impairments in long-term opiate users in treatment.

BACKGROUND: Long-term opiate users experience pervasive social difficulties, but there has been surprisingly limited research focused on social-cognitive functioning in this population. AIM: The aim of this study was to investigate whether three important aspects of social cognition (facial emotion recognition, theory of mind (ToM) and rapid facial mimicry) differ between long-term opiate users and healthy controls. METHODS: The participants were 25 long-term opiate users who were enrolled in opiate substitution programmes, and 25 healthy controls. Facial emotion recognition accuracy was indexed by responses to 60 photographs of faces depicting the six basic emotions (happiness, sadness, anger, fear, surprise and disgust). ToM was assessed using the Reading the Mind in the Eyes task, which requires participants to infer mental states of others from partial facial cues. Rapid facial mimicry was assessed by recording activity in the zygomaticus major and corrugator supercilii muscle regions while participants passively viewed images of happy and angry facial expressions. RESULTS: Relative to the control group, the opiate user group exhibited deficits in both facial emotion recognition and ToM. Moreover, only control participants exhibited typical rapid facial mimicry responses to happy facial expressions. CONCLUSIONS: These data indicate that long-term opiate users exhibit abnormalities in three distinct areas of social-cognitive processing, pointing to the need for additional work to establish how social-cognitive functioning relates to functional outcomes in this group. Such work may ultimately inform the development of interventions aimed at improving treatment outcomes for long-term opiate users.

Episodic foresight deficits in regular, but not recreational, cannabis users.

BACKGROUND: Cannabis use is associated with a range of neurocognitive deficits, including impaired episodic memory. However, no study to date has assessed whether these difficulties extend to episodic foresight, a core component of which is the ability to mentally travel into one's personal future. This is a particularly surprising omission given that episodic memory is considered to be critical to engage episodic foresight. AIMS: In the present study, we provide the first test of how episodic foresight is affected in the context of differing levels of cannabis use, and the degree to which performance on a measure of this construct is related to episodic memory. RESULTS: Fifty-seven regular cannabis users (23 recreational, 34 regular) and 57 controls were assessed using an adapted version of the Autobiographical Interview. The results showed that regular-users exhibited greater impairment of episodic foresight and episodic memory than both recreational-users and cannabis-naïve controls. CONCLUSIONS: These data therefore show for the first time that cannabis-related disruption of cognitive functioning extends to the capacity for episodic foresight, and they are discussed in relation to their potential implications for functional outcomes in this group.

Stereotype threat and social function in opioid substitution therapy patients.

OBJECTIVES: People with a history of substance abuse are subject to widespread stigmatization. It seems likely that this societal disapproval will result in feelings of stereotype threat, or the belief that one is the target of demeaning stereotypes. If so, stereotype threat has the potential to contribute to functional difficulties including poor social outcomes. METHODS: Eighty drug users on opioid substitution therapy and 84 demographically matched controls completed measures of mental health and social function. The opioid substitution therapy group were additionally asked to complete a measure that focused on their feelings of stereotype threat in relation to their drug use history. Bivariate correlations and hierarchical regression analyses were conducted to establish the magnitude and specificity of the relationship between stereotype threat and social functioning. RESULTS: Relative to controls, the opioid substitution therapy group reported higher levels of negative affect and schizotypy, and poorer social functioning, with all three of these indices significantly correlated with their feelings of stereotype threat. The results also showed that stereotype threat contributed significant unique variance to social functioning in the opioid substitution therapy group, even after taking into account other background, clinical, and mental health variables. CONCLUSIONS: Social functioning is an important aspect of recovery, yet these data indicate that people with a history of drug abuse who believe they are the target of stereotypical attitudes have poorer social functioning. This relationship holds after controlling for the impact of other variables on social functioning, including mental health. The theoretical and practical implications of these findings are discussed. PRACTITIONER POINTS: Concerns about being stereotyped can shape the social experiences of opioid substitution therapy patients. Opioid substitution therapy patients who feel negatively stereotyped experience greater social function deficits, and this relationship emerges after controlling for important clinical and mental health variables. Understanding the relationship between feeling stereotyped and social function may assist practitioners in their treatment. The study is cross-sectional, and thus, experimental or longitudinal research is required to determine the causal direction between stereotype threat and social function.

Deconstructing the nature of episodic foresight deficits associated with chronic opiate use.

OBJECTIVES: Episodic foresight refers to the capacity to mentally travel forward in time and has been linked to a wide variety of important functional behaviours. Evidence has recently emerged that chronic opiate use is associated with deficits in this critical capacity and that these difficulties are not simply a secondary consequence of broader cognitive dysfunction. The current study aimed to better understand the circumstances in which chronic opiate users might be expected to have problems with episodic foresight, by addressing whether deficits reflect compromised scene construction, self-projection, or narrative ability. METHODS: Thirty-five chronic opiate users and 35 demographically matched controls completed an imagination task in which they were instructed to imagine and provide descriptions of an atemporal event, a plausible, self-relevant future event, as well as complete a narrative task. These three imagination conditions systematically varied in their demands on scene construction, self-projection, and narrative ability. RESULTS: Consistent with prior literature, chronic opiate users exhibited reduced capacity for episodic foresight relative to controls. However, this study was the first to show that these difficulties were independent of capacity for scene construction and narration. Instead, a specific impairment in self-projection into the future appears to contribute to the problems with episodic foresight seen in this clinical group. CONCLUSIONS: Deficits in self-projection into the future may have important implications in therapeutic environments given that many relapse prevention strategies rely heavily on the ability to project oneself into an unfamiliar future, free of problem substance use. PRACTITIONER POINTS: A reduced capacity for episodic foresight highlights the importance of refining current relapse prevention protocols that place significant demands for mental time travel into the future. Psychosocial treatments should focus on the attainment of more immediate or short-term goals. It is difficult to delineate the effects of specific substances given long-standing drug use history common to chronic opiate users. Conclusions relating to neurological functioning are speculative given the absence of neuroimaging data.

Episodic foresight deficits in long-term opiate users.

RATIONALE: There is considerable literature showing that opiate use is associated with a range of neurocognitive deficits, including deficits in executive control and episodic memory. However, no study to date has assessed whether these neurocognitive difficulties extend to the ability to mentally time travel into one's personal future. This is a surprising omission given that executive control and episodic memory are considered to be critical for episodic foresight. In addition, opiate-related brain changes have been identified in the neural regions that underlie the capacity for episodic foresight. OBJECTIVE: In the present study, we assessed how episodic foresight is affected in the context of chronic opiate use, as well as the degree to which any deficits are related to difficulties with executive control and episodic memory. METHODS AND RESULTS: Forty-eight long-term heroin users enrolled in an opiate substitution program and 48 controls were tested. The results showed that, relative to controls, the clinical group exhibited significant impairment in episodic foresight but not episodic memory (as indexed by an adapted version of the Autobiographical Interview). For executive function, the clinical group was impaired on only one of three measures (Inhibition). CONCLUSIONS: These data provide important preliminary evidence that episodic foresight might be particularly susceptible to the neurocognitive effects of opiate use, as the difficulties identified were not secondary to more general executive control or episodic memory impairment. Because a number of widely used relapse prevention protocols require the ability to mentally project into the future, these data have potentially important practical implications in relation to the treatment of substance dependence disorders.

Prospective memory impairment in long-term opiate users.

RATIONALE: Opiate use is associated with a range of neurological and cognitive deficits. However, to date, no studies have assessed whether these cognitive deficits extend to the ability to perform intended actions in the future (i.e. prospective memory). Reduced ability in this area might be anticipated due to impaired executive functions and episodic memory associated with long-term opiate use. OBJECTIVES: The main objectives of this study are to assess the performance of long-term opiate users on a laboratory measure of prospective memory which closely simulates the types of prospective memory tasks encountered in everyday life ('Virtual Week') and to investigate the extent to which prospective memory performance is related to executive functions and episodic memory ability. METHODS: Twenty-six long-term heroin users enrolled in an opiate substitution program, and 30 controls with no previous history of drug use were tested on Virtual Week. Retrospective memory and executive functions were also assessed. RESULTS: Long-term opiate users were significantly impaired on prospective memory performance compared with controls (p = 0.002, η(2) p = 0.17), and these deficits did not vary as a function of prospective memory task type (regular, irregular, event, time). The findings also suggest that retrospective memory difficulties contribute to the prospective memory difficulties seen in opiate users (r s = 0.78, p < 0.001) but that executive dysfunction is less influential. CONCLUSIONS: Prospective memory is sensitive to long-term opiate use. Importantly, opiate users suffer from generalised deficits in prospective memory, regardless of the task demands, which may have significant implications for day-to-day functioning. These results may therefore contribute to the development of clinical intervention strategies to reduce the negative impact of prospective memory failures in daily life.