Treating alcoholism is incredibly difficult on many levels. One of the most difficult areas to deal with is social interaction, how people with alcoholism can interact with others. Alcoholics can have many problems with social exclusion. This is partially due to the severe stigma that accompanies alcoholism, but it's also due to the difficulties that being an alcoholic can produce on social interaction. Regardless, being an alcoholic can result in ostracism and a breaking down of social support networks, and that can make recovery, especially in times of stress, that much more difficult.

But of course, it's not just the act of being socially ostracized or excluded, it also matters how the person being excluded responds. And there are some indications that alcoholics have a larger response to social exclusion than controls. But do they? And if so, why?

Maurage et al. "Disrupted Regulation of Social Exclusion in Alcohol-Dependence: An fMRI Study" Neuropsychopharmacology, 2012.

So the authors of this study wanted to look at how people with alcoholism respond to things like social rejection compared to controls. They took 22 recovering alcoholics (abstinent, all male, all inpatient treatment and in the 3rd week of detox), and 22 controls, and put them in an fMRI scanner to look at changes in blood oxygenation in the brian. By determining where more or less oxygenated blood is going, fMRI gives an idea of where more or less activity may be taking place.

While in the fMRI, the participants played a "game". The game was a ball throwing game between themselves and two other "people" who were really just computers. At first, the participant was told that they were not yet connected to the computer, but they could watch the other two people play the game (a condition called implicit social exclusion). Next, they "entered" the game and could pass a ball back and forth with the other two players (social inclusion). After this, they were explicitly excluded from the game, as the other "players" started only throwing to each other. Finally, the participants got re-included in the game, with the other players throwing the ball to them again.

When they looked at the results, they found that both groups, the alcohol dependent and the controls, felt the same amount of social exclusion during the exclusion part of the game. But their fMRI responses showed some major differences. All participants saw increases in activity in the cingulate cortex and ventral prefrontal cortex during social exclusion. But the alcohol dependent patients showed less ventral prefrontal cortex activity than controls, and also showed additional increased activity in the insula.

But of course, what does that mean? Activation in areas like the ventral prefrontal cortex and the cingulate cortex is associated with social rejection. In particular, the cingulate cortex and the insula are associated with feelings of social rejection, while the ventral prefrontal cortex provides some negative feedback and decreases cingulate responses. So the author hypothesize that the alcohol dependent subjects (1) show more response to social rejection, as they have a response both in the cingulate and in the insula, and (2) that they have a decreased ability to suppress the response to social rejection, as they show decreased prefrontal activity.

It's an interesting study. Of course, we can't prove immediately that if you increase activity in the ventral prefrontal cortex, you'll make people feel less socially excluded, or that if you increase activity in the cingulate and insula, people will feel left out. It's probably more complicated than that. But it's very interesting to see that the alcohol dependent subjects had differences in their brain responses to social rejection, even thought they reported the same emotional response.

And it makes me wonder how we might change these responses. The authors saw these changes in the prefrontal areas which suggest that maybe people with alcoholism cannot control or suppress a sense of social rejection as well as controls. It would be very interesting to see what happened to this signaling after a targeted behavioral therapy intervention, or whether these signals are different in recovering alcoholics with strong social support vs those without. It would also be interesting to see if we COULD stimulate one of these areas and the effect this might have on feelings of social rejection. Hopefully studies like this are the first step to figuring out additional therapies for alcohol dependent patients, to help them in their recovery and make their new lives easier.

Maurage P, Joassin F, Philippot P, Heeren A, Vermeulen N, Mahau P, Delperdange C, Corneille O, Luminet O, & de Timary P (2012). Disrupted regulation of social exclusion in alcohol-dependence: an FMRI study. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 37 (9), 2067-75 PMID: 22510722