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Studying the Connection Between Empathy and Substance Use in Adolescents

Drew Winters, PhD, of the CU Department of Psychiatry, published research showing that greater empathy leads to decreased drug and alcohol use.

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Written by Greg Glasgow on April 26, 2024

Does an adolescent’s level of empathy influence whether or not they will use drugs or alcohol? 

It’s a question that Drew Winters, PhD, director of the Affective Social Cognition, Executive Functioning, and Neuro-Development (ASCEND) lab in the Department of Psychiatry in the University of Colorado School of Medicine, set out to answer in research published this month in the Journal of Drug Issues.

The research was motivated by Winters’ clinical work with adolescents whose lack of empathy often led to negative outcomes.

“There’s a subset of teenagers who didn’t seem to understand or respond to other people’s emotions very well,” he says. “They could appear very engaging with me, but then I would hear a week later, when they came back, that they were doing criminal activities or harming others. That brought up the question of, ‘How do you help people who don’t seem to think that other people’s emotions have value and are willing to exploit those for their own gain?’”

Measuring empathy and its connections to substance use

Winters and his research team conducted a longitudinal analysis of existing data that used a standard empathy measure called the Interpersonal Reactivity Index to find out if adolescents being treated for substance use had steeper drops in substance use over time if they developed higher levels of empathy through treatment.

“We wanted to know, if empathy increases during treatment, will they respond to the social consequences of substance use — and how that relates to substance use directly,” he says. “We looked at follow-up data six months after treatment, and we were able to find that was the case.”

Specifically, Winters and his team found that higher levels of the type of empathy known as cognitive empathy — the ability to make inferences about how other people think and feel — made adolescents more responsive to the social consequences of substance use, which included recognizing the impact of their substance use on themselves and their friends and family. Those adolescents had a greater decrease in substance use over time.

“If you're less likely to understand or infer how another person thinks or feels, you have less data to signal when a pattern of behavior is problematic and make changes accordingly,” he says. “We are saying, ‘The more I'm able to infer what another person around me, who is in my social domain, feels and thinks, the more I recognize that these consequences are meaningful. That motivates me to be engaged in treatment, and that directly relates to decreases in substance use.’”

Changing brain patterns

Winters’ research is now looking at ways to improve empathy, including the use of transcranial magnetic stimulation — non-invasive electric stimulation of targeted brain regions that has no known significant risks — to help the brain function in a different way.

“It's shown to help in depression in various age groups,” he says, “and there's a real interest in trying to see how the treatment changes dynamics in the brain and helps it function in a way that may create the path to developing these skills and translate into more socially conscious behavior.”

It’s also important to look at an adolescent’s social and family situations, he says — evaluating the quality of their relationships and helping an adolescent to understand why other people’s thoughts and feelings should be important to them.

“That might be meaningful in some situations — to be able to connect and understand others, being able to infer people’s emotions around them, to foster the quality of their relationships to help guide them on their path,” he says. “Social impairments are traditionally considered a feature of problematic substance use, but this data suggests that substance use treatment may need to consider psychological deficits in empathy as a factor in severity and maintenance of substance use. 

“This data suggests that substance use treatment that equips patients with the psychological capacity to take in social data can have lasting effects beyond treatment,” he adds. “We want to help them realize the importance of perspectives and feelings among those around them as well as the importance of those relationships, which can motivate prosocial behavior rather than getting high.” 

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Drew Winters, PhD