Effects of Cognitive and Affective Empathy on Substance Using Behavior in Adolescents

Background and Purpose: Social/interpersonal impairment is a diagnostic criterion for substance use disorder. However, substance using behavior is rarely examined as an effect of social functioning, including cognitive and affective empathy. Some studies have shown correlates of cognitive and affective empathy with substance using behavior among adolescents (e.g. Baskin-Sommers, Waller, Fish, & Hyde, 2015; Kirisci, Tarter, Vanyukov, Reynolds, & Habeych, 2004; Wymbs et al., 2012). However, research has yet to examine how changes in cognitive and affective empathy together impact substance using behavior among adolescents using longitudinal data. Testing these variable associations in longitudinal study is critical for understanding the change mechanisms; ultimately developing effective social work interventions. The present study examines changes in both cognitive and affective empathy, predicting substance use over time among adolescents in outpatient treatment.

Methods: We conducted secondary data analyses using longitudinal data of adolescents in outpatient treatment from the Adolescent Drug Abuse Treatment Outcome Study. The sample consisted of 826 adolescents between the ages of 12-18 (15.4±1.3); predominately white (52%) and male (68%). The original study followed adolescents entering substance use treatment at baseline (prior to treatment), 1, 3, and 6 months during the treatment, along with 6-months follow-up after completing treatment. We used self-report cognitive and affective empathy measures (subscales of interpersonal reactivity index; Davis 1983). For substance use, we used a dichotomous measure indicating any substance use vs no-use (alcohol, marijuana, cocaine, or hallucinogen), which was obtained via participants’ self-report at each time point. In order to examine if previous status of cognitive and affective empathy predict the following substance using incidence over time, we used level and shape latent growth curve models with cognitive and affective empathy as time-varying covariates. We tested cross lagged effects of cognitive and affective empathy predicting substance use. Age, gender, and race were controlled in the models. Mplus with WLSMV estimator was used.

Results: Overall, cognitive (general slope = 2.53, p <.01) and affective empathy (general slope = 1.48, p <.01) increased over time, and substance use (general slope = -1.80, p < .01) decreased over time. Affective empathy consistently predicted reduced substance use over time (effect = -0.03, p = .02); however cognitive empathy was not a significant predictor after controlling for the other variables.  The baseline correlation between cognitive and affective empathy measures was 0.6 (p<.001). None of the demographics predicted changes in outcomes.

Conclusions and Implications: The current study found that increased affective empathy significantly predicted reduced substance use over time. This finding supports the previous literature, and extends it to the longitudinal relationships among the outpatient treatment population. However, contrary to our expectation, cognitive empathy did not predict substance use. Although cognitive and affective empathy are related constructs, affective empathy may be the main mechanism underlying a felt sense of social connection that motivates healthy responses to social consequences related to substance use. The present findings suggest that affective empathy may be an important treatment target for adolescent substance use. Implications in social work practice and research will be discussed.