Clinical Psychology Review 84 (2021) 101971

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Clinical Psychology Review

journal homepage: www.elsevier.com/locate/clinpsychrev

Review

Emotional processes in binge drinking: A systematic review and perspective

Séverine Lannoy a, b, *, Theodora Duka c, d, Carina Carbia e, Joël Billieux f, Sullivan Fontesse b,
Valérie Dormal b, Fabien Gierski g, h, Eduardo López-Caneda i, Edith V. Sullivan a,
Pierre Maurage b, *
a
Stanford University, Department of Psychiatry and Behavioral Sciences, Stanford, California, USA
b
Louvain Experimental Psychopathology research group (LEP), Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
c
Behavioral and Clinical Neuroscience, School of Psychology, University of Sussex, Brighton, UK
d
Sussex Addiction and Intervention Centre, University of Sussex, Brighton, UK
e
APC Microbiome Ireland, Biosciences Building, University College Cork, Cork, Ireland
f
Institute of Psychology, University of Lausanne, Lausanne, Switzerland
g
Cognition Health and Society Laboratory (EA 6291), Université de Reims Champagne-Ardenne, Reims, France
h
Psychiatry and Addictology Departments, CHU de Reims & EPSM Marne, Reims, France
i
Psychological Neuroscience Laboratory, Research Center in Psychology (CIPsi), School of Psychology, University of Minho, Campus, Gualtar, Braga, Portugal

A R T I C L E I N F O A B S T R A C T

Keywords: Binge drinking is a widespread alcohol consumption pattern commonly engaged by youth. Here, we present the
Emotional identification first systematic review of emotional processes in relation to binge drinking. Capitalizing on a theoretical model
Emotional response describing three emotional processing steps (emotional appraisal/identification, emotional response, emotional
Alcohol
regulation) and following PRISMA guidelines, we considered all identified human studies exploring emotional
Binge drinking
abilities among binge drinkers. A literature search was conducted in PubMed, Scopus, and PsychINFO, and a
standardized methodological quality assessment was performed for each study. The main findings offered by the
43 studies included are: 1) regarding emotional appraisal/identification, binge drinking is related to heightened
negative emotional states, including greater severity of depressive and anxiety symptoms, and have difficulties in
recognizing emotional cues expressed by others; 2) regarding emotional response, binge drinkers exhibit
diminished emotional response compared with non-binge drinkers; 3) regarding emotional regulation, no
experimental data currently support impaired emotion regulation in binge drinking. Variability in the identifi­
cation and measurement of binge drinking habits across studies limits conclusions. Nevertheless, current findings
establish the relevance of emotional processes in binge drinking and set the stage for new research perspectives
to identify the nature and extent of emotional impairments in the onset and maintenance of excessive alcohol
use.

1. Introduction older) have already drunk alcohol, and 30% engaged in binge drinking
(NIAAA, 2018). Moreover, nearly 12% of youth before the legal age (12-
Binge drinking consists of drinking large quantities (more than 60 gr 20 years old, United States) and 40% of college students (18-22 years
of pure ethanol on one occasion, leading to a blood alcohol concentra­ old) report binge drinking habits (NIAAA, 2018). As bingers drink
tion level of at least 0.08%) in a short time interval – usually less than heavily but irregularly, this habit is also characterized by withdrawal
two hours (Courtney & Polich, 2009; National Institute of Alcohol Abuse episodes. The repeated alternation between high intake and withdrawal,
and Alcoholism [NIAAA], 2004; World Health Organization, 2018. This known to be particularly detrimental for brain functioning (Alaux-
drinking pattern is common to youth from adolescence to young Cantin et al., 2013; Pascual, Blanco, Cauli, Miñarro, & Guerri, 2007), has
adulthood in most Western countries (ESPAD Group, 2016; Substance guided some authors to propose that binge drinking might lead to ce­
Abuse and Mental Health Services Administration [SAMHSA], 2017). rebral impairments similar to those reported in severe Alcohol Use
Recent statistics show that almost 90% of young people (18 years old or Disorder (AUD) (e.g., Scaife & Duka, 2009). Comparable impairments

* Corresponding authors at: Stanford University, Department of Psychiatry and Behavioral Sciences, 401 Quarry Rd, Stanford, CA 94305, USA.
E-mail addresses: severine.lannoy.phd@gmail.com (S. Lannoy), pierre.maurage@uclouvain.be (P. Maurage).

https://doi.org/10.1016/j.cpr.2021.101971
Received 9 June 2020; Received in revised form 10 December 2020; Accepted 8 January 2021
Available online 13 January 2021
0272-7358/© 2021 Elsevier Ltd. All rights reserved.
S. Lannoy et al. Clinical Psychology Review 84 (2021) 101971

between binge drinkers and patients with severe AUD have actually psychopathological disorders. A dominant theoretical view for
been identified by neuropsychological (see Carbia, López-Caneda, describing emotion depicts it as a multidimensional response comprising
Corral, & Cadaveira, 2018 for a systematic review), neuroimaging, and multiple components of emotional processing (Phillips, Drevets, Rauch,
electrophysiological (see Cservenka & Brumback, 2017; Maurage, Petit, & Lane, 2003a). The constellation of components combines three suc­
& Campanella, 2013 for reviews) studies. Nevertheless, whereas cessive steps, usually following a stimulus presentation: emotional
emotion research constitutes a burgeoning field in severe AUD, appraisal and identification, emotional response, and emotional regu­
explaining excessive drinking episodes and relapse risks (e.g., Bora & lation (Phillips et al., 2003a). As this model identifies distinct emotional
Zorlu, 2017; Le Berre, 2019), no paper has reviewed available data to processes and has received strong support (e.g., Pessoa, 2017), we will
determine the role of emotional processes in binge drinking. Emotional use it as a theoretical framework for the present review. First, emotional
alterations play a role in excessive alcohol use, but also in the devel­ appraisal and identification allow assessing an emotional stimulus or
opment of comorbid affective disorders that influence control over situation. Emotional stimuli may be internal (self-emotional states) or
drinking (Boden & Fergusson, 2011). Thus, identifying alterations in external (situation or other individuals’ emotional expressions). In
emotional control and related processes may enhance a fundamental human research, this process has been investigated by self-report
understanding of hazardous drinking in youth. Moreover, the neurotoxic questionnaires requiring one to identify internal states (for internal
effects of alcohol on the developing brain together with emotional and stimuli) or by paradigms requiring the identification of emotionally
stressful events occurring during adolescence may increase the pro­ salient stimuli; e.g., facial emotional expressions, emotional scenes (for
pensity of emotional disturbances (Agoglia & Herman, 2018; Elsayed external stimuli). Specific brain regions are involved in this external
et al., 2018) and create a self-perpetuating disorder. identification, namely the amygdala, insula, ventral striatum, thalamus,
and hypothalamus (Britton et al., 2006; Murphy, Nimmo-Smith, &
1.1. Dual-process approach of binge drinking Lawrence, 2003; Pessoa, 2017; Phillips et al., 2003a). Second, emotional
response is a reaction to the emotional situation. The inference of the
Dominant neuroscientific models of addictive behaviors and models emotional experience leads to feelings and reactions. This response is
of binge drinking have focused on drug-driven emotions and inhibitory often described by cognitive, physiological, and behavioral correlates (e.
control (e.g., Goldstein & Volkow, 2011; Koob, 2015), without inte­ g., danger-related thoughts, accelerated heartbeats, increased sweat,
grating emotional processes per se. Indeed, most studies capitalized on a behavioral approach/avoidance tendencies). In human research, this
dual-process view, proposing an interaction between two types of pro­ process has been investigated by paradigms inducing affective states (e.
cesses related to specific brain systems (e.g., Blanco-Ramos, Cadaveira, g., mood induction, fear conditioning). The brain regions associated
Folgueira-Ares, Corral, & Rodríguez Holguín, 2019; Carbia, Corral, with this process are the amygdala, ventral striatum, insula, and orbi­
Doallo, & Caamaño-Isorna, 2018; Castellanos-Ryan, Rubia, & Conrod, tofrontal cortex (Britton et al., 2006; Murphy et al., 2003; Phillips et al.,
2011; Lannoy, Billieux, & Maurage, 2014; Oei & Morawska, 2004; 2003a). The final stage of emotional processing is the emotional regula­
Peeters et al., 2012). The first one, System A, is sustained by the (bottom- tion of affective states and action tendencies (e.g., voluntarily slowing
up) limbic brain network (Hampton, Adolphs, Tyszka, & O’Doherty, breath, using relaxation or cognitive restructuring). This step is critical
2007) and involves processes such as automatic/motivational ten­ for personal and social adaptation, poor emotional regulation being
dencies (e.g., positive bias towards alcohol; Carbia, López-Caneda, et al., considered a central transdiagnostic process explaining several psy­
2018; reward-seeking, expectancies towards alcohol; Castellanos-Ryan chopathological states (see Sloan et al., 2017 for a review). In human
et al., 2011; Oei & Morawska, 2004). The second one, System B, is sus­ research, emotional regulation has been investigated by paradigms
tained by the (top-down) prefrontal brain network (Daw, Niv, & Dayan, involving response to emotional stimuli or control from responding to
2005) and encompasses cognitive processes such as executive functions these stimuli. The specific neural correlates associated with this process
or more specifically the ability to control alcohol consumption (Lannoy, are the anterior cingulate and dorsomedial prefrontal cortices
Maurage, D’Hondt, Billieux, & Dormal, 2018; Oei & Morawska, 2004). (Esperidião-Antonio et al., 2017; Murphy et al., 2003; Phillips et al.,
In line with what has been found in severe AUD, results showed an 2003a; Stevens, Hurley, & Taber, 2011).
imbalance between these systems in binge drinking: high alcohol bias/ These emotional processing steps enable disentanglement of the
expectancies towards alcohol combined with poor executive control complexity of emotions and allow the exploration of individual abilities
predicts binge drinking (Carbia, López-Caneda, et al., 2018; Morawska to process and react to emotional stimuli. It is worth noting that these
& Oei, 2005; Peeters et al., 2012). Studies focusing on adolescence also steps are frequently intertwined, but can also be reported independently
speculated that the interaction between Systems A and B would be (e.g., an emotional response may occur without a specific emotional
explained by a brain maturation imbalance: (a) limbic and paralimbic stimulus presentation and evaluation). Critically, this model describes
brain areas mature during early adolescence, following hormonal emotional processing as the successive steps occurring in a specific sit­
changes, and this modification results in increased reward sensitivity; uation, but the processing of emotional signals may also lead to long-
(b) conversely, prefrontal and parietal cortices mature gradually during term emotional outcomes (e.g., depressive symptoms; Phillips, Dre­
late adolescence, and this later maturity explains poor control abilities vets, Rauch, & Lane, 2003b). The relationship between alcohol and
(Shulman, Harden, Chein, & Steinberg, 2015; Steinberg, 2007). The depression being crucial to better understand the onset and perpetuation
interaction between heightened reward sensitivity and poor control of alcohol misuse (Boden & Fergusson, 2011), this paper will consider
abilities might therefore lead to risk-taking behaviors in adolescence both short-term (e.g., self-reported emotional states at the time of the
(Casey & Jones, 2010; Somerville, Hare, & Casey, 2011; Steinberg, study) and long-term (e.g., persistent and significant depressive or
2007), including binge drinking (Noël, 2014; Peeters, Vollebergh, Wiers, anxious symptoms) perspectives.
& Field, 2014). These proposals, however, have been based primarily on In severe AUD, the role of emotional processing is critical and may
studies exploring System A functioning through cue-reactivity, System B explain the maintenance of substance abuse (Koob, 2015). Although
functioning through memory/executive function abilities, or both sys­ patients can exhibit emotional deficits resulting from the alcohol’s ef­
tems. To address the dearth of knowledge regarding the contribution of fects on the brain (Bora & Zorlu, 2017), these emotional deficits can also
emotional processes, this review considers how emotional processing be involved in relapse (Le Berre, 2019). Patients with severe AUD are
adds value to the current understanding of binge drinking. impaired for the whole emotional processing stream, with deficits in
emotional identification and regulation being particularly salient (Le
1.2. The role of emotion Berre, 2019). In binge drinking, the study of emotional processes only
emerged recently. It has been proposed that the repeated alternations
Emotion plays an essential role in the emergence and maintenance of between high alcohol consumption and abstinence led to deleterious

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S. Lannoy et al. Clinical Psychology Review 84 (2021) 101971

brain effects in binge drinking, especially in the prefrontal cortex and well as single-case or case series studies or publications without exper­
amygdala, which might produce similar emotional impairments than imental data (e.g., comments, reviews).
those observed in severe AUD (Stephens et al., 2005). The aim of this The guidelines of the Preferred Reporting Items for Systematic re­
review is to highlight how emotion research may bring insight into views and Meta-Analyses (PRISMA) were followed (Moher, Liberati,
understanding the antecedents and consequences of binge drinking. We Tetzlaff, & Altman, 2009). Inclusion criteria included peer-reviewed
aim to explore which emotional processing steps are altered in binge articles published in English between January 1st, 2000 and June 1st,
drinking and how emotional impairments may be related to alcohol- 2020. The systematic research was conducted in three databases
related outcomes in a non-clinical population. For this purpose, we (Pubmed, Scopus, PsychINFO). Keywords were determined following
adopted a comprehensive and systematic approach to review emotion the theoretical proposal of Phillips et al. (2003a) for emotion (emotional
studies in binge drinking for the first time. We expect that emotional appraisal OR emotional identification OR emotional response OR emotional
difficulties will be reported in binge drinking, particularly for emotional regulation OR emotion OR emotions) and related to binge drinking (binge
identification and response, as these stages appear particularly related to drinking OR heavy drinking OR social drinking OR college drinking). The
the effects of alcohol (Bora & Zorlu, 2017; Stephens et al., 2005). initial search produced 575 papers, 43 of which met inclusion criteria
for this review (see Fig. 1 for a flowchart of article selection). As an
2. Methods example, the search for emotional response AND binge drinking in
PubMed led to 72 results, 18 were removed because they were already
2.1. Inclusion criteria and articles selection found in other research (i.e., emotional appraisal, emotional identifi­
cation) and 54 abstracts were screened. Articles were excluded when
The systematic research has been conducted according to the model they did not focus on human studies (n=11), emotional processing
of emotional processing previously described (Phillips et al., 2003a, (n=16), or binge drinking (n=10). We read 17 full-texts and excluded
2003b). The reliability of this framework is supported in various studies six other articles (intervention studies, no binge drinking measure).
(e.g., Caparelli et al., 2017; Rutter et al., 2019) and offers a theoretically Then, four articles were included, related to internal emotional identi­
driven research including distinct emotional processes. As this research fication (i.e., Bekman, Winward, Lau, Wagner, & Brown, 2013; Pape &
field is nascent, lenient inclusion criteria were used to offer a broad Norström, 2016; Scaife & Duka, 2009; Strine et al., 2008). The final
representation of the field. To determine inclusion criteria, we used a research led to the identification of seven articles, included for the
modified PICOS (Population, Intervention, Comparator, Outcome, Study evaluation of emotional response. This procedure was applied for all
design/setting) procedure for observational studies (Liberati et al.,
2009): 1) the Population referred to human participants (adolescents
and adults, identified age range: 13-74 years old) with current binge
drinking (as a pattern of alcohol consumption) or having presented at
least one binge drinking episode. Studies referring to other patterns of
alcohol use (e.g., severe AUD, fetal alcohol spectrum disorders) that may
bias the current results were excluded. We also excluded animal studies.
In order to offer a comprehensive view of the relationship between binge
drinking and emotional processing, no exclusion criterion was related to
personal, demographic, and socio-economic characteristics. Regarding
psychopathological conditions, we included studies assessing depression
and anxiety, as these psychopathological symptoms are closely related
to impaired affective processing and thus of critical importance when
considering the links between emotional variables and binge drinking.
The presence of other psychopathological disorders not specifically
related to emotional processes (e.g., Attention Deficit Hyperactivity
Disorder, Posttraumatic Stress Disorder) constituted an exclusion crite­
rion as they may bias the interpretation of emotional difficulties (e.g.,
the difficulties observed may not be especially related to binge drinking
but rather, at least partly, to the comorbid pathological condition, which
is out of the scope of the present review); 2) regarding Intervention, we
focused on alcohol drinking and considered both the immediate (i.e.,
emotional processing after drinking alcohol; acute consumption) and
long-term alcohol influence (i.e., stable emotional processing among
binge drinkers, outside the intoxication episodes). As the definition of
binge drinking varies widely across studies, we included all studies
referring to the concept of binge drinking, recognizing that the speci­
ficity of alcohol use criteria would be evaluated in the quality assess­
ment; 3) as Comparator, we considered two types of studies: those
presenting experimental comparisons (between binge drinking and
control groups or between emotional and control conditions) and those
evaluating the relationship between binge drinking and emotional
processing (without group comparison), controlling for personal, de­
Fig. 1. PRISMA flowchart of articles selection.
mographic, and psychopathological variables when statistically appro­
Fig. 1 illustrates the different steps of article selection and inclusion through the
priate; 4) the Outcome focused on emotion. Accordingly, research using
PRISMA guidelines (identification, screening, eligibility, inclusion), and the
self-report measures, behavioral tasks, electrophysiological, or neuro­ number of articles kept and excluded at each selection step. The procedure
imaging data were included if participants were required to process leads to the inclusion of 43 articles, 19 related to internal emotional identifi­
emotional information or if emotional measures were taken; 5) the cation, 12 related to external emotional identification, 7 related to emotional
Study design included correlational or experimental studies but response, among which one also informs about emotional regulation, and 5
excluded research focused on the evaluation of clinical interventions as more related to emotional regulation.

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S. Lannoy et al. Clinical Psychology Review 84 (2021) 101971

searches. The first author performed the search in the databases and the and Italy), one from Uruguay, and one from Thailand. The yearly
first and last authors (SL and PM) conducted the articles’ selection based number of publications increased after 2012 and most studies were
on exported PDF files. cross-sectional (81.4%). Among longitudinal studies (18.6%), seven
were related to the evaluation of internal emotional states and its as­
2.2. Methodological quality assessment sociation with binge drinking and one with external emotional identi­
fication. Self-reported measures were mainly used to assess internal
The existing literature describes many ways to assess the quality of emotional identification and emotional regulation, whereas studies
research studies without a specified standard (Zeng et al., 2015). Indeed, assessing external emotional appraisal/identification and emotional
such assessments may appear subjective and have to be adapted ac­ response used behavioral tasks or a combination of behavioral and
cording to the specific aims of each review. Consequently, for the pre­ neuroimaging/(electro)physiological measures. Only six studies
sent review, identified articles were assessed based on an adapted (13.9%) focused on the effects of acute alcohol intake at binge-drinking
version of the AXIS criteria (Downes, Brennan, Williams, & Dean, 2016). level or among binge drinkers for the evaluation of emotional experi­
This tool was developed to be adapted across all scientific disciplines, ence and emotional response. Finally, in 16 of the studies included
and its reliability was ensured by a Delphi panel (validation of 18 ex­ (37.2%), participants had to process emotional stimuli (emotional
perts) (Downes et al., 2016). Its non-specificity affords a simple and scenes, emotional facial expressions, emotional words, or emotional
clear way for a critical appraisal of the literature, which matched our voices).
aim to include studies using a variety of approaches (e.g., neuroscience,
psychology) to assess emotional processing. 3.2. Quality assessment
The final criteria appear in Table 1, with the detailed evaluation of
each study. In summary, six items were deleted or modified from the The methodological quality of the 43 studies (Table 1) was globally
original scale because they were not directly relevant: items 8 and 9 estimated as good according to the applied criteria (i.e., only three
were combined in a unique item (item 13 in the adapted scale, referring studies had a score below 50%). All studies had clear research objectives
to manipulation of the dependent variable and its appropriateness), and the majority took the influence of confounding factors into account
evaluation of sample size was added in item 3 (to determine what a (e.g., depression, anxiety, drug use) (65.1%). The selected studies
sufficient sample size was, we referred to previous studies and defined a covered various designs and methodologies, but the vast majority pro­
minimum of 25 participants for group studies; Carbia, Corral, et al., posed clear study aims and a justified experimental protocol. Never­
2018, and 52 participants per predictors for correlational studies; theless, most studies did not justify their sample size based on a priori
Maxwell, 2000), and items 13, 15, and 19 were deleted as they referred power computation or previous experiments. Studies comparing groups
to non-response bias, internal consistency (already assessed in other with experimental measures also had small sample sizes (i.e., 60% had
items), and conflicts of interest, respectively. Several adaptations were fewer than 25 participants per group) with often unbalanced gender
also conducted regarding selection criteria and representativeness of the ratio (e.g., some studies focusing only on women). Moreover, we found a
population to meet the specific needs of the present paper (e.g., evalu­ poor evaluation of binge drinking habits in 58.1% of the papers, few
ation of timeframe, intensity, and frequency of binge drinking). To in­ studies combining sufficient quantity (i.e., at least 56/60 gr) and time­
crease the procedure reliability, this quality assessment was performed frame (i.e., at least six months) measures to evaluate habits validly.
by two independent judges (authors SL and PM). The total agreement
between the assessors was 87.9% (= 605/688), which can be evaluated 3.3. Emotional processing in binge drinking
as very strong (McHugh, 2012). Assessment discrepancies were related
to two items (6 and 10). Thus, the minimum quantity of alcohol in a 3.3.1. Emotional appraisal and identification (Table 2)
binge drinking episode (i.e., the consumption of at least 60 gr of pure Emotional identification of internal cues. This section comprises 19
ethanol on one occasion, 56 gr was considered if authors used distinct studies that evaluated the identification of internal emotions. This
categorization for girls; binge drinking score) and the reliable ways to subsection has been divided into two categories: 1) the current
determine statistical significance (e.g., p-values, confidence intervals) emotional states (i.e., those felt during the evaluation like stress or short-
were discussed to reach a consensus. A score (i.e., percentage of "Yes" term negative/positive affect); 2) the longer-term and prolonged
answers) was computed to provide an overview of the quality associated emotional states or mood disorders, like depression and anxiety.
with each study (i.e., poor quality for scores below 50%, fair quality for First, the evaluation of current emotional states showed that binge
scores between 50 and 69%, good quality for scores between 70% and drinking is differentially associated with loneliness, stress, and short-
79%, strong quality for scores of 80% and beyond; Black et al., 2017; term affect according to age. In adolescents (13-15 years old), loneli­
Maurage, Masson, Bollen, & D’Hondt, 2020). ness was related to past 30-day binge drinking (Stickley, Koyanagi,
Koposov, Schwab-Stone, & Ruchkin, 2014), but in college students (18-
3. Results 29 years old) perceived stress predicted binge drinking two weeks later
(Chen & Feeley, 2015). Regarding mood, an initial study indicated that
3.1. Description of the studies binge drinkers (18-30 years old) reported less positive mood than non-
binge drinkers (Townshend & Duka, 2005), but results were not sup­
For each study, data were extracted systematically using the PICOS ported in other studies among similar populations (Hartley, Elsabagh, &
framework. All details regarding the sample, inclusion/exclusion File, 2004; Scaife & Duka, 2009). Another study evaluating mood
criteria, or emotional processes and measures are reported in considered the effects of school-related stress and sex in college students
Tables 2–4. The Results section describes the key conclusions related to (mean age: 20.83 years old). In men, school-related stress was indirectly
each research study and is divided into three sub-sections, organized related to binge drinking through its positive relation with depressive
according to the theoretical model of emotional processing (Phillips mood, which was directly related to binge drinking. In women,
et al., 2003a): emotional appraisal and identification (subdivided in depressive mood was indirectly related to binge drinking through school
self/internal emotional identification and other/external emotional stress, which was directly and negatively related to binge drinking
identification), emotional response, and emotional regulation. (Pedersen, 2013). The relationship between binge drinking and mood is
Study characteristics are illustrated in Fig. 2. Regarding the thus influenced by stress and differs according to sex. Interestingly, a
geographical distribution (i.e., affiliation of the first author), the papers study evaluated whether alcohol abstinence was related to negative
selected were mainly from North America (the United States of America mood in young binge drinkers (16-18 years old). The prevalence of
and Canada) and Europe (the United Kingdom, Belgium, Sweden, Spain, negative mood was related to the specific number of drinks consumed on

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S. Lannoy et al. Clinical Psychology Review 84 (2021) 101971

Table 1
Studies scoring using the adapted quality assessment AXIS (Downes et al., 2016).
Authors Date AXIS Items % score

1 2 3a/b 4 5 6 7 8 9 10 11 12 13 14 15 16

Balodis et al. 2011 Y Y N/N Y N N N Y Y Y Y N Y Y Y Y 64.71

Bekman et al. 2013 Y Y Y/N Y N Y N Y Y Y Y Y Y Y Y Y 82.35
Carbia et al. 2020 Y Y Y/N N N N Y Y Y Y Y Y Y Y Y Y 76.47
Chen & Feeley 2015 Y N Y/N N N N N N N Y Y Y Y N Y N 41.18
Cohen-Gilbert et al. 2017 Y Y N/N Y N Y N Y Y Y Y Y Y Y Y Y 76.47
Connell et al. 2015 Y Y N/N Y N N N Y Y Y Y Y Y Y Y N 64.71
Ehlers et al. 2007 Y Y Y/N Y N N N N Y Y Y Y Y Y Y Y 70.59
Ehret et al. 2013 Y Y Y/N Y N N N N N Y Y Y Y Y Y Y 64.71
Ewing et al. 2010 Y Y Y/N Y N Y N Y Y Y Y Y N Y Y Y 76.47
Gowin et al. 2020 Y Y Y/N Y N Y Y Y Y Y Y Y Y Y Y Y 88.24
Hartley et al. 2004 Y Y N/Y Y N Y Y Y Y Y Y Y Y Y Y Y 88.24
Haynes et al. 2005 Y Y Y/N Y Y Y Y Y Y Y Y Y N Y Y Y 88.24
Hefner et al. 2013 Y Y N/N Y N N N N N Y Y Y Y Y Y Y 58.82
Herman et al. 2018 Y Y N/N Y N Y Y N N Y Y Y Y Y Y Y 70.59
Howland et al. 2010 Y Y Y/Y Y N Y N Y Y Y Y Y N Y Y Y 82.35
Huang et al. 2018 Y Y Y/N Y N Y Y Y Y Y Y Y Y Y N N 76.47
Khan et al. 2018 Y Y N/N Y N Y N Y Y Y Y Y N Y Y Y 70.59
Laghi et al. 2018 Y Y Y/N Y N Y N N N Y Y Y Y Y Y Y 70.59
Lannoy et al. 2017 Y Y N/N Y N Y Y Y Y Y Y Y Y Y Y Y 82.35
Lannoy et al. 2018 Y Y N/N Y N Y Y Y Y Y Y Y Y Y Y Y 82.35
Lannoy et al. 2018 Y Y N/N Y N Y Y Y Y Y Y Y Y Y Y Y 82.35
Lannoy et al. 2019 Y Y Y/N Y N Y Y Y Y Y Y Y Y Y Y Y 88.24
Leganes-Fonteneau et al. 2020 Y Y N/N Y N Y Y N N Y Y Y Y Y Y Y 70.59
Lindgren et al. 2018 Y Y Y/N Y N N N N N Y Y Y Y Y Y Y 64.71
Loeber & Duka 2009 Y Y N/N Y N N N N N Y Y Y Y Y Y Y 58.82
Maurage et al. 2009 Y Y N/N Y N Y Y Y Y Y Y Y Y Y Y Y 82.35
Maurage et al. 2013 Y Y N/N Y N Y Y Y Y Y Y Y Y Y Y Y 82.35
Mngoma et al. 2020 Y N Y/N N N N N Y Y N Y Y N N Y Y 47.06
Mushquash et al. 2013 Y Y Y/N Y Y N N N N Y Y Y N Y Y Y 64.71
Nourse et al. 2017 Y Y Y/N Y N N N Y Y Y Y Y N N Y Y 64.71
Pape & Norström 2016 Y Y Y/N Y Y Y Y Y Y Y Y Y Y Y Y Y 94.12
Pedersen 2013 Y N Y/N Y N N N N N Y Y Y N Y Y N 47.06
Poncin et al. 2017 Y Y N/N Y N Y N N N N Y Y Y Y Y Y 58.82
Rose & Grunsell 2008 Y Y N/N Y N Y Y N N Y Y Y Y N N Y 58.82
Ruiz et al. 2020 Y Y Y/N N N Y Y Y Y Y Y Y N Y Y Y 76.47
Scaife & Duka 2009 Y Y Y/N Y N Y Y Y Y Y Y Y Y Y N Y 82.35
Stephens et al. 2005 Y Y N/N Y N Y Y Y Y Y Y Y Y Y N Y 76.47
Stickley et al. 2014 Y Y Y/N Y Y N N N N Y Y Y N Y Y Y 64.71
Strine et al. 2008 Y Y Y/N N Y Y N Y Y Y Y Y Y Y Y N 76.47
Townshend & Duka 2005 Y Y Y/N Y N Y Y Y Y Y Y Y Y Y Y Y 88.24
Trojanowski et al. 2019 Y Y Y/N Y N Y N Y Y Y Y Y Y Y Y Y 82.24
Venerable & Fairbairn 2020 Y Y Y/Y Y Y N N N N Y Y Y Y Y Y Y 76.47
Wichaidit et al. 2019 Y Y Y/N N N N N Y Y Y Y Y N Y Y Y 64.71

Legend: N = No; Y = Yes

Note: Question related to each item:
Introduction
(1) Were the aims/objectives of the study clear?
Methods
(2) Was the study design appropriate for the stated aim(s)?
(3) Was the sample size (a) sufficient (i.e., at least 25 subjects per group or 52 per predictor) and (b) justified (i.e., power analysis, reference to samples or effect sizes
reported in earlier studies)?
(4) Was the target/reference population clearly defined (Is it clear who the research was about?)?
(5) Were measures undertaken to address and categorize non-responders?
(6) Were the selection criteria clearly defined and selective enough (e.g., alcohol intensity) to focus on binge drinkers?
(7) Was the timeframe of binge drinking habits enough (i.e., 6 months), so that one could reasonably expect to see an association between binge drinking and emotional
processes?
(8) Were key potential confounding variables considered (e.g., included in pre-selection criteria or adjusted statistically)?
(9) Were key potential confounding and outcome variables measured appropriately?
(10) Is it clear what was used to determine statistical significance and/or precision estimates (p-values, CIs)?
(11) Were the methods (including statistical methods) sufficiently described to enable them to be repeated/reproduced?
Results
(12) Were the basic measures (i.e. demographics) adequately described?
(13) Were the dependent variables (i.e. emotional processes) manipulated, and was this manipulation adequately described?
Discussion
(14) Were the authors’ discussions and conclusions justified by the results?
(15) Were the limitations of the study discussed?
Other
(16) Was ethical approval or consent of participants attained?

5
 Table 2

S. Lannoy et al.
Description and main results of studies evaluating emotional appraisal and identification in binge drinking.
Authors (year) Participants Intervention Comparator Experimental design Outcomes Scoring

Sample (n) Age Gender ratio Inclusion criteria Binge drinking criteria Control group/ Processes Task/scale Stimuli Main results Limits
(% of males) variable measured

Emotional identification of internal cues

Bekman et al. 39 BD Range 51% N/A No information 82.35

(2013) 16-18 6-week research Negative affect at about affective states
following abstinence: early stage of prior the onset of
Mean No recent substance Drinking alcohol on 26 non-BD (no Anxiety and two assessments abstinence: BD > alcohol use
17.74 consumption more than 100 history of binge depression (start and end) and non-BD
occasions at lifetime. drinking or alcohol daily follow-up (3-6
No psychiatric or use problems) Mood times/day) Depression, anxiety:
neurological At least 3 binge BD > non-BD
disorders drinking episodes (≥ The Hamilton Rating
70 alcohol gr for boys Scales for Anxiety Correlations between
and ≥ 56 gr for girls and Depression negative affect and
on one occasion) maximum number of
during the past State-Trait Anxiety drinks consumed on
month Inventory one occasion and
total number of
At least 1 withdrawal Self-reported drinks
symptom following a negative affects
recent drinking (down, angry, and
episode stressed)
Chen and Feeley 179 college Range 46.9% N/A Number of binge Analyses were Stress 2-week research N/A Convenience sample 41.18
(2015) students 18-29 drinking episodes in controlled for age, Students with higher
the past 2-week (≥ gender, ethnicity, Loneliness Perceived Stress stress depicted
Mean 70 alcohol gr for boys and health status Scale increased binge
6

19.76 and ≥ 56 for girls in 2 drinking 2 weeks

hours) UCLA Loneliness later
Scale
No associations were
found with loneliness
Ewing et al. 45 college Range 44.44% No MRI At least 42 alcohol gr N/A Depressive AUDIT N/A Depression was No control group 76.47
(2010) students 21-33 contraindication, (men) or 28 (women) symptoms positively associated
personal or family per drinking Beck Depression with brain
Mean history of occasion, 2-5 times Anxiety Inventory activations (insula,
22.8 psychopathological per week, for 4 weeks symptoms cingulate, ventral
disorder, current Beck Anxiety tegmentum,
medical condition, Number of binge Inventory striatum, and
mental retardation, drinking episodes (at thalamus) while
left handedness, or least 70 gr) in the fMRI: taste-cue viewing alcohol cues
current substance use past month paradigm (alcohol
No alcohol, caffeine, and non-alcohol Anxiety was

Clinical Psychology Review 84 (2021) 101971

and nicotine use appetitive cues) positively associated
prior scanning with brain
activations (striatum,
thalamus, insula, and
inferior frontal, mid-
frontal, and cingulate
gyri) while viewing
alcohol cues
Hartley et al. 14 BD Range 64.3% N/A ≥ 80 alcohol gr on 13 teetotalers Trait anxiety and The Hospital Anxiety N/A Trait anxiety and Comparison with a 88.24
(2004) 18-23 one occasion depression and Depression Scale depression: BD < group of non-
teetotalers drinkers (i.e., it
Visual analogue assesses the effect of
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 Table 2 (continued )

S. Lannoy et al.
Authors (year) Participants Intervention Comparator Experimental design Outcomes Scoring

Sample (n) Age Gender ratio Inclusion criteria Binge drinking criteria Control group/ Processes Task/scale Stimuli Main results Limits
(% of males) variable measured

Mean Binge drinking score rating scales alcohol consumption

21.13 ≥ 24 Mood (alertness, well- NS for mood rating but not a specific
being, anxiety) effect of binge
drinking)
Haynes et al. 8,580 adults at 18-74 N/A Absence of mental ≥ 48 alcohol gr on Analyses were Depression N/A Hazardous drinking, No information 88.24
(2005) baseline disorder at baseline one occasion at least adjusted for age, 18-month study binge drinking, and about the evaluation
once a month gender, socio- severe alcohol use of depression and
demographic and Clinical Interview disorders were not anxiety during the 18
-economic variables, Schedule at baseline related to anxiety or months (e.g.,
other substance use (n=2,413 who depression at follow- recovery)
and mental health completed the up
follow-up have no
mental disorder) Sub-threshold of
anxiety and
AUDIT depression at
baseline was related
Severity of Alcohol to the onset of severe
Dependence alcohol use disorders
Questionnaire (weak evidence)
Howland et al. 193 college Range Analyses were N/A Mood was affected Not reported 82.35
(2010) students 21-24 No alcohol problems controlled for gender 2-week research the morning after
or other substance At least one binge and session Mood (alcohol versus alcohol consumption
Mean use, no medical drinking episode (≥ placebo) and (BAC of 12%)
21.47 condition 70 alcohol gr for boys Alcohol assessment following
or ≥ 56 for girls) in administration beverage
7

No night shifts work, the past month versus placebo administration

no regnancy, no (morning and
travel across two or Alcohol afternoon)
more time zones in administration:
the prior month 1.068 g/kg for boys Profile of Mood
and 0.915 g/kg for States
girls with cans of
beer in one-hour
interval. Non-
alcoholic beer as
placebo condition.
Mngoma et al. 355 youth Range 100% N/A No specific binge N/A Anxiety Brief Symptom N/A Suicidal thoughts No inclusion of 47.06
(2020) 14-24 drinking criteria Inventory were associated with women
Depression depression, anxiety,
Mean Rosenberg Self- worthlessness, and
18.6 Esteem Scale binge drinking

Clinical Psychology Review 84 (2021) 101971

Social Provisions
Scale

Substance use
Mushquash et al. 191 women Mean 19.9 N/A N/A Dichotomic alcohol N/A Depression N/A Depressive No inclusion of men 64.71
(2013) measure: 4-week research symptoms predicted
0: no more than 56 gr Use of structural Mood binge drinking over
in 2 hours equation modeling Depression Adjective one week but binge
1: more than 56 gr in Checklist drinking did not
2 hours at least once predict depression.
in the past week Center for
Epidemiological
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 Table 2 (continued )

S. Lannoy et al.
Authors (year) Participants Intervention Comparator Experimental design Outcomes Scoring

Sample (n) Age Gender ratio Inclusion criteria Binge drinking criteria Control group/ Processes Task/scale Stimuli Main results Limits
(% of males) variable measured

Studies Depression
Scale

Profile of Mood
States
Nourse et al. 201 college Mean 21.1 25.4% N/A AUDIT score ≥ 7 N/A Anxiety Generalized Anxiety N/A No association No inclusion of men 64.71
(2017) students Questionnaire between hazardous
drinking and Small convenience
Depression Patient Health depression or anxiety sample
Questionnaire

AUDIT
Pape and 2,171 youth Range 43% N/A Frequency of alcohol Separate analyses Anxiety 13-year research, 4 N/A 94.12
Norström people 13-17 use and intoxication according to age (to assessment times Emotional distress
(2016) Time 1 feelings in the past consider was not associated
12 months developmental Depression The Hopkins with binge drinking Subjectivity related
Mean trajectories) and Symptom Check List in early adolescence to the binge drinking
14.9 gender measure
Loneliness (as a The Depressive Mood From adolescence to
control measure Inventory adulthood (mean
at the age: 16.4 yo to 21.8
longitudinal UCLA Loneliness yo) and in late
level) Scale adulthood (mean
age: from 21.8 yo to
28.3 yo), depression,
8

but not anxiety, was

positively associated
with binge drinking
Pedersen (2013) 248 college Range 37.09% N/A Number of binge Separate analyses for Depressive mood Behavioral Risk N/A In men, binge Single-item measure 47.01
students 18-29 drinking episodes (≥ men and women. Factor Surveillance drinking was of depression
70 alcohol gr for boys Analyses controlled Stress System (BRFSS) positively related to
Mean or ≥ 56 for girls) in for class level and depression
20.83 the past month employment status School stress scale
In women, the
relation between
binge drinking and
depression was
explained by class
level (first university
year), employment
status (higher

Clinical Psychology Review 84 (2021) 101971

number of work
hours) and school-
related stress
Rose and 10 BD Range 50% No psychiatric or 10 non-BD (binge Mood Visual Analog Scale N/A Ratings of Not reported 58.82
Grunsell 18-25 substance use ≥ 80 alcohol gr per drinking score ≤ 16) (alert, content, “stimulated”
(2008) disorder, no current week relaxed, stimulated, decreased between
Mean medication Alcohol lightheaded, and baseline and post-
21.5 Binge drinking score administration irritable), completed preload:
No alcohol drinking, ≥ 24 versus placebo (1) before alcohol (1) placebo
caffeine, or fat meal drinking and (2) 30 condition, BD < non-
before the Alcohol minutes after BD
experiment administration: drinking alcohol (2) alcohol
0.6 g / kg for boys condition, BD > non-
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 Table 2 (continued )

S. Lannoy et al.
Authors (year) Participants Intervention Comparator Experimental design Outcomes Scoring

Sample (n) Age Gender ratio Inclusion criteria Binge drinking criteria Control group/ Processes Task/scale Stimuli Main results Limits
(% of males) variable measured

and 0.5 g / kg for BD

girls with lemonade
in a 500 ml solution Ratings of
drank in a 30-minute “lightheaded”
period. In the control following alcohol
condition, 500 ml of preload, BD < non-
lemonade with drops BD
of ethanol (≤ 5 ml)
Ruiz et al. 1505 Range 25% N/A Number of binge Analyses were Emotional AUDIT N/A Psychological Not reported 76.47
(2020) participants 18-30 drinking episodes (≥ controlled for the distress distress:
70 alcohol gr for boys total volume of Alcohol Early drinkers > Late
Mean or ≥ 56 for girls on alcohol consumed consequences drinkers
23.25 one occasion) in the and sex questionnaire
last 12 months Significant
Kessler Scale of relationship between
Late drinkers (first psychological psychological
alcohol use after 15 distress (anxiety, distress and negative
yo) and early depression, and non- consequences of
drinkers (first specific distress) alcohol
alcohol use before 14
yo) Doherty Scale of Psychological
Emotional Contagion distress was not
associated with binge
drinking but with
negative
9

consequences of
alcohol
Scaife and Duka 30 BD Range 60% Binge drinking score 30 non-BD (binge Mood Profile of Mood N/A No significant Not reported 82.35
(2009) 18-29 No use of illicit drug > 31 (median split) drinking score < 31) States difference between
or medication 1 week BD and controls, only
Mean before the a gender effect
20.6 experiment, no showed higher
alcohol drinking 12 arousal in female
hours before the
experiment
Stickley et al. 4,045 Range 47.4% N/A Drinking more than Loneliness Adapted Center for N/A Loneliness was Single-item measure 64.71
(2014) adolescents 13-15 70 alcohol gr on one Analyses controlled Epidemiological associated with binge of loneliness
occasion at least oncefor age, parental Studies Depression drinking in the last
in the past month education, family Scale month among
structure, and adolescents in the US
depressive

Clinical Psychology Review 84 (2021) 101971

symptoms.
Strine et al. 217,379 adults 18 or older N/A N/A Analyses were Anxiety and Patient Health N/A Adults who No information on 76.47
(2008) ≥ 70 alcohol gr for adjusted by sex, age, depression Questionnaire presented current the causality link
boys and ≥ 56 for socio-demographic depression or had a between anxiety/
girls on one occasion and -economic status Evaluation of lifetime history of depression and
in the past month smoking habits, depression or anxiety alcohol use
height, weight, exhibited increased
Heavy drinking: > 28 physical activity, and smoking, obesity,
gr per day for boys alcohol consumption physical inactivity,
and > 14 for girls binge, and heavy
. drinking
Townshend and 38 BD Range 60.5% ≥ 48 alcohol gr per 34 non-BD (binge Mood Profile of Mood N/A BD had less positive Self-reported alcohol 88.24
Duka (2005) 18-30 week drinking score ≤ 16) States mood use
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 Table 2 (continued )

S. Lannoy et al.
Authors (year) Participants Intervention Comparator Experimental design Outcomes Scoring

Sample (n) Age Gender ratio Inclusion criteria Binge drinking criteria Control group/ Processes Task/scale Stimuli Main results Limits
(% of males) variable measured

No
psychopathological Binge drinking score
Mean disorder, ≥ 24
20.9 neurological
disorder, or
substance use
disorder

No use of drug,
sleeping tablet, hay
fever and alcohol
prior the experiment
Venerable and 60 BD Range 50% No medical Drinking at least 2 Comparison between Mood 7-day study, 18- N/A When controlling for Less BD compared to 76.47
Fairbairn 21–28 contraindication for times/ week, 56 alcohol and placebo month follow-up baseline drinking, non-BD answered at
(2020) alcohol drinking alcohol gr per sessions greater negative follow-up
Mean 22.5 occasion Self-report mood, mood reduction after
No severe alcohol use Analyses exploring anxiety, and alcohol- alcohol drinking
disorders, Number of binge the effects of alcohol related stimulation predicted drinking
extreme body mass drinking episodes (≥ on mood were and sedation problems at follow-
index, and no 70 alcohol gr for boys controlled for up
pregnant women or ≥ 56 for girls on predrink mood and Transdermal sensors
one occasion) in the lagged (7 days) Greater positive
past 30 days mood mood after alcohol
Mood scale: positive drinking also
Alcohol (upbeat, content, predicted drinking
10

administration happy, euphoric, problems and binge

0.82 g/kg for boys energized) and drinking at follow-up
and 0.74 g/kg for negative (nervous,
girls (mix of sad, irritated, lonely,
cranberry and bored) mood after
vodka) served in alcohol use
three equal parts at
0, 12, and 24 min. Short Inventory of
In the control Problems
condition,
isovolumic amount
of cranberry juice
Wichaidit et al. 38,186 students Age range 45.5% N/A At least one binge Analyses were Mood Substance (tobacco, N/A Depressed mood was No information on 64.71
(2019) 12-17 drinking episode (≥ controlled for socio- alcohol, illicit drug) significantly the causality
60 alcohol gr for boys demographic and and behaviors associated with
Mean and 50 for girls on -economic variable, (gambling, sexual alcohol drinking in

Clinical Psychology Review 84 (2021) 101971

15.2 one occasion) in the substance use and behaviors, gaming, the past year, the
past month psychopathology and social media use) past month, and with
past-month binge
Patient Health drinking
Questionnaire

Emotional identification of external cues

Carbia et al. 180 college Range 46.67% No personal or family Number of binge Analyses were Emotional 2-year research Positive, Boys: no significant No 76.47
(2020) students at 18-20 history of severe drinking episodes (≥ controlled for memory negative, effect neuropsychological
follow-up alcohol use disorder, 60 alcohol gr for boys cannabis use, AUDIT and neutral assessment at
Mean illicit drug use, and ≥ 40 gr for girls) tobacco use, and words Girls: BD had an baseline
18.01 neurological or in the last 3 months psychopathology Alcohol Timeline emotional memory
psychiatric disorders Followback bias for negative
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 Table 2 (continued )

S. Lannoy et al.
Authors (year) Participants Intervention Comparator Experimental design Outcomes Scoring

Sample (n) Age Gender ratio Inclusion criteria Binge drinking criteria Control group/ Processes Task/scale Stimuli Main results Limits
(% of males) variable measured

words, lower recall

Emotional Verbal for positive and
Learning Test neutral words,
(assessed at follow- increased false
up) alarms for negative
emotional
distractors.
Ehlers et al. 30 BD Range 50% No psychiatric At least one binge 36 non-BD and non- Emotional Facial discrimination Happy, Cross-sectional 70.59
(2007) 18-25 disorder drinking episode (> drug users identification task (answer to neutral, and Binge drinking + alcohol use data
59 BD and drug 70 alcohol gr) during happy or sad faces sad faces drug use history:
users Mean adolescence; with or and do not answer to decreased P3a
19.91 without drug neutral) latency during the
consumption view of all faces
EEG recording:
event-related Binge drinking and
potentials (P3a and binge drinking +
P3b) drug use: decreased
P3b amplitude
during the view of
happy faces
Gowin et al. 177 BD Range 72.31% No lifetime history of At least one binge 309 non-BD Emotional Penn Emotion Emotional Machine learning: Heterogeneity in the 88.24
(2020) 22–35 alcohol abuse or drinking episode (≥ identification Recognition Test facial Emotion processing BD sample
dependence 70 alcohol g for boys (happy, sad, angry, expressions did not perform
Mean or ≥ 56 for girls on scared or neutral of better than chance
27.9 one occasion) per emotional faces) happiness,
11

week in the last year sadness, The best model to

fMRI measures: anger, and identify BD
Emotional task fear compared to non-BD
(matching of faces compared to included social and
with angry, fearful, neutral ones language processing
or neutral emotional
expressions)
Huang et al. 32 BD Range 50% No history of At least 5 binge 32 non-BD (no more Emotional Appraisal of No behavioral Not reported 76.47
(2018) 18-30 neurological or drinking episodes (≥ than one binge appraisal emotional images (9- Emotional difference in the
neuropsychiatric 84 alcohol gr for boys drinking episode in point Likert scale) scenes: ratings of emotional
Mean disorder, visual or or ≥ 70 for girls the last 6 months) negative, images.
23.3 auditive problem, within 2-hour) in the EEG recording: positive,
learning difficulty, last 6 months event-related theta erotic, and Modulation of event-
left-handed power at frontal, neutral related theta power
participant central, and parietal stimuli (early and later
sides processing): BD <

Clinical Psychology Review 84 (2021) 101971

No drug or non-BD
medication use
before the study
Khan et al. 147 college Range / No psychiatric At least one binge Analyses were Distress Appraisal of distress No information on 70.50
(2018) students 18-23 disorder (inclusion of drinking episode (≥ controlled for gender tolerance The Structured tolerance predicted the causality
moderate 50 alcohol gr for boys and drinking Clinical Interview for alcohol-related
Mean depression), illicit or ≥ 40 for girls in quantity DSM-IV problems in BD,
19.92 substance use, or two hours) in the when controlling for
significant cognitive past month The Distress drinking quantity
deficit Tolerance Scale and sex differences.

Timeline Follow back The relationship

between alcohol-
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 Table 2 (continued )

S. Lannoy et al.
Authors (year) Participants Intervention Comparator Experimental design Outcomes Scoring

Sample (n) Age Gender ratio Inclusion criteria Binge drinking criteria Control group/ Processes Task/scale Stimuli Main results Limits
(% of males) variable measured

Brief Young Adult related problems and

Alcohol distress tolerance,
Consequences absorption, and
Questionnaire regulation was
mediated by drinking
Beck Depression to cope.
Inventory
Lannoy et al. 20 BD Range 45% Binge drinking score 20 non-BD (binge Emotional Emotional Emotional No significant group Subjective 82.35
(2017) 18-23 No personal or family ≥ 16 drinking score ≤ 12) crossmodal crossmodal task facial difference evaluation of alcohol
history of severe identification (identification of expression use (drunkenness)
Mean alcohol use disorder, emotional stimuli of of anger and Non-BD were slower
19.73 psychological, anger and happiness happiness than BD for the
neurological or based on facial and recognition of
medical disorders, vocal processing) Emotional emotional faces
medication or drug bursts of
use, normal visual anger and
and auditory abilities happiness
Lannoy, 17 BD Range 58.8% No personal or family Binge drinking score 17 non-BD (binge Emotional Emotional Emotional No significant Small sample size 82.35
D’Hondt, et al. 18-29 history of severe ≥ 16, drinking score crossmodal crossmodal task facial behavioral difference
(2018) alcohol use disorder, ≥ 60 alcohol gr per between 1 and 12, ≤ identification (identification of expression
Mean psychological, occasion, ≥ 20 gr per 30 alcohol gr per emotional stimuli of of anger and N100 latency, anger:
20.52 neurological or hour, 2-4 times per occasion, ≤ 3 times anger and happiness happiness BD > non-BD,
medical disorders, week per week) based on facial and teetotalers
medication or drug vocal processing) Emotional
use, normal visual 19 teetotalers bursts of P3b amplitude,
12

and auditory abilities EEG recording anger and congruent happiness:

happiness BD > non-BD,
teetotalers in

Crossmodal
integration for anger
in incongruent trials
Latency: BD > non-
BD, teetotalers

Amplitude: BD>non-
BD, teetotalers
Lannoy, Dormal 23 BD Range 47.8% No personal or family Binge drinking score 23 non-BD (binge Emotional Facial emotional Facial Overall emotion Small sample size 82.35
et al. (2018) 18-27 history of severe ≥ 16 drinking score ≤ 12) recognition recognition test emotional recognition:
alcohol use disorder, (morphed stimuli) expressions BD < non-BD
Mean psychological, of anger,

Clinical Psychology Review 84 (2021) 101971

20.02 neurological or contempt, No specific effects of
medical disorder, disgust, fear, emotion
medication or drug happiness,
use, normal visual and sadness
abilities
Lannoy et al. 52 BD Range 65.4% No personal or family At least one binge 42 non-BD (no binge Emotional Facial emotional Facial Possible influence of 88.24
(2019) 18-27 history of severe drinking episode (> drinking episode in recognition recognition test emotional Recognition of fear impaired
alcohol use disorder, 60 alcohol gr) per the last year, binge (morphed stimuli) expressions and sadness: participants on the
Mean or psychiatric month drinking score ≤ 12) of anger, BD < non-BD group results
21.09 disorder contempt,
Binge drinking score disgust, fear, These deficits
≥ 16 happiness, concerned 21.15 and
and sadness
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 Table 2 (continued )

S. Lannoy et al.
Authors (year) Participants Intervention Comparator Experimental design Outcomes Scoring

Sample (n) Age Gender ratio Inclusion criteria Binge drinking criteria Control group/ Processes Task/scale Stimuli Main results Limits
(% of males) variable measured

15.38% of the
sample, respectively
Leganes- 48 participants Students 50% No psychological High and low BD: Comparison between Emotional Emotional Facial Emotion Recruitment of two 70.59
Fonteneau Mean or neurological median split on the high and low BD identification identification emotional identification, fear: BD groups that did
et al. (2020) 21.2 disorder, normal binge drinking score (matching of expressions low BD > high BD not have the same
visual abilities emotional word with of fear, consumption
Youth Students, median emotional face; anger, Emotional patterns
Mean score = 15.8 congruent or happiness, perception
15.4 Youth, median score incongruent) surprise, Sadness: low BD <
= 8.5 sadness, and high BD
Emotional disgust Happiness: low BD <
perception threshold high BD
No positive family Baseline: low alcohol 18 non-BD (< 30 Emotional 9-month, two The word After 9 months, P1, 82.35
history of severe use, alcohol gr per week) identification assessments: “paper” N2, P3 latencies: BD
alcohol use disorder, no binge drinking pronounced > controls
Maurage et al. 18 BD Mean 18.16 38.9% tobacco or drug use, episode Emotional valence with No comparison
(2009) at time 2 psychiatric, medical detection task prosody of between emotional
or neurological Time 2: distinction (auditory stimuli, anger and cognitive event-
problem, auditory between BD (> 200 positive or negative happiness related potentials
impairment alcohol gr per week) valence)
and controls
EEG recording:
event-related
potentials (P1, N2,
P3)
13

Maurage, 12 BD Range 58.3% No positive personal Consumption of 12 non-BD (< 20 Emotional Two-alternative Auditory Behavioral Small sample size 82.35
Bestelmeyer, 19-32 or family history of more than 50 alcohol alcohol gr per identification forced choice task stimuli categorization:
et al. (2013) severe alcohol use gr per occasion, at occasion, < 1 per (morphed stimuli: expressing BD < non-BD
Mean disorder, medical, least 3 times a week; week, < 10 gr per fear – anger negative
23.8 psychiatric, or with consumption hour) continuum) affective Bilateral superior
neurological speed 20 gr per hour bursts temporal gyrus:
problem, drug or fMRI recording, related to BD < non-BD
tobacco use, auditory whole brain fear and Right middle frontal
impairment, left- anger gyrus:
handedness BD > non-BD
participant

Note. All alcohol units have been converted in grams of pure ethanol, according to the number of grams per unit in each country. BD = binge drinkers; AUDIT = Alcohol Use Disorders Identification Test; DSM = Diagnostic
and Statistical Manuel of mental disorders; fMRI = functional Magnetic Resonance Imaging; EEG = electroencephalogram; yo = years old.

Clinical Psychology Review 84 (2021) 101971

 Table 3

S. Lannoy et al.
Description and main results of studies evaluating emotional response in binge drinking.
Authors Participants Intervention Comparator Experimental design Outcomes Quality
(year)
Sample (n) Age Gender Inclusion criteria Binge drinking criteria Control group/ Processes measured Task/scale Stimuli Main results Limits
ratio variable
(% of
males)

Balodis et al. 87 college Range 33.33% No allergic reaction Drinking at least Contrast Physiological stress Stress (public task) N/A Stress condition, Small 64.71
(2011) students 19-27 to alcohol or once per month between stress level and No-stress tension, anxiety, sample size
contraindication to (mean occasions/ and non-stress (crossword puzzles) increase in cortisol:
Mean drink alcohol, month = 6.08, conditions Mood alcohol, placebo <
20.00 cardiovascular SD=4.3; mean Cortisol and alpha- soft groups
disease, or alcohol gr/ occasion amylase
neurological = 74.2) Alcohol Risk-taking:
disorder. administration Risk-taking task alcohol, placebo >
Alcohol versus placebo soft groups
No food before the administration: versus soft drink Profile of Mood
experiment BAC level of 0.08%, States Risk-taking was not
fresca soda and related to stress
Vodka (alcohol), Mood evaluation
Fresca soda and
flattened tonic water
(placebo), Fresca
soda (soft); 3 glasses,
10–15 min intervals
Connell 10 BD Range 40% N/A At least one binge 11 non-binge Electrophysiological Passive viewing of Neutral, LPP amplitudes, Small 64.71
et al. 18-22 drinking episode (≥ drinkers (no emotional response neutral, positive, and positive, and negative images: BD sample size
(2015) 70 alcohol gr for boys binge drinking negative emotional negative < non-BD
or ≥ 56 for girls) in episode in the images images from
14

9 BD with the past year past year) the IAPS EPN amplitude,
depressive Electrophysiological negative and neutral
symptoms 12 controls with recording: event- images: BD > non-BD
depressive related potentials
symptoms (EPN, P3, LPP) Reduced later
processing P3 and
LPP, all emotional:
depressed BD < non-
depressed BD
Hefner et al. 72 college Range 50% No history of alcohol- Alcohol use: ≥ 42 Alcohol Startle response to Shock tolerance Electric Startle response in No inclusion 58.82
(2013) students 21-35 related problem, alcohol gr for boys administration anxiety and fear threshold assessment shocks of predicted condition: of
medical or and 28 for girls on versus placebo intensity BD < placebo, soft attentional
Mean psychopathological one occasion in the versus soft drink Experimental task (maximum groups measures
21.60 disorder last year (color square cues; tolerance for
predicted (fear each Alcohol stress-
No alcohol/food use Alcohol elicitation) and participant) response dampening,

Clinical Psychology Review 84 (2021) 101971

before the administration: unpredicted (anxiety specific to anxiety
experiment BAC level of 0.08%, elicitation) shocks and persistent in time
fruit juice and vodka
(alcohol), fruit juice Electromyographic
and water (placebo), activity
fruit juice (soft); 2
glasses, 15min
interval
Lindgren 149 college Range 53.29% No major medical At least one binge Control by Emotional and Emotional Alcohol approach or No 64.71
et al. students 21-25 problem or alcohol drinking episode (≥ contrasting alcohol-related Implicit alcohol- videos drinking identity assessment
(2018) use disorder. 70 alcohol gr for boys emotional videos responses related association inducing associations: non- of baseline
Mean or ≥ 56 for girls) in (positive, test (alcohol excite, sadness, significant mood
21.55 No alcohol, drug, or the last month alcohol approach, happiness,
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 Table 3 (continued )

S. Lannoy et al.
Authors Participants Intervention Comparator Experimental design Outcomes Quality
(year)
Sample (n) Age Gender Inclusion criteria Binge drinking criteria Control group/ Processes measured Task/scale Stimuli Main results Limits
ratio variable
(% of
males)

food use before the negative, and and drinking or neutral Sad mood moderated
experiment neutral) identity) state. the negative relation
between implicit
Alcohol Self-Concept alcohol excite
Scale associations and
drinking
Mood induction
(video clips) Happy and neutral
mood moderated the
Mood evaluation positive relation
after the video between implicit
alcohol excite
Alcohol taste test associations and
drinking
Loeber and 36 moderate Mean 52.78% Body mass index At least 80 alcohol gr Control by Emotional response Abstract stimuli with Bursts of Avoidance in S+ The alcohol 58.82
Duka social 21.6 between 18 and 28, per contrasting to aversive noise eye tracking 102 db trials: group
(2009) drinkers no pregnant or week (≤ 320) emotional measures: alcohol < placebo guessed they
breastfeeding positive and Inhibition of occurrence of Presentation received
women, heavy Alcohol negative words emotional aversive (102 db, S+) of positive Stop-signal alcohol
smoker (≥ 20 administration: information after the or no noise (S− ) after or negative performance: (compared
cigarettes/day), Alcohol dose of 0.8 Alcohol auditory aversive specific stimuli words alcohol < placebo to the
dyslexia, mental or g/kg, 90% v/v administration procedure during the placebo
neurological alcohol, tonic water, versus placebo Instrumental affective group)
15

disorder, drug use and Angostura Bitter training: same Go/No-Go Go/No-Go, positive
(alcohol), tonic procedure with task versus negative
No illicit drugs, water and Angostura possibility to avoid words: alcohol <
medication, and Bitter (placebo); the noise placebo
alcohol use before 10×50 ml, 3 min
the experiment intervals Stop Signal task Reaction time,
negative words:
Affective Go/No-Go alcohol > placebo
task
Poncin et al. 32 BD Range 59.4% No personal or family Consumption > 60 23 non-BD Emotional response Anagram solution No No difference in No 58.82
(2017)1 18-30 history of substance alcohol gr per (consumption < to distress task (soluble and emotional distress rating assessment
use disorder occasion, at least 2 20 alcohol gr per insoluble anagrams) stimuli of emotional
Mean times a week, with week, < 0.5 Anagram induced states before
20.88 consumption speed occasion per Visual analogue scale distress predicted distress
> 20 gr per hour week, (distress) blaming others in the induction
consumption whole sample

Clinical Psychology Review 84 (2021) 101971

speed < 10 gr Emotion regulation
per hour) (self-blame, blaming Acceptance: BD <
others, rumination, non-BD
catastrophizing,
putting into Anagram induced
perspective, positive distress was related
refocusing, positive, to rumination and
reappraisal, self-blame in BD
acceptance, and
refocusing on
planning)

(continued on next page)

 S. Lannoy et al. Clinical Psychology Review 84 (2021) 101971

one occasion and to the total number of drinks consumed before the
abstinence period (Bekman et al., 2013). Further, depressive and anxiety
Quality

76.47
symptoms were more pronounced in binge drinkers than in non-binge
drinkers during the early stages of abstinence (before 4 weeks) but

Not reported
disappeared with longer abstinence. In general, these studies suggest
that current emotional states (loneliness, stress, mood) are associated
Limits

with binge drinking and with early stages of alcohol abstinence in binge
drinkers, but relevant parameters including age and the type of
emotional states need to be determined.

discriminate aversive

(also in later blocks)

conditioned stimuli
Electromyographic

conditioning in BD Additional studies have explored whether mood impairments were

BD had reduced
observed after drinking alcohol at binge levels (acute alcohol con­
impaired fear
conductance:
Main results

abilities to sumption). Rose and Grunsell (2008) showed that mood evaluation
Outcomes

and skin

differed between binge drinkers and non-binge drinkers (18-25 years

old) following both alcohol and placebo intakes. Binge drinkers showed
diminished feelings of stimulation in the placebo condition, and more
lightheadedness in the alcohol condition (Rose & Grunsell, 2008). The
frequencies
intensities

mood alterations after drinking alcohol were supported and extended by

Bursts of
different
Stimuli

another study indicating impaired mood the morning after drinking

and

alcohol (average of 0.12 g% breath alcohol concentration) in young

people (21-24 years old) who presented at least one binge-drinking
frequencies; low and

Electromyographic
intensity with low,

recording and skin

episode in the past month (Howland et al., 2010). Longitudinally,

Note. All alcohol units have been converted in grams of pure ethanol, according to the number of grams per unit in each country. BD = binge drinkers.
medium, and high

before an aversive
Self-consciousness

high tones as CS+

Aversive auditory
procedure (63-dB

burst of 97-dB,

alcohol consumption affected both positive and negative mood in young

conductance

adults (21-28 years old), higher alcohol-induced positive mood was

Task/scale

40msec)

associated with more frequent binge drinking and more alcohol-related

scale

problems after 18-month, and higher negative mood reduction from

alcohol predicted more alcohol-related problems (Venerable & Fair­
bairn, 2020). Together, these findings suggest that drinking alcohol
Experimental design

Processes measured

Fear conditioning

(acute intoxication) impairs mood in binge drinkers and has implica­

tions for understanding differential effects of current and long-term
emotional states in binge drinking (long-term effects of alcohol).
This study describes animal and human experiments, but we focused on the human research in the current review.

Second, cross-sectional studies showed that binge drinking is related

to depression and anxiety in different age ranges and countries. In all
studies, the diagnosis of depression and anxiety was based on cutoff
drinking score ≤

matched on age,
9 non-BD (binge

scores from validated questionnaires but was not formally performed by

severe alcohol
Control group/

Groups were

anxiety, and

use disorder
Comparator

a psychiatrist. A large-scale study conducted in the United States eval­

depression,

severity of

uated the prevalence of binge drinking in adults (18 years old or older)
variable

gender,
13.2)

with current or previous depression diagnosis. Participants with current

depression or having a lifetime history of depression or anxiety exhibi­
ted more binge drinking habits than controls (Strine et al., 2008). In
Binge drinking criteria

Binge drinking score

Thailand, another large-scale study conducted among adolescents (12-

17 years old) supported the association between binge drinking and
Intervention

depression, particularly among girls (Wichaidit, Pruphetkaew, & Assa­

nangkornchai, 2019). In South Africa, suicidal thoughts were associated
≥ 27

with depression, anxiety, worthlessness, and binge drinking in young

men (Mngoma, Ayonrinde, Fergus, Jeeves, & Jolly, 2020). In Uruguayan
college students (18-30 years old), however, psychological distress (i.e.,
anxiety, depression, distress) was not associated with binge drinking but
Inclusion criteria

rather with negative alcohol consequences (Ruiz, Pilatti, & Pautassi,

This study also evaluates emotional regulation processing.

2020). Longitudinal studies enable specifying antecedents of these re­

lations. In college students (mean age of 19.9 years old), depressive
N/A

symptoms predicted binge drinking over one week in women (Mush­

quash et al., 2013). Longer-term longitudinal studies indicated that sub-
Gender

33.3%
males)

clinical anxious and depressive symptoms in the general population (18-

(% of
ratio

74 years old) were related to the onset of AUD but not of binge drinking
at 12-month follow-up (Haynes, Farrell, Singleton, Meltzer, & Aya,
2005). However, in the transition from adolescence to adulthood (13-17
Range
19-30

21.65
Mean
Age

years old at baseline), a 13-year longitudinal study specified that

depressive symptoms were positively associated with binge drinking
Participants

(Pape & Norström, 2016). Interestingly, depressive and anxiety symp­

Sample (n)

toms among binge drinkers were related to greater activations in limbic

9 BD

and fronto-striatal regions when viewing alcohol cues compared to other

Table 3 (continued )

appetitive cues, supporting the relationship between depression, anxi­

ety, and the potential reinforcement of alcohol drinking (Ewing, Filbey,
(2005)2

Chandler, & Hutchison, 2010).

Stephens
Authors

et al.
(year)

Finally, the relationships identified between internal emotional

states and binge drinking did not address the specificity of these
1
2

16
 S. Lannoy et al.
Table 4
Description and main results of studies evaluating emotional regulation in binge drinking.
Authors Participants Intervention Comparator Experimental design Outcomes Quality
(year)
Sample Age Gender Inclusion criteria Binge drinking Control group/ Processes Task/scale Stimuli Main results Limits
(n) ratio criteria variable measured
(% of
males)

Cohen- 23 Range Not No MRI The number of Continuous view Impact of Positive, Negative emotional Small sample 76.47
Gilbert college 18-20 reported contraindication, binge drinking of binge drinking emotional Structured Clinical negative, and background: higher size
et al. students neurological episodes (≥ 70 (0 – 19 BD scenes on the Interview neutral binge drinking
(2017) Mean disorder, and use of alcohol gr for episodes in the ability to images from episodes related to
18.80 illicit drugs. Low use boys or ≥ 56 for past three inhibit an Counseling Center the IAPS decreased activation
of marijuana and girls in one months) automatic Assessment of of the dorsolateral
tobacco occasion) in the response Psychological prefrontal cortex,
three-past month Contrast between Symptoms dorsomedial
No alcohol use before emotional images prefrontal cortex, and
the experiment (positive and Go/No-Go task anterior cingulate
negative) and (letters as target cortex.
neutral ones stimuli; emotional
images as Positive emotional
preliminary background: non-
background) significant results

fMRI recording
Ehret et al. 1,084 Mean 37% N/A At least one Analyses were Emotional Daily Drinking N/A Greater binge No information 64.71
(2013) college age of binge drinking adjusted for regulation Questionnaire drinking in on the causality
students 20.1 episode (≥ 70 gender, participants with
alcohol gr for membership The Rutgers lower protective
17

boys or ≥ 56 for affiliation in a Alcohol Problems behavioral strategies,

girls) in the last fraternity or poor drinking refusal
month sorority, and Protective self-efficacy for social
typical weekly Behavioral pressure or emotional
drinking Strategies regulation

Drinking Refusal Participants with high

Self-Efficacy (social drinking refusal self-
pressure, efficacy in social and
emotional relief, emotional contexts:
opportunistic) protective behavioral
strategies were not
Drinking Motives related to alcohol
(enhancement, consequences
social, coping,
conformity)

Clinical Psychology Review 84 (2021) 101971

Herman et al. 30 Range 30% No MRI Binge drinking Continuous view Inhibition of Barratt Emotional Successful inhibition No evaluation of 70.59
(2018) college 18-37 contradiction, mental score as a of binge drinking fear (facial Impulsiveness facial of fear: higher binge socio-emotional
students or continuous expressions) Scale expressions of drinking scores functioning
Mean neurological variable Control by fear and related to decreased
23.40 disorder, no comparing Impact of Alcohol Use neutral facial activation in frontal
significant fearful fearful Questionnaire expressions and parietal brain
impairment of vision expressions to emotional areas
neutral ones expressions on Affective Stop
decision- Signal Task (fearful Delayed reward after
making abilities and neutral facial the fearful
(delay expressions as presentation: higher
discounting) target stimuli) binge drinking scores
(continued on next page)
 Table 4 (continued )

S. Lannoy et al.
Authors Participants Intervention Comparator Experimental design Outcomes Quality
(year)
Sample Age Gender Inclusion criteria Binge drinking Control group/ Processes Task/scale Stimuli Main results Limits
(n) ratio criteria variable measured
(% of
males)

related to decreased
Affective Delay frontopolar activation
Discounting Task
(fearful and neutral
facial before target
trials)

fMRI recording
Laghi et al. 1,004 Range 39.34% N/A At least one Comparison of Emotion The binge eating N/A Cognitive reappraisal: No 70.59
(2018) high- 16-21 binge drinking three groups: 227 regulation scale no group difference consideration of
school episode (≥ 50 BD, 89 binge confounding
students Mean alcohol gr for eaters, 37 Drinking quantity Expression variables (e.g.,
17.90 boys or ≥ 40 for participants and frequency suppression: BD < negative
girls on one presenting both binge eaters and emotions)
occasion) in the binge behaviors The Emotion participants with both
past two weeks Regulation binge behaviors
Questionnaire
(expression
suppression and
cognitive
reappraisal)
Trojanowski 776 Range 20.10% N/A At least one Mixture Emotion N/A Depression, eating No information 82.24
et al. college 17-22 binge drinking modeling was regulation Eating Disorder disorders, on the causality
18

(2019) students episode (≥ 70 used to create Examination impulsivity, emotion

Mean alcohol gr for four groups: BD, regulation, quality of
18.79 boys or ≥ 56 for binge eaters, Drinking Timeline life:
girls on one both bingers, and Follow-back Low binge < binge
occasion) in the low bingers eaters and both
past month Drinking Motives bingers
and Eating Motives
Questionnaire Social and
enhancement
Thinness and motives:
Restricting BD > low binge
Expectancies
Inventory

UPPS-P (negative
and positive

Clinical Psychology Review 84 (2021) 101971

urgency, lack of
premeditation, lack
of perseverance,
sensation seeking)

Difficulties in
Emotion
Regulation Scale

Beck Depression
Inventory

AUDIT
(continued on next page)
 S. Lannoy et al. Clinical Psychology Review 84 (2021) 101971

emotional states in binge drinkers relative to comparison groups (either

Note. All alcohol units have been converted in grams of pure ethanol, according to the number of grams per unit in each country. BD = binge drinkers; AUDIT = Alcohol Use Disorders Identification Test; fMRI = functional
non-binge drinkers1 or teetotalers2). For example, it has been shown that
Quality

young adult binge drinkers (18-23 years old) exhibited lower trait-
anxiety and depression than teetotalers (Hartley et al., 2004). Yet, the
comparison between binge drinkers and teetotalers may lead to unex­
pected results, as teetotalers may exhibit higher levels of somatic anxiety
and aggressive mood (Gil-Hernandez & Garcia-Moreno, 2016). Further,
in comparison with non-binge drinkers, adolescent binge drinkers (16-
Limits

18 years old) presented greater anxiety and depressive symptoms

(Bekman et al., 2013), but this result was not replicated among young
adults (mean age of 21.1 years old; Nourse, Adamshick, & Stoltzfus,
2017).
Interim summary: The investigation of internal emotional identifi­
Main results
Outcomes

cation shows that both current emotional states as well as depression

and anxiety symptoms are related to binge drinking. Overall, findings
seem to indicate that loneliness is more prevalent in early adolescence,
whereas high stress levels are more frequent in late adolescence. The
evaluation of mood leads to consistent results in studies evaluating
alcohol drinking and abstinence, showing an increase of positive mood
Stimuli

immediately after alcohol drinking and the emergence of negative mood

the day after drinking or when adolescents quit drinking. Finally, the
relation between binge drinking and depression or anxiety is supported
in several studies but also seems influenced by other alcohol outcomes,
Quality of Life

such as severe AUD or alcohol-related problems. These findings are

particularly important for healthcare providers, as emotional identifi­
Task/scale

Inventory

cation of internal cues is related to binge drinking in prospective studies.

Emotional identification of external cues. External emotional identifi­
Experimental design

cation has been investigated in binge drinking by 12 studies using

various measures. This subsection has been divided into two categories.
First, external emotional appraisal, namely the ability of binge drinkers to
measured
Processes

appraise emotional situations (e.g., emotional situations or scenes), was

measured in two studies. Second, emotional identification, the ability of
binge drinkers to identify emotional states expressed by other in­
dividuals (e.g., emotional faces), was targeted in ten studies. For the
sake of clarity, we first describe in each subsection the results obtained
Control group/
Comparator

with self-reported and behavioral measures, before shifting to the

studies based on brain-functioning measures.
variable

Regarding emotional appraisal, a first study underlined that poor

self-reported distress appraisal predicted alcohol-related problems in
binge drinkers (18-23 years old). This relationship was explained by a
propensity to drink to deal with negative emotions (Khan et al., 2018).
Binge drinking
Intervention

Then, emotional appraisal was assessed through brain electrophysio­

logical activity (electroencephalographic recordings) while participants
criteria

rated positive, negative, erotic, and neutral images (Huang, Holcomb,

Cruz, & Marinkovic, 2018). Results comparing binge drinkers and non-
binge drinkers (18-30 years old) showed no group difference in the self-
reported appraisal of emotional images. However, reduced sensitivity in
Inclusion criteria

event-related theta power was found in binge drinkers during emotional

appraisal, both at early and later processing stages. During emotional
appraisal, binge drinkers also presented attenuated differences between
neutral and emotional conditions in comparison with non-binge
drinkers. This indicates that attentional resources during emotional
appraisal are reduced in binge drinkers, potentially limiting their ability
Gender

males)
(% of

to evaluate and react to emotional stimuli accurately (Huang et al.,

ratio

2018).
Regarding the identification of others’ emotional states, recent
studies present behavioral insights about the binge drinkers’ abilities to
Age

Magnetic Resonance Imaging.

identify and recognize emotional expressions. Performing a crossmodal

Participants

identification task (facial and vocal stimuli depicting anger and happi­
Sample

ness), binge drinkers did not differ from non-binge drinkers (18-23 years
(n)
Table 4 (continued )

old; Lannoy, Dormal, Brion, Billieux, & Maurage, 2017). However, in a

more complex task, binge drinkers (18-27 years old) exhibited poorer
Authors
(year)

1
Individuals with regular drinking habits but without binge drinking pattern
2
Non-drinking participants

19
S. Lannoy et al. Clinical Psychology Review 84 (2021) 101971

Fig. 2. Description of the studies.

Fig. 2 illustrates the distribution of the studies included in this systematic review: the number of studies per country, the number of studies per year (studies
conducted in Europe in dark grey, studies conducted in North America in light grey, studies conducted in South America in middle grey, and studies conducted in
Asia in white), and the study methods (from white to black: 51.2% of studies used self-reported measures, 18.6% behavioral measures, 11.6% electrophysiological
measures, 11.6% neuroimaging measures, and 7% physiological measures).

performance than non-binge drinkers in recognizing emotional cate­ that low binge drinkers had difficulties to detect sadness whereas high
gories presented at different intensities (Lannoy et al., 2018). This first binge drinkers correctly detected sadness but poorly recognized fear
study produced a group effect nonspecific to emotional category, (Leganes-Fonteneau, Pi-Ruano, & Tejero, 2020). Finally, evaluating the
whereas a second exploration in a larger sample specified that binge impact of emotional processing on memory, it has been shown that
drinkers had impairments in recognizing fear and sadness (Lannoy et al., college students with binge drinking (18-20 years old) had a negative
2019). Individual single-case analyses have also been conducted in this emotional recall bias. Results showed no significant effects in males but
larger sample to explore the percentage of binge drinkers who actually an emotional memory bias for negative words in females; i.e., higher
presented a clinically significant emotional recognition deficit compared recall of negative words, increased false alarms for negative emotional
to a group of matched control participants: 21.15% of binge drinkers distractors, and lower recall of positive and neutral words (Carbia,
were identified as having a deficit for fear recognition and 15.38% for Corral, Caamaño-Isorna, & Cadaveira, 2020). These findings thus sup­
sadness recognition. These studies thus illustrate that binge drinkers port the proposal of impaired processing of external emotional contents
have overall difficulties to recognize emotions, while clinical deficits in binge drinkers and show possible specific difficulties with negative
were identified in a subsample of binge drinkers. Then, comparing binge emotions.
drinkers with different alcohol consumption intensities (high and low In addition to these results, studies have evaluated emotional iden­
binge-drinking score) among college students (mean age of 21.2 years tification through electrophysiological brain measures. Indeed, behav­
old) and youth (mean age of 15.4 years old), another study indicated ioral studies were not always able to detect subtle differences between

20
S. Lannoy et al. Clinical Psychology Review 84 (2021) 101971

binge drinkers and healthy controls (e.g., Lannoy et al., 2017). Elec­ 3.3.2. Emotional response (Table 3)
trophysiological measures thus offer a complementary observation of Emotional response has been assessed in seven studies focused on
the brain correlates during external emotional identification. Ehlers binge drinking, using various measures and emotional induction pro­
et al. (2007) focused on young adults who had experienced at least one cedures. We first describe results obtained with behavioral evaluations,
binge drinking episode or had both binge drinking and drug use his­ then synthetize the insights offered by physiological and brain data, and
tories, and compared them to non-bingeing and non-drug-consuming finally we illustrate emotional responses after drinking alcohol.
controls (18-25 years old). Electrophysiological activity was explored A behavioral study demonstrated the effect of mood induction by
during the identification of happy, sad, and neutral faces, and results short video clips (sad, happy, and neutral mood) on specific drinking
suggested a reduced recruitment of attentional resources during responses (i.e., implicit and explicit alcohol-related associations and
emotional identification in young adults with a binge drinking history (i. effective drinking in a taste test) in binge drinkers (21-25 years old;
e., decreased amplitude of the late P3 component). Young adults with Lindgren et al., 2018). A positive relation was found between alcohol-
binge drinking and drug history also depicted an earlier latency of the depressed associations (i.e., low excitement) and alcohol drinking and
initial P3 component for all stimuli compared with controls, this being was stronger after the induction of sadness, whereas the link between
interpreted as a possible effect of alcohol and drug use on developmental alcohol excitement and alcohol drinking was stronger after the induc­
changes in the P3. Another study (Lannoy et al., 2018) explored tion of happy or neutral mood (Lindgren et al., 2018). Beyond the po­
emotional crossmodal integration as described above and showed dif­ tential effects of alcohol consumption in mood described earlier (i.e.,
ferences in electrophysiological activity in binge drinkers compared to drinking alcohol leads to negative mood), this study suggested that a
both teetotalers and non-binge drinkers (18-29 years old). In particular, specific emotional situation may influence drinking-related responses in
greater brain activity was observed for anger processing than for binge drinkers (e.g., sad mood leads to drinking alcohol). However,
happiness in binge drinkers, they also presented increased brain activity these results only modestly predicted effective drinking in the taste test.
during incongruency (e.g., a happy face presented together with an Whereas this study showed the effects of both positive and negative
angry voice). Differences in electrophysiological activity were finally emotional induction, another study explored distress induction using the
observed when binge drinkers had to process vocal stimuli consisting of anagram solution task (requiring participants to resolve soluble and
the emotional enunciation of a semantically neutral word. Results insoluble anagrams); however, binge drinkers (18-30 years old) did not
indicated that after nine months of binge drinking, participants (mean present higher self-reported distress than non-binge drinkers after the
age of 18.17 years old at baseline) who did not present a binge drinking task (Poncin, Vermeulen, & de Timary, 2017).
pattern at baseline depicted delayed latency of the ERP components Physiological measures (e.g., body changes related to a stimulation)
related to early perceptive-attentional (P1, N2) and late decision-related present an additional perspective on induced emotional responses. In
(P3) processing (Maurage, Pesenti, Philippot, Joassin, & Campanella, one study, binge drinkers and non-binge drinkers (19-30 years old) were
2009), supporting that short-term binge drinking leads to modification conditioned to an aversive auditory procedure (i.e., fear conditioning; a
of brain activity during emotional identification of anger and fear. conditioned stimulus notifying the appearance of an aversive stimuli)
Eventually, the occurrence of brain modifications during emotional while electromyographic data and skin conductance were recorded
identification has been supported by a neuroimaging study (Maurage, (Stephens et al., 2005). Binge drinkers exhibited impaired fear condi­
Bestelmeyer, Rouger, Charest, & Belin, 2013) that used morphed audi­ tioning as they did not present 1) the classical increased amplitude of the
tory stimuli (fear-anger continuum). Relative to non-binge drinkers, startle response when the conditioned stimulus (aversive stimulus) was
binge drinkers (19-32 years old) presented poorer ability to categorize presented before the unpleasant noise related to fear conditioning; or 2)
emotional contents at the behavioral level and disrupted brain activa­ an increased galvanic skin response for the conditioned stimulus (Ste­
tion during emotional identification, namely lower activation of the phens et al., 2005). Second, electrophysiological brain responses to the
bilateral superior temporal gyrus and increased activation of the right passive viewing of neutral, positive, and negative emotional images
middle frontal gyrus. Authors proposed that the lower temporal acti­ were aimed at assessing the differential and combined effects of binge
vation observed in bingers indicated an impaired processing of affective drinking and depressive symptoms (Connell, Patton, & McKillop, 2015).
sounds, whereas the greater frontal activation reflected a compensatory Binge drinkers (18-22 years old) had attenuated attentional and higher-
activity. Brain responses during emotional identification (i.e., emotional order cognitive resources to negative emotional stimuli [i.e., lower Late
faces of anger, fear, or neutral expressions) were also used to classify Positive Potential (LPP) amplitude]. The combination of binge drinking
binge drinkers and non-binge drinkers (22-35 years old) using machine and depressive symptoms also showed an increased early attentional
learning algorithms. Results, however, showed that emotional processes engagement (Early Posterior Negativity) for negative and neutral im­
were not among the variables offering a reliable distinction between ages, but a reduced later processing (P3 and LPP) for all emotional
groups. Neural correlates of social cognition were conversely related to a categories (Connell et al., 2015). Thus, physiological data support an
trustworthy group classification (Gowin, Manza, Ramchandani, & Vol­ overall blunted emotional response in binge drinkers.
kow, 2020). Support of these results come from investigations of emotional
Interim summary: The investigation of external emotional identifi­ response after drinking alcohol at binge levels. A study using an auditory
cation highlights emotional difficulties related to binge drinking. aversive conditioned procedure revealed that after drinking alcohol at
Emotional appraisal was only documented in two studies. Results binge levels, social drinkers (mean age of 21.6 years old) presented less
showed lower attentional resources to appraise emotional images in avoidance of aversive noise than participants who were not subjected to
binge drinkers, while poor appraisal of distress was related to alcohol- binge drinking levels acutely (Loeber & Duka, 2009). This study sup­
related problems. Lower attentional resources to identify emotional im­ ported the presence of an impaired emotional response during binge
ages were also linked to binge drinking. Regarding facial expressions drinking episodes, leading to a decreased avoidance of negative stimuli.
processing, findings highlight consistent difficulties to recognize fear, Beyond the discrimination noise procedure, acute drinkers had poorer
while impairments in the recognition of sadness need to be further behavioral control. Indeed, during prepotent response inhibition (i.e.,
supported. Brain activity during emotional facial expressions processing control of automatic behavioral responses) of affective words, acute
appears to be disturbed in binge drinking, but this impairment is not drinkers exhibited more commission errors in response to positive words
sufficient to distinguish binge drinkers from non-binge drinkers. In order and slower reaction times in response to negative words (Loeber &
to delineate clinical perspectives, longitudinal findings are still needed Duka, 2009), suggesting low control towards positive stimuli and slow
to determine whether disrupted external emotional identification is a (reduced) response towards negative stimuli.
consequence of binge drinking (alcohol’s effect on the brain) and/or a Finally, studies have evaluated how the expectancies related to
risk factor for excessive drinking. alcohol may alter emotional responses following stress in college

21
S. Lannoy et al. Clinical Psychology Review 84 (2021) 101971

students. In an initial study (Balodis, Wynne-Edwards, & Olmstead, in the past three months was related to lower brain activations in the
2011), three groups (19-27 years old) were compared: drinkers with dorsolateral prefrontal cortex, dorsomedial prefrontal cortex, and
alcohol intoxication at binge levels, placebo drinkers (who believed they anterior cingulate cortex when viewing negative emotional back­
were drinking alcohol) and sobers (knowing they were not drinking grounds. No association was found with positive versus neutral scenes.
alcohol). Physiological and self-reported emotional responses were Using neutral and fear facial expressions, Herman et al. (2018) showed
evaluated following two conditions: stress (speech task in public) and that higher binge drinking scores were related to lower activations in
non-stress. Exposure to stress in the alcohol and placebo groups induced frontal and parietal brain areas during successful fear inhibition among
less tension and anxiety and a smaller increase in cortisol compared to a sample of adults (18-37 years old), suggesting that binge drinkers
the placebo, demonstrating that alcohol expectancies altered subjective would be less distracted by negative emotional backgrounds, which
and physiological responses to stress (Balodis et al., 2011). This reduced actually leads to an increase of their cognitive abilities in a fearful
physiological response to stress after drinking alcohol at binge levels context. In that sense, these results also support the inappropriate
was also supported by a study evaluating the specific alcohol stress- (reduced) emotional response in binge drinkers (see the above section).
response dampening (i.e., reduction of the stress reaction after drink­ This study also evaluated the relevance of emotions on the ability to
ing alcohol; Hefner, Moberg, Hachiya, & Curtin, 2013). In this study, differ a reward (i.e., delay discounting task) and showed that higher
participants (21-35 years old) performed a task while receiving pre­ binge drinking scores were related to lower frontopolar activations
dictable and unpredictable electric shocks (induction of fear and anxi­ during delayed reward decision after fear presentation. Although these
ety). The startle response was reduced in acute binge drinking in the studies go beyond the regulation of emotional response per se, they
unpredictable condition (anxiety elicitation); however, this result was suggest that the indirect processing of emotional stimuli before or dur­
observed in participants who actually drank alcohol but not in the pla­ ing cognitive processing may affect binge drinkers’ abilities to control
cebo group, demonstrating a genuine alcohol-related dampening effect behavioral reactions (Cohen-Gilbert et al., 2017; Herman et al., 2018).
to uncertain threat. Interim summary: The evaluation of emotional regulation has led to
Interim summary: The investigation of emotional responses high­ inconsistent results across studies, making it difficult to specify associ­
lights consistent results supporting that binge drinkers exhibit attenu­ ations between emotional regulation disturbances and binge drinking.
ated emotional responses, shown by 1) reduced startle in response to Studies using self-reported measures highlighted mixed results, with
fear; 2) low electrophysiological attentional engagement in response to possible emotion regulation difficulties in specific contexts (e.g., after
negative images, and 3) less avoidance of aversive stimuli. Most results the insoluble anagram task or when emotional coping is needed).
are observed with physiological data, behavioral evidence of impaired Studies using neuroimaging measures support the possibility of binge-
emotional response and its consequences (e.g., inappropriate reactions related brain modifications related to regulatory processes affected by
such as initiation of fight or drinking alcohol excessively) is thus lacking. the processing of emotional stimuli.
Longitudinal data are needed to understand the causal relationship be­
tween impaired emotional response and binge drinking. 4. Discussion

3.3.3. Emotional regulation (Table 4) This systematic review describes the current state of emotion
Emotional regulation was explored in five studies: three measured research in binge drinking. Emotional deficits have been largely docu­
global emotion regulation strategies through self-reported measures, mented in severe AUD, where they are considered a key factor
and two evaluated how the presentation of emotional stimuli affects explaining alcohol-related problems and relapse (e.g., Bora & Zorlu,
cognitive abilities (conceptualized as a specific regulatory strategy) in 2017; Le Berre, 2019). Bingeing is a harmful drinking pattern, wide­
binge drinking. A further study (Poncin et al., 2017) described earlier is spread in adolescence, with increased prevalence in young adults,
also relevant to the exploration of emotion regulation strategies. possibly evolving toward AUD. The contribution of emotion research is,
A study targeting emotion regulation strategies demonstrated that however, less straightforward in binge drinking than in severe AUD,
the distress induced by an insoluble anagram task was associated with only suggesting difficulties in specific emotional processes, such as
self-reported maladaptive emotion regulation strategies (rumination impaired emotional response and reactivity associated with alcohol’s
and self-blame) among binge drinkers but not non-binge drinkers effects on the amygdala (Stephens et al., 2005). To offer a systematic
(Poncin et al., 2017). However, with no previous distress induction, a exploration of emotional processes in binge drinking, we capitalized on
study evaluating cognitive reappraisal and expressive suppression as the theoretical proposal of Phillips et al. (2003a), referring to three steps
adaptive and maladaptive emotion regulation strategies respectively, of emotional processing: emotional appraisal and identification (that has
showed that only adolescent binge drinkers (16-21 years old) who also been split into two subsections related to internal and external
presented binge eating had poor emotion regulation (Laghi, Liga, & emotional states), emotional response, and emotional regulation.
Pompili, 2018). This observation was supported among young adults This review supports the proposal of impaired emotional processes in
(17-22 years old), results showing that emotion regulation strategies did binge drinking by centrally showing that 1) internal emotional states as
not differ between binge drinkers and non-binge drinkers (Trojanowski, well as symptoms of depression and anxiety are associated with or
2019). Finally, when considering emotional regulation in the specific predict alcohol use and binge drinking, and that binge drinkers have
context of alcohol drinking, college students who had lower protective difficulties to identify emotions expressed by others; 2) binge drinkers
behavioral strategies (i.e., alcohol-related regulation strategies such as also present a reduced behavioral and cerebral response to emotional
slowing the consumption speed) and poor drinking refusal self-efficacy stimulations or situations, but 3) binge drinkers do not appear to have
reported higher binge drinking. The relationship between alcohol- impairments to regulate emotional responses. We have identified the
related problems and emotional distress was mediated by coping- need for longitudinal studies controlling for alcohol-related outcomes to
related drinking motivations (Ehret, Ghaidarov, & LaBrie, 2013), also advance knowledge, but our systematic evaluation already has impli­
reported previously (Khan et al., 2018). cations for fundamental research and clinical applications. Notably,
Combining behavioral and neuroimaging measures, two studies these findings underline the role of emotional processes, which should
evaluated whether the presentation of emotional stimuli can affect be integrated in the current models of binge drinking. In the introduc­
control ability (inhibition of automatic responses) and its relation to tion, we noted that most proposals consider that addiction is related to
binge drinking (Cohen-Gilbert et al., 2017; Herman, Critchley, & Duka, heightened appetitive cues reactivity, reward seeking and poor execu­
2018). Presenting positive and negative emotional scenes before inhi­ tive functioning, contributing to a poor control of alcohol-related be­
bition targets, Cohen-Gilbert et al. (2017) showed that, among college haviors (e.g., Lannoy et al., 2014; Voon et al., 2020). Recent systematic
students (19-20 years old), a higher number of binge-drinking episodes reviews focusing on binge drinking support this proposal (Carbia,

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Corral, et al., 2018; Courtney, Li, & Tapert, 2019; Lees et al., 2019). related to external emotional identification and emotional responses in
Here, we note the role of emotion with the model of Phillips et al. binge drinking. In contrast to this clear result, impairments in emotional
(2003a), which purports several conceptual considerations. Referring to regulation in both general and drinking contexts remain to be fully
dual-process models, emotion could be considered as part of System A investigated.
and drives automatic behaviors (Steinberg, 2007; Volman, Roelofs, Regarding the appraisal and identification of emotional states,
Koch, Verhagen, & Toni, 2011). However, this review clearly underlines several difficulties have been reported in young adult binge drinkers.
that emotional processing does not present a total overlap with auto­ Lower percentage of correct emotional identification were observed
matic processing, as it also involves regulatory processes. An alternative among binge drinkers in complex experimental paradigms, whereas
addiction model considering emotional processing is the triadic neuro­ increased brain activity was found in less demanding tasks (Lannoy,
cognitive model, which postulates the existence of a third system Maurage, et al., 2018; Maurage, Petit, & Campanella, 2013), suggesting
modulating the interaction between Systems A and B, i.e., the insular that binge drinkers could show neural compensation for their emotional
cortex. According to this proposal (Noël, Brevers, & Bechara, 2013), the processing difficulties. With measures of electrophysiological activity,
insula converts interoceptive information into subjective experiences (e. consistent results emphasized that binge drinkers have attentional dif­
g., physiological sensations), which activates System A and reduces the ficulties in focusing on and efficiently appraising emotional content (e.
cognitive resources of System B. The role of the insula is widely described g., Ehlers et al., 2007; Huang et al., 2018), which consequently hampers
in emotional processing and related to the identification of and response emotional identification (Lannoy et al., 2019). These findings constitute
to emotional stimuli (Phillips et al., 2003a; Wilcox, Pommy, & Adinoff, initial insight into the scope and limit of emotional difficulties in binge
2016). Nevertheless, with regards to the model of Phillips et al. (2003a), drinkers, which warrants consideration at the clinical level, as a poor
emotional processing also requires cognitive abilities that are, in this processing of emotional content has been associated with psychiatric
model, encompassed in System B. These conceptual issues may be symptoms (Phillips et al., 2003b).
answered by considering a recent position that goes beyond dual or Variability in emotional valences and intensities themselves, and in
triadic models and refers to unitary models, in which all cognitive and the context of binge drinking need explication. The current literature
emotional processes are conceptualized into a functionally integrated indicates difficulties related to negative emotional processing (Huang
system. Various evidence has supported this unitary approach (Hommel et al., 2018; Lannoy, Maurage, et al., 2018; Leganes-Fonteneau et al.,
& Wiers, 2017; Melnikoff & Bargh, 2018; Murphy et al., 2003; Pessoa, 2020) but stops short of providing systematic evaluations and compar­
2017), showing that the nature of psychological processes is composed isons across emotional conditions. Indeed, although a tendency emerges
of several features. This integrated proposal also comports with the for deficits in fear recognition (Lannoy et al., 2019; Leganes-Fonteneau
emotion model (Phillips et al., 2003a), showing that emotional pro­ et al., 2020; Stephens & Duka, 2008), it remains unclear whether the
cessing encompasses both automatic and cognitive processes. Indeed, recognition of specific emotions is affected in binge drinking. Further,
the theoretical background approached in this review does not only the production of emotional responses is impaired in binge drinkers, in
consider emotion as a situation driving alcohol-related behaviors, but particular in negative emotional context (Connell et al., 2015; Hefner
also as a multidimensional process bringing strong insights to the study et al., 2013; Herman et al., 2018; Loeber & Duka, 2009; Stephens et al.,
of binge drinking and AUD. 2005). Such impairment is described by attenuated emotional response,
In particular, the internal emotional state has a role in binge drinking both after acute alcohol consumption and among people without current
(e.g., Bekman et al., 2013; Mushquash et al., 2013; Pape & Norström, intoxication but presenting a binge drinking pattern. Nevertheless,
2016). Although the current literature does not inform about the ability considering the model of Phillips et al. (2003a), it is unclear whether this
to identify one’s own emotional states (i.e., detecting and labeling the altered response is the result of poor emotional appraisal and identifi­
emotions felt), it does show a consistent relationship between excessive cation (e.g., reduced emotional response due to a misperception of the
drinking and the presence of symptoms of depression and anxiety. emotional significance) or a genuine emotional response impairment (e.
Although this association is well-known to researchers and clinicians g., inability to generate an appropriate emotional response). The
working with patients presenting severe AUD (Boden & Fergusson, consideration of this theoretical model emphasizes the emotional pro­
2011), it remained uncertain in non-AUD binge drinkers. Whereas binge cesses that are disturbed in binge drinking but also calls for an in-depth
drinking is often considered as driven by positive emotions (Kuntsche, investigation of emotional processing to address the nature of these
Knibbe, Gmel, & Engels, 2005), this literature review extends this difficulties. Although some studies implicate the need to consider
consideration to negative emotions, the "dark side" of excessive drinking emotional regulation in binge drinking, and despite the relevance of this
(Koob, 2015). Binge drinking was related to loneliness in adolescence process in severe AUD (Petit et al., 2015), experimental results are
and to depressive symptoms in the transition from adolescence to lacking. Indeed, neuroimaging findings showed decreased brain acti­
adulthood and during adulthood. It is thus possible that emotional vations during negative emotion-related inhibition (Cohen-Gilbert et al.,
dysregulation contributes to the escalation of binge drinking in late 2017; Herman et al., 2018), but no finding supports that this deficiency
adolescence, when alcohol is readily available (Rowland et al., 2016) is directly related to poor regulation of the emotional response, as pro­
and positive expectancies abound (e.g., drinking to deal with negative posed in emotional processing (Phillips et al., 2003a). Additionally, re­
emotions). Considering mood evaluation, available studies showed sults based on self-reported measures do not demonstrate a specific
promising results, but no convincing conclusion can be drawn due to the impairment to regulate one’s own emotions in binge drinking (Laghi
limited number of studies and the inconsistent mood evaluation across et al., 2018; Trojanowski, 2019), difficulties of binge drinkers being only
them (see Table 2). Future studies should further the understanding of related to specific contexts (e.g., Ehret et al., 2013; Poncin et al., 2017).
acute binge drinking effects on mood in order to determine how binge Upcoming studies should thus further explore emotion regulation by
drinking may affect emotional states and how acute effects may pre­ considering the role of additional factors such as population heteroge­
dispose to potential chronic effects (e.g., Howland et al., 2010; Vener­ neity and personality traits (Gierski et al., 2017; Maurage, de Timary, &
able & Fairbairn, 2020). One possibility is that the relationship between D’Hondt, 2017).
negative emotional states and future alcohol abuse may be induced by Taken together, these findings indicate that binge drinkers exhibit
the repetition of excessive drinking episodes, which could support the poor identification of emotional and social cues as well as poor
late appearance of this association. Importantly, this association could emotional responses. These processes constitute risk factors for the
also be explained by an impaired emotional processing, possibly leading perpetuation of excessive alcohol use (e.g., Rupp, Derntl, Osthaus,
to negative affect and social difficulties. Indeed, the current systematic Kemmler, & Fleischhacker, 2017) and may lead to negative emotional
review focused on a model of emotional processing (Phillips et al., states, reinforcing the vicious circle of AUD (Boden & Fergusson, 2011).
2003a) which enabled an understanding of the presence of disruptions Currently lacking are prospective evaluations that would enable

23
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Séverine Lannoy, PhD, is Postdoctoral Researcher at Stanford University, United States.
of social cognition on alcohol dependence treatment outcome: poorer facial emotion
Her areas of research focus on alcohol misuse in youth and its transition towards alcohol
recognition predicts relapse/dropout. Alcoholism: Clinical and Experimental Research,
use disorders. She targets cognitive and emotional processes using behavioral and
41(12), 2197–2206. https://doi.org/10.1111/acer.13522.
neurophysiological approaches.
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Theodora Duka, MD, PhD, is Professor of Experimental Psychology at University of Fabien Gierski, PhD, is Associate Professor at University of Reims Champagne-Ardenne,
Sussex, United Kingdom. Her areas of research focus on the cognitive and emotional France. His areas of research focus on alcohol use disorders using neuropsychological and
mechanisms involved in drug addiction. She uses neurophysiology and human neuroimaging approaches.
psychopharmacology.
Eduardo López-Caneda, PhD, is Associate Professor at University of Minho, Portugal. His
Carina Carbia, PhD, is Postdoctoral Researcher at University College Cork, Ireland. Her areas of research focus on alcohol misuse in youth using neuropsychological, electro­
areas of research focus on the factors involved in alcohol misuse in youth using neuro­ physiological, and neuroimaging approaches.
psychological, neuroimaging, and gut microbiome approaches.
Edith V. Sullivan, PhD, is Professor and Principal Investigator at Stanford University
Joël Billieux, PhD, is Associate Professor of Clinical Psychology at the University of School of Medicine, California, United States. Her areas of research focus on alcohol
Lausanne, Switzerland. His areas of research focus on the psychological factors (cognitive, misuse and dependence from adolescence to senescence using neuropsychology and
affective, motivational, interpersonal) involved in the etiology of addictive behaviors. neuroimaging approaches

Sullivan Fontesse, is PhD student at UCLouvain, Belgium. His areas of research focus on Pierre Maurage, PhD, is Senior Research Associate at the Belgian fund for scientific
the psychosocial factors involved in alcohol use disorders (dehumanization) using research (FNRS) and Professor at UCLouvain, Belgium. His areas of research focus on
behavioral and neuroimaging approaches. alcohol use disorders and target neuropsychological and emotional processes using a
combined behavioral and neuroscientific approach.
Valérie Dormal, PhD, is Postdoctoral Researcher and Project Manager at UCLouvain,
Belgium. Her areas of research focus on alcohol misuse in youth using neuroimaging and
neurophysiological approaches.

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