Acute alcohol effects on facial expressions of emotions in social drinkers: a systematic review

Figures & data

Figure 1 Heuristic model of facial emotion processing.

Notes: Rectangle indicates processes within individuals; ellipse denotes a social influence.

Figure 2 Process of study selection according to PRISMA flow diagram.⁵³

Abbreviation: PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Table 1 General design of studies reviewed

Experimental manipulation
Reference(s)	Samples	Sex (female)	Age, years (mean ± SD/range)	Drinking behavior and other characteristics	Design	Placebo controlc	Baseline controld	Blindinge	Randomi zationf
^Citation93	138	Mixed (65%)	21–28	Social drinkers (self-report)	Within-subject Between-subject	Yes	No	Single	Yes
^Citation71, ^Citation72, ^Citation85, ^Citation92a	720	Mixed (50%)	21–28	Social drinkers (self-report)	Within-subject Between-subject	Yes	No	Single	Yes
^Citation60	49	Mixed (55%)	23.9±2.6 19–32	Social drinkers (TPQ)	Within-subject Between-subject	Yes	Yes	Single	Yes
^Citation64	54	Male	21–35	Social drinkers (self-report)	Within-subject Between-subject	Yes	Yes	Single	Yes
^Citation58	27	Mixed (70%)	30.3±7.3 21–48	Panic disorder, social drinkers (self-report)	Between-subject	Yes	Yes	Double	Yes
^Citation69	42	Female	23.3±2	Social drinkers (self-report)	Between-subject	No	Yes	No	Yes
^Citation65, ^Citation66a	136	Male	20.78±2.1 18–30	Social drinkers (B-MAST)	Within-subject Between-subject	Yes	Yes	Single	Pseudo
^Citation67, ^Citation68c	61	Female	22.9±3 19–30	Students, social drinkers (self-report)	Between-subject	Yes	Yes	Double	Yes
^Citation70	88	Mixed (50%)	24.36±4.2	Dating couples, social drinkers (self-report)	Within-subject Between-subject	No	Yes	No	Yes
^Citation62	42	Mixed (not specified)	21–28	Social drinkersb	Between-subject	Yes	Yes	Single	Yes
^Citation63	169	Mixed (50%)	21–28	Social drinkersb (ADS)	Between-subject	Yes	Yes	Single	Yes
^Citation61	138	Mixed (50%)	21–35	Smokers, social drinkers (self-report)	Within-subject Between-subject	Yes	Yes	Single	Yes
^Citation59	63	Male	>21	Students	Within-subject Between-subject	No	No	Not reported	Yes

Notes:

a Publications derive from one experimental investigation and count as one experiment;

b Cahalan drinking history inventory;

c administration of both alcoholic and nonalcoholic drinks within one investigation;

d repeated assessment of values prior to and after drink consumption, which also allows for the control of potential confounding variables (eg, alcohol or food intake prior to the day of testing);

e participant or experimenter or both not made aware of whether alcohol or placebo administered;

f random allocation to specific drinking group.

Abbreviations: TPQ, Tridimensional Personality Questionnaire; B-MAST, Brief Michigan Alcoholism Screening Test; ADS, Alcohol Dependence Scale.

Table 2 Characteristics of oral alcohol administration in studies reviewed

Reference(s)	Period of drink consumption	Dose of alcohol	Time between consumption end and recording facial expression	BAC assessment		Mean BAC, mg/dL (SD)
				Predrink	Postdrinka
^Citation93	36 minutes	0.82 g/kg (males) 0.74 g/kg (females)	0–3 minutes, 13–36 minutes	Yes	0, 40 minutes	Overall: 74 0 minutes postdrink: 63 (16) 40 minutes postdrink: 73 (17)
^Citation71, ^Citation72, ^Citation85, ^Citation92	36 minutes	0.82 g/kg (males) 0.74 g/kg (females)	0–3 minutes, 13–36 minutes	Yes	0, 40 minutes	Overall: 74 0 minutes postdrink: 68 (15) 40 minutes postdrink: 76 (14)
^Citation60	15 minutes	0.5 g/kg	20 minutes	Yes	After task completion, not specified	21
^Citation64	30 minutes	0.82 g/kg	During drink administration	Yes	40, 90 minutes	40 minutes postdrink: 63 (11) 90 minutes postdrink: 83 (17)
^Citation58	20 minutes	Not reported	20 minutes	No	Postdrink, not specified	74–79
^Citation65, ^Citation66	20 minutes	0.99 g/kg	10 minutes	Yes	10 minutes; after task completion	Pretask: 111 (12) Posttask: 123 (12)
^Citation69	20 minutes	2.3 mL/kg (high) 0.77 mL/kg (low)	During drink administration	No	90 minutes	High dose: 105 (17) Low dose: 15 (9)
^Citation67, ^Citation68	5 minutes	0.39 g/kg (high) 0.22 g/kg (low)	30 minutes	No	Not assessed	–
^Citation70	30 minutes	2.3 g/kg	10 minutes	Yes	5 minutes	80
^Citation62	30 minutes	0.67 g/kg	Not specified	Yes	During drink administration; 5 minutes; prior to and after instruction (not specified)	Prior to instruction: 62 After instruction: 59
^Citation63	30 minutes	0.82 g/kg (males) 0.74 g/kg (females)	18 minutes	Yes	10, 11, 23, 50 minutes	10 minutes postdrink: 83 (18) 11 minutes postdrink: 85 (17) 23 minutes postdrink: 91 (16) 50 minutes postdrink: 92 (15)
^Citation61	30 minutes	0.82 g/kg (males) 0.74 g/kg (females)	3 minutes	Yes	30, 47 minutes	30 minutes postdrink: 87 (16) 47 minutes postdrink: 90 (15)
^Citation59	3 minutes	1.9 g/kg (high) 0.9 g/kg (low)	12 minutes	No	Not assessed	–

Notes:

a Postdrink BAC specified in minutes after drink completion or in relation to a given task.

Abbreviation: BAC, breath-alcohol concentration.

Table 4 Facial expressions of negative emotions: evocation, coding, and acute alcohol effects

Emotion induced by	Reference	Facial coding method	Registered facial expressions	Main findings on alcohol effects on facial expressions	Additional findings
Humorous cartoons	^Citation67	FACS	12 alone, 13, 14	Heightening alcohol effect on facial expressions of non-enjoyment in low dose condition (no differences between high dose and control)	Stimuli were judged more negatively in low-beverage group (vs other groups); correlation between rated negative affect and certain facial expressions of nonenjoyment; no alcohol × extraversion interaction
Panic provocation	^Citation58	MAX	Fear/distress score; false smiles (masking reactions)	Decreasing alcohol effect on facial expressions of fear/distress and masking behavior of fear (sum score); decreasing alcohol effect on false smiles	No alcohol effect on facial expressions of fear as single variable
Picture presentation (pleasant, threat, disgust)	^Citation60	EMG	Musculus corrugator activity	Heightening alcohol effect on facial expressions of negative emotions	No sex effect; drinking behavior × picture-type interaction trend
Shock-based provocation	^Citation66	FACS	4, 5, 23, 24	Heightening alcohol effect on facial expressions of anger	Anger out × beverage group × level of provocation interaction effect; anger control × beverage-group interaction effect
	^Citation65	FACS	1, 2, 4, 5, 20	No main alcohol effect on facial expressions of anxiety	Level of provocation × trait anxiety × beverage-group interaction effect
Self-disclosing speech	^Citation62	MAX	Gaze aversion; lip compression/lip biting; furrowed brow	Decreasing alcohol effect on facial expression of shame	Heightened alcohol effect on heart rate; no sex effects
	^Citation63	FACS	9, 10, 14, 15, 20, 1+4	No alcohol effect on facial expressions of negative emotions	Order × beverage group interaction effect; no-beverage group × parental history of alcoholism interaction
Smoking-cue exposure	^Citation61		9, 10, 14, 15, 20, 1+4	Decreasing alcohol effect on facial expressions of negative emotions during smoking-cue exposure	Marginally significant sex effect on facial expressions of negative emotions during smoking-cue exposure (women > men); time × beverage group interaction
Social interaction	^Citation93	FACS	9, 14, 15, 20; 12+14, 15, 23, 24 (smile control)	No alcohol effect on facial expressions of negative emotions; group racial composition × beverage-group interaction effect on smile control à elimination of group racial composition effects under alcohol	–
	^Citation69	BOSIM	Frowning	Heightening alcohol effect on frowning	Frowning × child sexual abuse history interaction
	^Citation72	FACS	9, 14, 15, 20	Decreasing alcohol effect on AUs 9, 14, 15	Main effect for sex on display of facial expressions (women > men)

Abbreviation: FACS, Facial Action Coding System; MAX, maximally discriminative facial movement coding system; EMG, electromyography; BOSIM, bar-observation social interaction measure; AUs, action units.

Figure 3 Experimental control methods for different beverage groups according to the study protocols.

Table 3 Facial expressions of positive emotions: evocation, coding, and acute alcohol effects

Emotion induced by	Reference	Facial coding method	Facial expressions registered	Main findings on alcohol effects on facial expressions	Additional findings
Couple conflict	^Citation70	Rating scale	Smile	Within level: decreasing alcohol effect on smiles Between level: no alcohol effect on smiles at initial 30 seconds, but decreasing alcohol effect on smiles after 3 minutes	—
Humorous cartoons	^Citation67	FACS	2, 6, 12	No main alcohol effect on facial expressions of exhilaration smiles	Self-reported elation increased in high (vs low) alcohol dose; alcohol dose × extraversion interaction
	^Citation68	FACS	2, 6, 12	No main alcohol effect on facial expressions of exhilaration smiles	No correlation between rated funniness and facial expressions of exhilaration smiles in beverage group (vs correlation in sober group)
	^Citation59	Rating scale	Smile frequency or duration	No main alcohol effect on smile frequency or duration	Type of humor × beverage-group interaction effect on smile frequency; no effect for level of intoxication on rated funniness; no correlation between rated funniness and smile frequency or duration in beverage group (vs correlation in sober group)
Self-disclosing speech	^Citation62	MAX	Smile	No alcohol effect on smiles	No sex effects, no time × beverage-group interaction effect
	^Citation63	FACS	12, 6+12, +1, 2, 25, 26	No alcohol effect on facial expressions of positive emotions	No beverage group × parental history of alcoholism interaction
Smoking cue exposure	^Citation61	FACS	12, 6+12, +1, 2, 25, 26	Heightening alcohol effect on facial expressions of positive emotions during smoking-cue exposure	Marginally significant sex effect on facial expressions of positive emotions during smoking-cue exposure (women > men); time × beverage-group interaction during smoking-cue exposure
Social interaction	^Citation64	FACS	6+12	Heightening main alcohol effect at individual and group levels (individual and simultaneous Duchenne smiles)	Self-reported social bonding increased in beverage group; time × beverage-group interaction on simultaneous smiles
	^Citation93	FACS	6+12	No main alcohol effect on smiles	Time × beverage-group interaction
	^Citation71	FACS	6+12	Heightening alcohol effect on smile contagion and smile duration No alcohol effect on non-Duchenne smiles	Group sex composition × beverage group interaction effect à elimination of sex differences under alcohol; Duchenne smile contagion correlated with drinking pattern
	^Citation85	FACS	6+12	Heightening main alcohol effect on individual and group level (individual and simultaneous Duchenne smiles)	No extraversion × beverage-group interaction on smiles
	^Citation92	FACS	6+12	Heightening main alcohol effect on individual and group level (individual and simultaneous Duchenne smiles)	Correlation of present and past smiles decreased in alcohol group
	^Citation69	BOSIM	Smile	No alcohol effect on smiles	No alcohol effect on self-reported enthusiasm
	^Citation72	FACS	6+12	Heightening main alcohol effect on individual and group level (individual and simultaneous Duchenne smiles)	Main effect for gender on the display of facial expressions (women > men); Heightening alcohol effect on self-reported social bonding

Abbreviations: FACS, facial action coding system; MAX, maximally discriminative facial movement coding system; BOSIM, bar-observation social interaction measure.

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