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Review

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

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Pages 369-385 | Published online: 05 Dec 2017

Abstract

Background

As known from everyday experience and experimental research, alcohol modulates emotions. Particularly regarding social interaction, the effects of alcohol on the facial expression of emotion might be of relevance. However, these effects have not been systematically studied. We performed a systematic review on acute alcohol effects on social drinkers’ facial expressions of induced positive and negative emotions.

Materials and methods

With a predefined algorithm, we searched three electronic databases (PubMed, PsycInfo, and Web of Science) for studies conducted on social drinkers that used acute alcohol administration, emotion induction, and standardized methods to record facial expressions. We excluded those studies that failed common quality standards, and finally selected 13 investigations for this review.

Results

Overall, alcohol exerted effects on facial expressions of emotions in social drinkers. These effects were not generally disinhibiting, but varied depending on the valence of emotion and on social interaction. Being consumed within social groups, alcohol mostly influenced facial expressions of emotions in a socially desirable way, thus underscoring the view of alcohol as social lubricant. However, methodical differences regarding alcohol administration between the studies complicated comparability.

Conclusion

Our review highlighted the relevance of emotional valence and social-context factors for acute alcohol effects on social drinkers’ facial expressions of emotions. Future research should investigate how these alcohol effects influence the development of problematic drinking behavior in social drinkers.

Introduction

It is both common sense and a corroborated finding of scientific research that alcohol affects emotions.Citation1Citation8 In Western countries, where social drinking is common and well accepted, alcohol is expected to facilitate interpersonal communication by promoting positive and attenuating negative emotions. Alcohol is frequently exploited as a social lubricant, and improvement in social interaction is one of the most commonly reported motives for occasional alcohol consumption in social drinkers.Citation5,Citation9Citation12 Indeed, moderate alcohol consumption has been found to enhance positive emotions in social drinking contexts.Citation12,Citation13 However, alcohol intake can also facilitate aggressive behavior, which might be due to negative effects of alcohol on impulse control.Citation14Citation18 As such, alcohol has repeatedly been found to modulate behavior associated with both positive and negative emotions according to social context.

In this review, we focus on expressions of emotions, due to their prominent role in social interaction. Facial expressions of emotions are an essential complement of verbal communication, as they validly reflect the subject’s emotional state and thus convey the emotional content of a message.Citation19Citation24 Simulated facial expressions of emotions can be distinguished from those of truly experienced emotions, due to subtle differences in patterns of facial activity.Citation25 Moreover, both encoding (ie, display) and decoding (ie, recognition) of facial expressions of emotions are mostly immediate and automatic processes.Citation26 Facial expressions thus enable quick information exchange, as often required in emotionally relevant situations.Citation27,Citation28 With the development of a systematic coding system by Ekman and Friesen that enabled the reliable measurement of facial activity, facial expressions became the most investigated component of nonverbal expressions of emotions.Citation21,Citation29,Citation30

In this review, we focus exclusively on social drinkers for two reasons. First, we were interested in the effects of alcohol intake on nonverbal communicative behavior under nonpathological conditions, which seems highly relevant given the frequent consumption of alcohol at social events in Western cultures. Second, findings in patients with alcohol abuse or dependence are difficult to interpret, due to persisting cognitive and motor impairments and emotional difficulties in this group.Citation31,Citation32 Despite alcohol’s ability to modulate expressions of emotions and despite the relevance of facial expressions of emotions for social interaction, we are the first to review alcohol effects on facial expressions of emotions in social drinkers.

Heuristic model of alcohol effects on facial emotion processing

To guide our literature search, we developed an heuristic model of alcohol effects on different stages of facial emotion processing (). Our heuristic model posits alcohol effects on the emotional state, encoding of emotional state into facial motor programs, the inhibitory gate for facial expressions, and compliance with social display rules.

Figure 1 Heuristic model of facial emotion processing.

Notes: Rectangle indicates processes within individuals; ellipse denotes a social influence.
Figure 1 Heuristic model of facial emotion processing.

Alcohol effects on emotional state

Empirical evidence suggests that the consumption of an alcoholic beverage increases self-reported pleasurable moods, euphoria, and elation.Citation1,Citation4,Citation5,Citation8 In addition, slightly to moderately drunk individuals show a decrease in self-reported stress and anxiety.Citation8,Citation33Citation35 Moreover, alcohol attenuates startle potentiation in response to unpleasant stimuli, possibly by lowering threat appraisal.Citation2Citation4,Citation36 Nevertheless, alcohol has also been found to increase self-reported anger states, thus indicating an aggression-facilitating effect of alcohol.Citation15,Citation37 Giancola found that individual-trait anger mediated the relationship between alcohol intake and aggression.Citation16

Alcohol effects on encoding of emotional state into facial motor programs

There is ample evidence that motor abilities deteriorate after alcohol intake.Citation38Citation40 With regard to facial expressions, Dethier et al found that long-term alcohol abuse and alcohol addiction impaired performance when deliberately encoding facial expressions of emotions.Citation31,Citation41 However, alcohol effects on deliberate encoding of facial expressions in social drinkers are (to our knowledge) not yet investigated.

Alcohol effects on inhibitory gate for facial expressions

It is assumed that before the motor expression of an affective state can be executed, the particular motor program has to pass an inhibitory gate specific for facial expressions. Alcohol effects on this inhibitory process seem likely, as disinhibiting alcohol effects on both a motor-inhibitory task performance and a cognitive-inhibitory task performance were reported by Rose and Duka.Citation42 Moreover, an event-related brain-potential study found that after alcohol intake, individuals have to activate more cognitive resources to regulate and inhibit behavioral responses in both early and later stages of inhibitory control.Citation43

Alcohol effects on compliance with social display rules

Social display rules include informal norms about when, where, and how emotions should be expressed, and are thought to moderate social nonverbal behavior, including facial expressions.Citation44,Citation45 Previous findings have suggested that alcohol might affect compliance with social display rules. First, as alcohol has been found to impair cognitive processes and inhibition, it possibly counteracts the inhibitory effect of social display rules.Citation42,Citation43 There is evidence that alcohol triggers increased nonverbal behavior that might usually be inhibited by social display rules in social drinking contexts.Citation46 Second, alcohol consumption might reduce the perceived necessity to comply with social display rules. Indeed, slightly to moderately drunk individuals are commonly expected to show disinhibited nonverbal (emotional) behavior that is often not in accordance with social norms.Citation17,Citation42,Citation43,Citation47

In conclusion, we assume that alcohol exerts influence on facial expressions of emotions via different pathways. Based on these pathways, we developed our search algorithm for identifying relevant studies. Moreover, in our search for literature, we applied a broad working definition of emotions that is widely accepted, in spite of the variety of theoretical views and concepts.Citation48 Accordingly, emotions are defined as temporary specific mental states of happiness, sadness, anger, anxiety, jealousy, pride, surprise, compassion, shame, guilt, envy, disappointment, relief, and mental states sufficiently similar to the emotions just mentioned.Citation48 We limited our search to laboratory studies, as these provide higher controllability than field studies and enable the detection of potential underlying mechanisms of action. Furthermore, we selected investigations that studied evoked emotional expressions using well-defined experimental methods. Previous research has shown that both affective responses to alcohol and the display of facial expressions depend on the method “prompting the [emotional] response, and how strong its impact is on motives or emotions”.Citation8,Citation22 Moreover, we examined how sample characteristics as well as personality variables influence alcohol effects on facial expressions of emotions. Due to previously reported effects of sex, drinking history, and alcohol expectancy (ie, individual beliefs about how emotions, mood, and behaviors are affected by alcohol) on general subjective alcohol effects, we also assumed these variables to influence the effect of alcohol on facial expressions of emotions.Citation7,Citation33,Citation49Citation52

Based on the aforementioned considerations, we developed the following hypothesis. We assumed that alcohol facilitates facial expressions of anger under aggressive provocation conditions, but also enhances facial expressions of positive emotions in innocuous drinking contexts. Additionally, we considered the role of sex, drinking history, and alcohol expectancy with regard to alcohol effects on facial expressions of emotions.

Materials and methods

The researchers prepared this review in compliance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for systematic reviews and meta-analysis.Citation53

Search algorithm

We used the PRISMA flow diagram to present the selection of suitable publications ().Citation53 First, we scanned our selected online databases with a predefined search algorithm. Having removed duplicates, we reviewed the titles and abstracts of the retrieved results and extracted relevant publications that met our predetermined criteria as regards content and methodology. The detailed selection process is further described in the following paragraphs.

Figure 2 Process of study selection according to PRISMA flow diagram.Citation53

Abbreviation: PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2 Process of study selection according to PRISMA flow diagram.Citation53

We searched for relevant empirical studies in the electronic databases PsycInfo, PubMed, and Web of Science (database selection was done according to similar systematic reviews dealing with alcohol effects on emotional parameters)Citation54Citation56 within the overall time span covered by each database (from 1887, 1900, and 1926, respectively) until May 2017 in English and German languages. Considering our heuristic model of facial emotion processing (), we applied the keywords “facial emotion encoding OR facial emotion inhibition OR nonverbal social behavior OR facial expression of emotion” to our search. Additionally, we searched for studies that used objective measurements of facial expressions of emotions. Objective measurements do not only minimize the risk of observer-decoding bias within one investigation but also increase comparability between several investigations on alcohol effects on facial expressions of emotions. Facial actions can be assessed most objectively via electromyography (EMG) or via established psychometrical coding systems. We added the keywords “facial action coding OR facial electromyography” to our search algorithm. Finally, we combined (“AND”) these keywords with “alcohol OR ethanol”, and retrieved 383 articles published in English and one published in German. A brief glance at these search results revealed the inclusion of articles describing certain well-examined topics associated with alcohol effects on facial expressions that were, however, irrelevant for our review. Those articles focused on alcohol effects on facial emotion recognition, the influence of prenatal alcohol consumption on infants’ facial expressions, and effects of pathological alcohol consumption. To exclude this literature, we narrowed our search algorithm using the “NOT” function (“NOT recognition NOT prenatal NOT pathologic”). This resulted in a total of 272 articles published in English that potentially suited the scope of our review. Moreover, we included three additional records previously identified through scanning reference lists.

Having excluded duplicates, the next step was conducted by two independent researchers in order to assure objectivity. This step consisted of the screening of both titles and abstracts of the obtained publications and the exclusion of those that appeared irrelevant for our review. In cases of disagreement, the researchers discussed their positions until they reached consensus. Deeper analysis of the remaining studies (n=19) was done with regard to eight exclusion criteria we applied to our review. The empirical studies 1) had to be published in a peer-reviewed journal and 2) conducted on social drinkers in 3) laboratory settings. We included only investigations that used 4) systematic observations and recordings of 5) facial expressions of positive and negative emotions 6) induced by experimental methods. As observational studies can always imply the risk of the aforementioned observer bias, we only included studies with observer data that were either based 7) on established psychometrical coding systems for facial expressions (facial action coding system, maximally discriminative facial movement coding system) or 8) on self-developed systematic coding rules with detailed observer instructions.Citation29,Citation57 According to this selection procedure and exclusion criteria, we identified 18 relevant publications with data derived from 13 primary studies (see for the detailed assignment of publications to primary studies).

Table 1 General design of studies reviewed

Results and discussion

In this section, we firstly review general characteristics, ie, sample characteristics, experimental control methods, and alcohol-administration characteristics, of the selected primary studies. Secondly, we describe and discuss acute alcohol effects on facial expressions of positive and negative emotions, whereby we used two perspectives. For the first perspective, we classified alcohol effects according to the valence of emotion expressed by the face. For the second perspective, we grouped these effects according to the level of social interaction implied in the study design. Thereby, we describe the methods to evoke and measure facial expression in more detail. As this systematized presentation of the data under these perspectives already goes beyond the mere presentation of results, we decided to combine results and discussion for better readability.

General characteristics of studies reviewed

From the primary studies selected, we retrieved information about general design, namely sample characteristics and experimental control methods () and characteristics of alcohol administration (). We describe each of these study features first, and then discuss their effects on the relationship between alcohol and facial expressions of emotions ().

Table 2 Characteristics of oral alcohol administration in studies reviewed

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

Sample characteristics

Sample sizes in the 13 primary studies included in our review were 27–720 participants. Except for one study, which was conducted with panic-disorder patients, all samples consisted of healthy participants.Citation58 In all but one investigation, participants were younger than 35 years. While eight of the studies were conducted with participants of both sexes, the others investigated either exclusively males (n=3) or used all-female samples (n=2; see for descriptive sample characteristics). Participants’ drinking habits () were assessed via self-report (eg, by psychometric questionnaires [n=4]) in all but one study. This study did not include any information about this topic,Citation59 whereas two other studies provided very detailed reports of the subjects’ drinking behavior.Citation60,Citation61

Experimental control methods

As shown in , we listed the control methods “placebo control”, “baseline control”, “blinding”, and “randomization”, which helped us to evaluate the methodical quality of the reviewed studies. Weaver et al considered only “randomization”.Citation59 Both control conditions and randomization were provided in two double-blind investigations and six single-blind investigations.Citation58,Citation60Citation68 The majority of studies used baseline control (n=10). Physiological measures during the testing, eg, recording of autonomous activation via heart/pulse rate or blood pressure, were considered rarely.Citation62,Citation63

The term “beverage group” describes the alcoholic or nonalcoholic beverage administered in a group of participants. Independently of this, drinkers can be either blinded or unblinded about the alcohol content of their beverages in a specific beverage group. While allocation to a specific beverage group was utilized as a between-subject factor (ie, each subject was allocated to one specific drinking group) in all investigations, only one study additionally compared the effect of different alcoholic and nonalcoholic drinks within subjects (beverage group as within-subject factor). There, subjects underwent two test sessions and were allocated to each drinking group once.Citation60 In most of the studies (n=10), participants were blinded to the content of their beverage. The assessment of alcohol expectancy (eg, via self-report) was neglected throughout. overviews the study protocols with regard to beverage groups and blinding.

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

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

Alcohol administration

We screened the studies with regard to the alcohol administered, the period of drink consumption (ie, the time subjects had to finish their drinks), and the time interval between drink consumption and the recording of facial expressions. Moreover, we extracted information on the assessment of breath-alcohol concentration (BAC) via spirometry. Alcohol-administration characteristics are reviewed in .

In all studies alcohol was administered orally, the dose was adjusted to the subjects’ body weight, and (if reported) ranged from 0.22 g/kg to 2.3 g/kg body weight. Only three studies administered a dose higher than 1 g/kg body weight.Citation59,Citation69,Citation70 Kushner et al administered variable alcohol doses to achieve a targeted BAC.Citation58 Two (low vs high) alcohol doses were compared for their effects on facial expressions of emotions in three studies included in our review.

Manipulation checks were accomplished by assessing subjective intoxication ratings (n=11) or postdrink breath alcohol measures (n=11). Predrink BACs were assessed in most studies (n=10). Repeated measurement of postdrink BACs to track blood-alcohol levels over time was included in seven studies. Facial expressions were recorded within different time frames (0–36 minutes) after drink completion. One study failed to report the time frame of recording.Citation62

Information on the period of drink consumption was provided by all studies but one. However, there was considerable heterogeneity regarding this period: 3–36 minutes. In order to increase comparability between studies with regard to alcohol-administration characteristics, we related the dose of alcohol (g/kg) to the time allowed for drink consumption (minutes). As such, the highest doses of alcohol related to the time for drink consumption were found in Weaver et al:Citation59 0.63 g/kg per minute (high dose) and 0.3 g/kg per minute (low dose). This was followed by doses of 0.04–0.12 g/kg per minute in four studies included in our review.Citation65Citation70 In the remaining studies (n=7) the ratio was from 0.02–0.03 g/kg per minute.

Effects of general study characteristics on relationship between alcohol and facial expressions of emotions

Regarding sample characteristics, sex effects on facial expressions of emotions after alcohol intake were analyzed in four studies ( and ), and yielded inconsistent results.Citation60Citation62,Citation71,Citation72 Two studies reported no effects of sex, whereas the others indicated a higher occurrence of facial expressions of positive () and negative () emotions in women independently of alcohol intake.

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

These findings suggest that alcohol does not diminish preexisting sex differences in facial expressions of emotions, which are commonly reported: Men are not only found to be generally less expressive than women but also to show different expressions, eg, more facial expressions interpreted as signs of pride and power, more facial expressions of anger, and fewer smiles compared to women.Citation73Citation78 In one of the reviewed studies, alcohol led to disappearance of sex differences in smile contagion, an effect that consists in the spread of smiling within a social group.Citation71 Sober all-male groups showed less smile contagion than sober mixed-sex groups; these differences vanished after alcohol consumption. This effect was not driven by the sex of the smile initiator, but by the sex of the person who received the smile.

Modulatory effects on facial expressions after alcohol intake by drinking pattern and drinking history were sparsely analyzed in the studies included in our review (n=2). In both studies, the authors found no significant differences in facial expressions under acute intoxication between light- and heavy-drinking groups. In one of these studies, there was only a trend toward heightened musculus corrugator activity (which indicates negative affect) in heavy drinkers ().Citation60 Previous research has found that light drinkers report increased sedation but also more aversive alcohol effects than moderate/heavy drinkers.Citation8,Citation49 Therefore, it seems that differences in subjective alcohol effects between light and heavy drinkers are not necessarily reflected in different facial expressions of emotion. With regard to experimental control methods, participant blindness is crucial in order to minimize the impact of alcohol expectancy.Citation9,Citation17,Citation18,Citation47,Citation50 Alcohol expectancy was not studied in our review, but has previously been found to influence (light vs heavy) drinking behavior.Citation51,Citation79,Citation80

With regard to alcohol-administration characteristics, none of the reviewed studies considered different effects that may occur during the ascending and descending limb of the BAC curve. However, this might be of relevance, as previous research has indicated that similar alcohol concentrations produce positive and stimulating effects on the ascending limb, but depressant effects on the descending limb.Citation52,Citation81Citation83 An EMG study by Pishkin et al demonstrated such differences between the ascending and descending limbs with regard to overall facial activity.Citation84 Compared to sober individuals, intoxicated participants showed more facial activity on the ascending limb after failure (negative emotion) and more activity on the descending limb after success (positive emotion). This finding suggests that pharmacokinetic properties determine alcohol effects on the facial expression of emotion.

In conclusion, despite their general relevance for subjective alcohol effects, the variables sex, drinking pattern, drinking history, and alcohol expectancy were (if at all) only sparsely analyzed in the reviewed studies. A such, their modulating effects on alcohol effects on facial expressions of emotions cannot be clarified by our review, and should be a topic in future research.

Alcohol effects on facial expressions of emotions

In order to provide a clearly arranged overview of the findings concerning acute alcohol effects on facial expressions of emotions, results were categorized in facial expressions of positive () and negative () emotions. Both general and dose-dependent alcohol effects are summarized. Thereafter, we review and discuss alcohol effects on facial expressions of emotions dependent on the level of social interaction imposed by the study design. We provide further information about study-design characteristics and particularly refer to the evocation and coding of facial expressions of emotions.

General alcohol effects

With regard to facial expressions of positive emotions, eight studies found no change after alcohol intake, whereas six other studies reported an increase in expressivity. Only one study reported a decrease in facial expressions of positive emotions after drinking.Citation70 For negative emotions, we identified an almost equal number of studies suggesting unaffected (n=3), increased (n=4), and decreased (n=6) facial expressions during intoxication.

Dose-dependent alcohol effects

Weaver et al did not find any dose-dependent alcohol effects on facial expressions of negative emotions; other studies reported increased or decreased facial expressions of negative emotions in high-compared to low-intoxication groups.Citation59,Citation67,Citation69 Moreover, interaction effects between level of intoxication and method of emotion induction on facial expressions of enjoyment occurred. According to this, the higher the alcohol level, the fewer smiles elicited by subtle humor; in contrast, there were no alcohol-dose effects on smiles elicited by blunt humor.Citation59 Ruch reported interaction effects between the level of intoxication and extraversion on facial expressions of enjoyment:Citation67 the higher the alcohol level, the fewer smiles displayed by extraverts; there was no alcohol-dose effect on smiles in introverts. In contrary, Fairbairn et al did not find any interaction effects between alcohol level and extraversion on facial expressions of positive emotions.Citation85

Overall, these inconsistent findings corroborated the assumption that there are crucial moderating variables with regard to alcohol effects on facial expressions of emotions.Citation17,Citation86 We have already considered pathways moderating how alcohol exerts influence on facial expressions of emotions (). One prominent factor included in our model was social interaction. In general, social interaction comprises communicative behavior between different actors who reciprocally respond to each other, and influence or direct each other.Citation87 The level of social interaction depends on different factors, eg, the number of interaction partners and the type of interaction (direct vs indirect, face to face vs virtual). The term “social drinkers”, which is commonly used for individuals who show a pattern of occasional, nonpathological alcohol consumption, already points to the relevance of social factors for drinking behavior in this group. Moreover, there is evidence that both the emotional response to alcohol (eg, more stimulating alcohol effects in the presence of a drinking partner vs drinking alone) and the display of facial expressions of emotions vary with the social context.Citation7,Citation8,Citation13,Citation22,Citation88 Therefore, we grouped the studies according to the level of social interaction imposed by the study design into those with low, moderate, and high levels of social interaction. With regard to the communicative function of nonverbal behavior, we assumed alcohol effects on facial expressions of emotions to increase with an increasing level of social interaction.Citation24

Alcohol effects on facial expressions of positive and negative emotions considering level of social interaction

We defined low-level social interaction contexts as situations in which participant attention is focused on a specific task that does not include direct social interaction. We assumed a moderate level of social interaction to be present in the studies in which participants were asked to deliver a video-taped speech about what they liked and disliked about their physical appearance. This assumption is based on the fact that participants addressed their speech to an indirect (virtual) but specified interaction partner. In the studies reviewed, the addressee was a group of psychology students. Contexts including face-to-face communication with at least one interaction partner were classified as high-level social interaction.

We found six primary studies that used a low level of social interaction. In four of these studies, the experimenters merely observed the participants during the experimental task, which consisted in the judgment of emotional pictorial stimuli or exposure to smoking cues.Citation59Citation61,Citation67,Citation68 In two other studies, the participants underwent a panic provocation or received electric shocks during the absence of the experimenters, who administered the stimuli from a separate room and observed task performance by using video surveillance.Citation58,Citation65,Citation66

Alcohol intake did not exert any effect on the facial expression of positive emotions (enjoyment) elicited by humorous stimuli ().Citation59,Citation67,Citation68 Moreover, an alteration of alcohol-dose level (high vs low) did not affect facial expressions of exhilaration in these studies. Participants who had consumed alcohol showed more frequent facial expressions of negative emotions in response to humorous stimuli than sober individuals ().Citation60,Citation67 Ruch reported increased facial expressions of negative emotions for only a low (vs high) alcohol dose.Citation67 Glautier et al found heightened EMG musculus corrugator activity, which is considered an indicator of negative affect after alcohol consumption, while watching pleasant, threat-related and disgust-related pictures.Citation60,Citation89 Therefore, in social drinkers who judged pictorial stimuli in settings with low levels of social interaction, alcohol merely showed increasing effects on facial expressions of negative emotions. It is of note that this effect occurred for both pleasant and unpleasant pictorial stimuli.

Sayette et al investigated the effect of alcohol on facial expressions of emotions that occurred during cigarette craving (12-hour smoking abstinence) in heavy smokers.Citation61 They found that during exposure to smoking cues (presentation of a lit cigarette), alcohol increased facial expressions of positive emotions () and marginally decreased the occurrence of facial expressions of negative emotions; however, this effect declined over time ().Citation61 Previous research by Sayette et al suggested that a smoker’s facial expression of positive emotions during cigarette craving indicates an increased likelihood of initiating smoking.Citation90

In a study by Kushner et al conducted on panic patients, slightly to moderately drunk participants showed decreased facial expressions of fear/distress, as well as less active facial behavior to suppress these signs under panic provocation ().Citation58 These findings can be interpreted in the context of previous findings of alcohol attenuating panic symptoms.Citation2,Citation4

Regarding healthy participants under provocation by electric shock (), there is evidence for an alcohol-dependent increase in the facial expression of anger, but no main effect of alcohol on facial expressions of anxiety.Citation65,Citation66 Alcohol enhanced the relationship between the individual’s actual facial expression of emotion and his or her trait anger or trait anxiety under certain levels of provocation (implemented by the intensity of electric shocks). Particularly, under alcohol, trait anger evoked facial expressions of anger under high provocation (ie, high-intensity shocks), and the increase in facial expressions of anxiety occurred only in highly anxious men under low provocation (ie, low-intensity shocks).Citation65,Citation66 These results were corroborated by other findings highlighting the influence of both aggression-related traits and provocation level on anger expression.Citation14Citation18

In two of the studies reviewed, we found a moderate level of social interaction.Citation62,Citation63 These studies, in which participants delivered a videotaped self-disclosing speech, reported no alcohol effects on the facial expression of positive emotions (). Alcohol decreased facial expressions of negative emotions in both studies (); however, in one of the studies this effect depended on whether the stressor was introduced before or after alcohol administration.Citation63 Also in the latter study, signs of fear and anger suppression measured by lip compression and lip biting were heightened within slightly to moderately drunk individuals in contrast to their sober counterparts. Alcohol was previously found to modulate signs of negative emotions visible in the face during delivering a speech. Particularly, Stevens et al found decreased facial blushing after alcohol intake and thus high-lighted the functional advantage of reduced (facial) signs of nervousness that increased the speakers’ self-confidence and reduced social anxiety.Citation91

Contexts with high-level social interaction were identified in five studies.Citation59,Citation61,Citation72,Citation79,Citation80,Citation85,Citation92,Citation93 In general, the process of group formation among unacquainted participants is commonly used in experimental paradigms aimed at investigating social context effects. Both positive and negative emotional states can equally be evoked by group formation.Citation7 Moreover, it is possible simultaneously to observe (facial) behavior on individual (reactions of one individual, eg, smiling) and group levels (simultaneous reactions of several individuals, eg, smile contagion) in this context.

Alcohol effects on smile behavior at both individual and group levels were found in three studies using the group-formation paradigm ().Citation64,Citation71,Citation72,Citation85,Citation92,Citation93 Fairbairn et al measured fewer smile controls, ie, facial expressions that counteract an occurring smile, under alcohol (), but no alcohol effects on facial expressions of positive and negative emotions themselves.Citation93 In another study, alcohol (vs placebo) decreased facial expression of negative emotions ().Citation72

In sum, within the process of group formation, alcohol consumption heightened the frequency of positive facial expressions and smile contagion, and at least partially decreased facial expressions of negative expressions. In a simulated couple-conflict situation, slightly to moderately drunk individuals showed significantly less positive facial expressions relative to their sober counterparts and a decline in expressing positive emotions over time ().Citation70 This might indicate that individuals can play their allocated role as conflict partner in a more authentic way after alcohol intake. In other words, slightly to moderately drunk individuals acted more as expected, ie, they performed more socially desirably, considering the given task. Summarizing alcohol effects on facial expressions of emotions in situations with a high level of social interaction, we conclude that moderate dosages of alcohol affect both positive and negative facial expressions in a way that increases desirable social behavior. Moreover, since alcohol also seems to dampen smile-control expressions, a further argument for the function of alcohol as social lubricant is available. In general, mood- and social bond-enhancing alcohol effects can be explained by a “social-attributional” approach, whereby alcohol interferes with the anticipation and elaboration of social rejection.Citation86 Alternatively, these effects might also be explained by so-called alcohol myopia, which describes a narrowing of perception and cognition by alcohol that temporarily alleviates worries and causes a feeling of relief.Citation35,Citation92 Further exploratory approaches on how alcohol affects emotions in social drinkers are elaborately discussed in a recent review by Sayette.Citation7

Increasing BACs, however, do not seem to enhance these effects, as shown by Parks et al ( and ).Citation69 In this study, increases in the administered alcohol dose (paralleled by increases in BAC) did not affect facial expressions of positive emotions but increased facial expressions of negative emotions.

Limitations

In the following, we briefly discuss limitations of this review. Moreover, we summarize limitations of the studies reviewed and provide suggestions for future research.

Limitation of this systematic review

In order to review alcohol effects on the facial expression of emotions in social drinkers, we categorized studies according to the level of social interaction imposed by the study design. There are also other factors given by our heuristic model of facial emotion processing () to organize the present review. However, we chose the level of social interaction, because we assumed it to be one of the most important moderating variables in this context and also for the pragmatic reason that all reviewed studies provided information on the level of social interaction, whereas this information would not have been available for the other variables included in our heuristic model.

Limitations of studies reviewed and suggestions for future research

There are also some limitations of the studies reviewed, each highlighting directions for future research. First, alcohol effects on facial expressions of anger and anxiety were assessed only in male participants.Citation65,Citation66 Due to pronounced sex differences in both facial expressions and aggression, generalization of these effects to female participants is not possible, and future studies should also investigate female samples.Citation16,Citation73Citation78,Citation94,Citation95 Second, the studies reviewed considered various emotions that are encoded into specific facial expressions. In order to enhance comparability of the studies, future research should refer to similar concepts of emotions; we propose using a broad working definition of emotion.Citation48 Moreover, there is to date no experimental investigation dealing with alcohol effects on facial expressions of sadness. However, such effects can be expected due to mood-enhancing and stress-dampening effects of alcohol, and should thus be examined in future research.Citation7

Third, the studies included in our review did not compare alcohol effects on facial expressions of emotions that appear on the ascending or descending limb of the BAC curve. However, since the same alcohol concentration often exerts different subjective effects (stimulating vs depressant) on the ascending vs descending limb of the BAC curve, this seems to be an important topic to be considered in future studies.Citation52,Citation83 Fourth, in one study, facial muscle activity was measured via EMG using surface electrodes.Citation60 Despite the high objectivity of this method, the spatial resolution is not good enough to distinguish fully among expressions of different emotions. Indeed, only musculus corrugator and zygomaticus activity are commonly interpreted as measures of negative and positive emotions, respectively. The use of needle electrodes would improve spatial resolution, but may irritate. The application of electrodes always leads to artificial conditions, possibly changing facial expressions. For a comprehensive analysis and interpretation of facial activity, we recommend an additional observer rating to distinguish among different kinds of emotion expressions. Concordance of EMG-recorded facial activity with observer ratings would facilitate the interpretation of certain patterns of EMG facial activity as indicative of the expression of specific emotions.

Fifth, a potential interaction between social context factors and the method used for emotion induction has not yet been studied, but might be considered. For example, emotion induction via picture presentation and anger provocation are confounded with low-level social interaction contexts.Citation59,Citation60,Citation65Citation68 Sixth, as already discussed, sex effects, the subjects’ drinking history, and alcohol expectancy have been sparsely investigated. Due to their importance for the relationship between alcohol and emotion, however, they should be considered systematically in future investigations. Seventh, no examination of alcohol effects on the facial expression of pain has yet been conducted. There is an established relationship between alcohol consumption and clinical pain: individuals suffering from pain tend to consume more alcohol, and individuals presenting with alcohol abuse often report pain symptoms.Citation96,Citation97 In addition, pain-dampening effects of alcohol could be proven experimentally.Citation55,Citation98 Moreover, there is a close relationship between emotion and pain: modulating effects of emotional stimuli on pain perception have been repeatedly reported.Citation99Citation103 In sum, due to close mutual relationships among alcohol, emotion, and pain, we would expect to find alcohol effects also on the facial expressions of pain.

Conclusion

Despite the common use of alcohol to modulate emotion, there is still little systematic research on alcohol effects on the facial expression of emotions. As we tried to demonstrate with our heuristic model (), alcohol can potentially impact facial expressions of emotion on various stages. To date, our review is the first approach to systematize the available literature on this research topic.

Overall, alcohol exerts effects on facial expressions of emotions in social drinkers. These effects are not generally disinhibiting, but vary depending on the valence of emotion and on social interaction. In moderate- and high-level social interaction, alcohol mostly influences facial expressions in a socially desirable way, thus underscoring the view of alcohol as social lubricant. Important research gaps to be closed by future studies are the investigation of alcohol effects on the facial expressions of sadness and pain, as well as the consideration of potential moderating variables (eg, alcohol expectancy). Future research should also investigate if socially desirable alcohol effects on facial expressions trigger increased drinking and thus might influence the development of problematic drinking behavior in social drinkers.

Acknowledgments

We thank the Ständige Kommission für Forschung und wissenschaftlichen Nachwuchs (FNK) and the Deutsche Forschungsgemeinschaft (DFG) for funding the related research projects “020624 Die akute Wirkung von Alkohol auf die Schmerzverarbeitung [Acute alcohol effects on pain processing]” and “GZ: HO 5573/1-1 Trinken gegen Schmerz? Physiologische und psychologische Wirkmechanismen von Alkohol auf die Schmerzwahrnehmung [Drinking against pain? Physiological and psychological effect mechanisms of alcohol on pain perception]”, which inspired the authors to perform this review.

Disclosure

The authors report no conflicts of interest in this work.

References

  • aan het RotMRussellJJMoskowitzDSYoungSNAlcohol in a social context: Findings from event-contingent recording studies of everyday social interactionsAlcohol Clin Exp Res200832345947118215215
  • DonohueKFCurtinJJPatrickCJLangARIntoxication level and emotional responseEmotion20077110311217352567
  • DonohueKFLangARPatrickCJAlcohol and emotions: potential dose effects and mechanisms of neuromuscular controlAlcohol Clin Exp Res200327Suppl 5136A12544017
  • LevensonRWAlcohol, affect, and physiology: positive effects in the early stages of drinkingGottheilEDruleyKPaskoSWeinsteinSStress and AddictionNew YorkBruner/Mazel1987173196
  • MillerMABershadAKde WitHDrug effects on responses to emotional facial expressions: recent findingsBehav Pharmacol201526657157926226144
  • Oscar-BermanMMarinkovićKAlcohol: effects on neurobehavioral functions and the brainNeuropsychol Rev200717323925717874302
  • SayetteMAThe effects of alcohol on emotion in social drinkersBehav Res Ther201788768928110679
  • SmithRCParkerESNobleEPAlcohol and affect in dyadic social interactionPsychosom Med197537125401091942
  • CooperMLFroneMRRussellMMudarPDrinking to regulate positive and negative emotions: a motivational model of alcohol useJ Pers Soc Psychol199569599010057473043
  • CoxWMKlingerEIncentive motivation, affective change, and alcohol use: a modelCoxWMWhy People DrinkNew YorkGardner Press1990291314
  • GoldmanMSBrownSAChristiansenBAExpectancy theory: thinking about drinkingBlaneHTLeonardKEPsychological Theories of Drinking and AlcoholismNew YorkGuilford1987181226
  • MonahanJLLannuttiPJAlcohol as social lubricantHum Commun Res2000262175202
  • PlinerPCappellHModification of affective consequences of alcohol: a comparison of social and solitary drinkingJ Abnorm Psychol19748344184254414699
  • AndersonCABushmanBJHuman aggressionAnnu Rev Psychol200253275111752478
  • ChermackSTGiancolaPRThe relation between alcohol and aggression: an integrated biopsychosocial conceptualizationClin Psychol Rev19971766216499336688
  • GiancolaPRThe influence of trait anger on the alcohol-aggression relation in men and womenAlcohol Clin Exp Res20022691350135812351929
  • HullJGBondCFSocial and behavioral consequences of alcohol consumption and expectancy: a meta-analysisPsychol Bull19869933473603714923
  • ZhangLWelteJWWieczorekWWThe role of aggression-related alcohol expectancies in explaining the link between alcohol and violent behaviorSubst Use Misuse200237445747112064429
  • DarwinCThe Expression of the Emotions in Man and AnimalsLondonJohn Murray1872
  • EkmanPRosenbergELWhat the Face Reveals: Basic and Applied Studies of Spontaneous Expression using the Facial Action Coding System (FACS)New YorkOxford University Press1997
  • MeesUZum Forschungsstand der Emotionspsychologie – eine Skizze [Regarding current research in emotion psychology – an outline]SchützeichelREmotionen und SozialtheorieFrankfurtCampus2006104123
  • ParkinsonBDo facial movements express emotions or communicate motives?Pers Soc Psychol Rev20059427831116223353
  • SokolowskiKEmotionMüsselerJPrinzWLehrbuch Allgemeine PsychologieHeidelbergSpektrum Akademischer Verlag2002337384 German
  • WatzlawickPBeavinJHJacksonDDPragmatics of Human Communication: A Study of Interactional Patterns, Pathologies, and ParadoxesNew YorkWW Norton2011
  • EkmanPExpression or communication about emotion?SegalGEWeisfeldCCUniting Psychology and Biology: Integrative Perspectives on Human DevelopmentWashingtonAmerican Psychological Association1997315338
  • BlairRJFacial expressions, their communicatory functions and neuro-cognitive substratesPhilos Trans R Soc Lond B Biol Sci2003358143156157212689381
  • DimbergUFacial electromyography and the experience of emotionJ Psychophysiol19883277282
  • ShariffAFTracyJLWhat are emotion expressions for?Curr Dir Psychol Sci2011206395399
  • EkmanPFriesenWVFacial Action Coding System: A Technique for the Measurement of Facial MovementPalo Alto (CA)Consulting Psychologists Press1978
  • KeltnerDEkmanPFacial expression of emotionLewisMHaviland-JonesJHandbook of Emotions2nd edNew York, NYGuilford Publications2000236249
  • DethierMDouwsLBlairySCognitive and emotional empathy in alcohol-dependent patients (ADs): a review of the literatureRev Francoph Clin Comport Cogn2011162136
  • SullivanEVRosenbloomMJPfefferbaumAPattern of motor and cognitive deficits in detoxified alcoholic menAlcohol Clin Exp Res200024561162110832902
  • HendlerRARamchandaniVAGilmanJHommerDWStimulant and sedative effects of alcoholSommerWHSpanagelRBehavioral Neurobiology of Alcohol AddictionHeidelbergSpringer2011489509
  • SayetteMAAn appraisal-disruption model of alcohol’s effects on stress responses in social drinkersPsychol Bull199311434594768272466
  • SteeleCMJosephsRADrinking your troubles away – II: an attention-allocation model of alcohol’s effect on psychological stressJ Abnorm Psychol19889721962053385073
  • CurtinJJPatrickCJLangARCacioppoJTBirbaumerNAlcohol affects emotion through cognitionPsychol Sci200112652753111760143
  • BushmanBJCooperHMEffects of alcohol on human aggression: an integrative research reviewPsychol Bull199010733413542140902
  • BrumbackTCaoDKingAEffects of alcohol on psychomotor performance and perceived impairment in heavy binge social drinkersDrug Alcohol Depend2007911101717560739
  • FogartyJNVogel-SprottMCognitive processes and motor skills differ in sensitivity to alcohol impairmentJ Stud Alcohol200263440441112160098
  • KingACByarsJAAlcohol-induced performance impairment in heavy episodic and light social drinkersJ Stud Alcohol2004651273615000501
  • DethierMEl HawaMDuchateauRBlairySEmotional facial expression recognition and expressivity in type I and type II alcohol dependent patientsJ Nonverbal Behav201438189105
  • RoseAKDukaTThe influence of alcohol on basic motoric and cognitive disinhibitionAlcohol Alcohol200742654455117878213
  • EuserASFrankenIHAlcohol affects the emotional modulation of cognitive control: an event-related brain potential studyPsychopharmacology2012222345947622371302
  • SieglerRHow Children DevelopNew YorkWorth Publishers2006
  • ZaalbergRMansteadAFischerARelations between emotions, display rules, social motives, and facial behaviourCogn Emot200418218320729148304
  • SteeleCMSouthwickLAlcohol and social behavior – I: the psychology of drunken excessJ Pers Soc Psychol198548118343981386
  • CritchlowBThe powers of John Barleycorn: beliefs about the effects of alcohol on social behaviorAm Psychol19864177517643527002
  • MeyerWUReisenzeinRSchützwohlAEinführung in die Emotionspsychologie – Band I: Die Emotionstheorien von Watson, James, und SchachterBernHans Huber2001
  • HoldstockLKingACde WitHSubjective and objective responses to ethanol in moderate/heavy and light social drinkersAlcohol Clin Exp Res200024678979410888066
  • KreuschFVilenneAQuertemontEAssessing the stimulant and sedative effects of alcohol with explicit and implicit measures in a balanced placebo designJ Stud Alcohol Drugs201374692393024172120
  • ReadJPWoodMDLejuezCWPalfaiTPSlackMGender, alcohol consumption, and differing alcohol expectancy dimensions in college drinkersExp Clin Psychopharmacol200412429830815571447
  • MoreanMECorbinWRSubjective response to alcohol: a critical review of the literatureAlcohol Clin Exp Res201034338539520028359
  • MoherDLiberatiATetzlaffJAltmanDGPreferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statementOpen Med200933123130
  • FortunataMOsórioFLRecognition of facial expressions by alcoholic patients: a systematic literature reviewNeuropsychiatr Dis Treat2014101655166325228806
  • Horn-HofmannCBüscherPLautenbacherSWolsteinJThe effect of nonrecurring alcohol administration on pain perception in humans: a systematic reviewJ Pain Res2015817518725960674
  • KunBDemetrovicsZEmotional intelligence and addictions: a systematic reviewSubst Use Misuse2010457–81131116020441455
  • IzardCEThe Maximally Discriminative Facial Movement Coding System (MAX) – ManualNewark (NJ)University of Delaware1979
  • KushnerMGMassieEDGaskelSMackenzieTFiszdonJAndersonNAlcohol effects on the facial expressions of anxiety patients undergoing a panic provocationAddict Behav19972222752809113222
  • WeaverJBMaslandJLKharazmiSZillmannDEffect of alcoholic intoxication on the appreciation of different types of humorJ Pers Soc Psychol19854937817874045704
  • GlautierSO’BrienJDixonJFacial electromyographic (EMG) responses to emotionally significant visual images: differences between light and heavy drinkersDrug Alcohol Depend200164333734511672948
  • SayetteMAMartinCSWertzJMPerrottMAPetersARThe effects of alcohol on cigarette craving in heavy smokers and tobacco chippersPsychol Addict Behav200519326327016187804
  • SayetteMASmithDWBreinerMJWilsonGTThe effect of alcohol on emotional response to a social stressorJ Stud Alcohol199253641545
  • SayetteMAMartinCSPerrottMAWertzJMHuffordMRA test of the appraisal-disruption model of alcohol and stressJ Stud Alcohol200162224725611327191
  • KirchnerTRSayetteMACohnJFMorelandRLLevineJMEffects of alcohol on group formation among male social drinkersJ Stud Alcohol200667578579316847549
  • ParrottDJGallagherKEZeichnerALiquid courage or liquid fear: alcohol intoxication and anxiety facilitate physical aggressionSubst Use Misuse201247777478622452787
  • ParrottDJZeichnerAStephensDEffects of alcohol, personality, and provocation on the expression of anger in men: a facial coding analysisAlcohol Clin Exp Res200327693794512824814
  • RuchWExtraversion, alcohol, and enjoymentPers Individ Dif199316189102
  • RuchWWill the real relationship between facial expression and affective experience please stand up: the case of exhilarationCogn Emot1995913358
  • ParksKAHequembourgALDearingRLWomen’s social behavior when meeting new men: the influence of alcohol and childhood sexual abusePsychol Women Q200832214515818668186
  • SampJAMonahanJLAlcohol-influenced nonverbal behaviors during discussions about a relationship problemJ Nonverbal Behav2009333193211
  • FairbairnCESayetteMAAalenOOFrigessiAAlcohol and emotional contagion an examination of the spreading of smiles in male and female drinking groupsClin Psychol Sci20153568670126504673
  • SayetteMACreswellKGDimoffJDAlcohol and group formation: a multimodal investigation of the effects of alcohol on emotion and social bondingPsychol Sci20122386987822760882
  • DimbergUThunbergMElmehedKUnconscious facial reactions to emotional facial expressionsPsychol Sci2000111868911228851
  • KringAMGordonAHSex differences in emotion: expression, experience, and physiologyJ Pers Soc Psychol19987436867039523412
  • KringMAGender and angerFischerAHGender and EmotionCambridgeCambridge University Press2002211231
  • LaFranceMHechtMAPaluckELThe contingent smile: a meta-analysis of sex differences in smilingPsychol Bull2003129230533412696842
  • MansteadASGender differences in emotionGaleAEysenckMWHandbook of Individual Differences: Biological PerspectivesOxfordJohn Wiley & Sons1992355387
  • TimmersMFischerAHMansteadASGender differences in motives for regulating emotionsPers Soc Psychol Bull1998249974985
  • JonesBTCorbinWFrommeKA review of expectancy theory and alcohol consumptionAddiction2001961577211177520
  • LeighBCStacyAWAlcohol expectancies and drinking in different age groupsAddiction200499221522714756714
  • AddicottMAMarsh-RichardDMMathiasCWDoughertyDMThe biphasic effects of alcohol: comparisons of subjective and objective measures of stimulation, sedation, and physical activityAlcohol Clin Exp Res200731111883189017949393
  • SöderlundHParkerESSchwartzBLTulvingEMemory encoding and retrieval on the ascending and descending limbs of the blood alcohol concentration curvePsychopharmacology2005182230531716160875
  • SutkerPBTabakoffBGoistKCRandallCLAcute alcohol intoxication, mood states and alcohol metabolism in women and menPharmacol Biochem Behav198318Suppl 13493546634848
  • PishkinVLawrenceBEBourneLECognitive and electrophysiologic parameters during ascending and descending limbs of the blood alcohol curveAlcohol Clin Exp Res19837176826342453
  • FairbairnCESayetteMAWrightAGLevineJMCohnJFCreswellKGExtraversion and the rewarding effects of alcohol in a social contextJ Abnorm Psychol2015124366067325844684
  • FairbairnCESayetteMAA social-attributional analysis of alcohol responsePsychol Bull201414051361138225180806
  • WirtzMADorsch: Lexikon der Psychologie18th edBernHans Huber2017
  • KirkpatrickMGde WitHIn the company of others: social factors alter acute alcohol effectsPsychopharmacology2013230221522623712603
  • LarsenJTNorrisCJCacioppoJTEffects of positive and negative affect on electromyographic activity over zygomaticus major and corrugator superciliiPsychophysiology200340577678514696731
  • SayetteMAWertzJMMartinCSCohnJFPerrottMAHobelJEffects of smoking opportunities on cue-elicited urge: a facial coding analysisExp Clin Psychopharmacol200311321822712940501
  • StevensSCludiusBBantinTHermannCGerlachALInfluence of alcohol on social anxiety: an investigation of attentional, physiological and behavioral effectsBiol Psychol20149612613324355243
  • FairbairnCESayetteMAThe effect of alcohol on emotional inertia: a test of alcohol myopiaJ Abnorm Psychol2013122377078124016015
  • FairbairnCESayetteMALevineJMCohnJFCreswellKGThe effects of alcohol on the emotional displays of whites in interracial groupsEmotion201313346847723356562
  • Bischof-KöhlerDVon Natur aus Anders: Die Psychologie der GeschlechtsunterschiedeStuttgartKohlhammer2006
  • GiancolaPRZeichnerAAn investigation of gender differences in alcohol-related aggressionJ Stud Alcohol19955655735797475039
  • LevensonJLMcClishDKDahmanBAAlcohol abuse in sickle cell disease: the PiSCES projectAm J Addict200716538338817882609
  • SheuRLussierDRosenblumAPrevalence and characteristics of chronic pain in patients admitted to an outpatient drug and alcohol treatment programPain Med20089791191718346064
  • ThompsonTOramCCorrellCUTsermentseliSStubbsBAnalgesic effects of alcohol: a systematic review and meta-analysis of controlled experimental studies in healthy participantsJ Pain201718549951027919773
  • BartleyEJRhudyJLThe influence of pain catastrophizing on experimentally induced emotion and emotional modulation of nociceptionJ Pain20089538839618226969
  • De WiedMVerbatenMNAffective pictures processing, attention, and pain tolerancePain200190116317211166983
  • KampingSBombaIKanskePDieschEFlorHDeficient modulation of pain by a positive emotional context in fibromyalgia patientsPain201315491846185523752177
  • Kenntner-MabialaRWeyersPPauliPIndependent effects of emotion and attention on sensory and affective pain perceptionCogn Emot200721816151629
  • RoyMPichéMChenJIPeretzIRainvillePCerebral and spinal modulation of pain by emotionsProc Natl Acad Sci U S A200910649209002090519926861