Theory of Mind in Psychoactive Substance Users: A Systematic Literature Review and Meta-analysis

Vollständiger Abstract

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Abstract Psychoactive substance use is associated with cognitive and social impairments, including deficits in Theory of Mind (ToM), a key ability for understanding mental states and regulating social interactions. Although consistent evidence indicates ToM deficits among alcohol users, it remains uncertain whether such impairments extend to other substances. This study aimed to examine ToM abilities in psychoactive substance users through a systematic review and meta-analysis and to determine potential differences across substance classes. The Embase, Scopus, PsycINFO, Web of Science, PubMed, PsycNet, LILACS, and SciELO databases were searched following PRISMA guidelines. Observational and experimental studies involving adults that compared ToM performance between psychoactive substance users and controls were included. Meta-analyses were conducted using Jamovi software (DerSimonian-Laird method), with subgroup analyses by substance class. Thirty-seven studies met the inclusion criteria, and 30 (35 distinct samples) provided data for meta-analysis. Overall, psychoactive substance users showed significantly poorer ToM performance than controls (SMD = -0.80; 95% CI = -1.13 to -0.47; I 2 = 93.35%). Subgroup analyses (alcohol, opioids, stimulants) revealed no significant differences among substance classes. Evidence regarding cannabis, hallucinogens, and nicotine remains limited. Psychoactive substance users exhibit substantial ToM deficits, possibly reflecting pre-existing vulnerabilities and/or substance-related neurotoxicity. These findings reinforce the importance of assessing sociocognitive skills in both prevention and treatment strategies for Substance Use Disorder.