Cue exposure in the treatment of drug dependence: the potential of a new method for preventing relapse.

Cue exposure has been used successfully in the treatment of neurotic disorders. Its application to the treatment of drug dependence is founded on the premise that craving for drugs can become classically conditioned to internal and external drug-related cues and that such conditioned craving responses play an important part in relapse to drug use. This article reviews the theoretical background for the use of cue exposure, research on cue reactivity in samples of drug-dependent persons and the role of cue reactivity in relapse. What evidence exists on the clinical effectiveness of cue exposure is reviewed in some detail and a number of clinical issues relating to its practical application are discussed. It is concluded that controlled trials of the effectiveness of cue exposure treatment for drug dependence should be implemented without further delay.

[1]  W. Zwick,et al.  Reactivity of alcoholics and nonalcoholics to drinking cues. , 1987, Journal of abnormal psychology.

[2]  R. Wise.  Action of drugs of abuse on brain reward systems , 1980, Pharmacology Biochemistry and Behavior.

[3]  J. Laberg,et al.  Psychophysiological indicators of craving in alcoholics: effects of cue exposure. , 1987, British journal of addiction.

[4]  A. R. Wagner,et al.  Development of context-specific tolerance to morphine: support for a dual-process interpretation. , 1986, Behavioral neuroscience.

[5]  J. Teasdale.  Conditioned abstinence in narcotic addicts. , 1973, The International journal of the addictions.

[6]  L. Kozlowski,et al.  Use and misuse of the concept of craving by alcohol, tobacco, and drug researchers. , 1987, British journal of addiction.

[7]  R. Hodgson,et al.  Modification of excessive drinking by cue exposure. , 1976, Behaviour research and therapy.

[8]  C. O'brien,et al.  Conditioning in human opiate addicts , 1976, The Pavlovian journal of biological science.

[9]  S. Siegel,et al.  Environmental specificity of tolerance , 1984, Trends in Neurosciences.

[10]  Herman Cp.  External and internal cues as determinants of the smoking behavior of light and heavy smokers. , 1974 .

[11]  N Birbaumer,et al.  Anxiety induced by false heart rate feedback in patients with panic disorder. , 1988, Behaviour research and therapy.

[12]  R. Hodgson,et al.  Alcohol dependence and the priming effect. , 1979, Behaviour research and therapy.

[13]  A. Zeichner,et al.  Assessment of smoking urge and its concomitants under an environmental smoking cue manipulation. , 1985, Addictive behaviors.

[14]  D. E. Morse,et al.  Neuroendocrine, psychophysiological and subjective reactivity to an alcohol placebo in male alcoholic patients. , 1987, Alcoholism, clinical and experimental research.

[15]  L. Melin,et al.  Covert extinction of amphetamine addiction , 1974 .

[16]  R. Hodgson,et al.  Cue exposure and response prevention with alcoholics: a controlled trial. , 1983, Behaviour research and therapy.

[17]  R. Blakey,et al.  An exposure approach to alcohol abuse. , 1980, Behaviour research and therapy.

[18]  S. Rachman.  Obsessions and compulsions , 2020, Anxiety.

[19]  S. Goldberg,et al.  Conditioned nalorphine-induced abstinence changes: persistence in post morphine-dependent monkeys. , 1970, Journal of the experimental analysis of behavior.

[20]  D. Abrams,et al.  Understanding Relapse and Recovery in Alcohol Abuse , 1986 .

[21]  J. Laberg.  Alcohol and expectancy: subjective, psychophysiological and behavioral responses to alcohol stimuli in severely, moderately and non-dependent drinkers. , 1986, British journal of addiction.

[22]  A. Wikler,et al.  Conditioning factors in opiate addiction and relapse , 1984 .

[23]  H. Cappell,et al.  Conditioned tolerance to the hypothermic effect of ethyl alcohol. , 1979, Science.

[24]  T. Baker,et al.  Morphine tolerance as habituation. , 1985, Psychological review.

[25]  H. de Wit,et al.  Role of unconditioned and conditioned drug effects in the self-administration of opiates and stimulants. , 1984, Psychological review.

[26]  A. Childress,et al.  Abstinent opiate abusers exhibit conditioned craving, conditioned withdrawal and reductions in both through extinction. , 1986, British journal of addiction.

[27]  O. Pomerleau.  Underlying mechanisms in substance abuse: examples from research on smoking. , 1981, Addictive behaviors.

[28]  A. Childress,et al.  Conditioned responses in a methadone population. A comparison of laboratory, clinic, and natural settings. , 1986, Journal of substance abuse treatment.

[29]  R. Hodgson,et al.  Cue Exposure and Relapse Prevention , 1982 .

[30]  P M Monti,et al.  Psychosocial stress and coping in smokers who relapse or quit. , 1987, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[31]  D J Rohsenow,et al.  Relevance of cue reactivity to understanding alcohol and smoking relapse. , 1988, Journal of abnormal psychology.

[32]  C. O'brien,et al.  Conditioned narcotic withdrawal in humans. , 1977, Science.

[33]  B. Bradley,et al.  Extinction of Craving During Exposure to Drug-related Cues: Three Single Case Reports , 1988, Behavioural Psychotherapy.

[34]  M. Raw.  Smoking Cessation Strategies , 1986 .

[35]  R. Hinson,et al.  Pavlovian conditioning and addictive behavior: relapse to oral self-administration of morphine. , 1986, Behavioral neuroscience.

[36]  Wilson Gt.  Cognitive processes in addiction. , 1987 .

[37]  T. Thompson,et al.  Susceptibility to readdiction as a function of the addiction and withdrawal environments. , 1965, Journal of comparative and physiological psychology.

[38]  C. O'brien.  Experimental analysis of conditioning factors in human narcotic addiction. , 1975, Pharmacological reviews.

[39]  A homeostatic model of Pavlovian conditioning: tolerance to scopolamine-induced adipsia. , 1984 .

[40]  O. Pomerleau,et al.  Salivation to drinking cues in alcohol abusers: toward the validation of a physiological measure of craving. , 1984, Addictive behaviors.

[41]  O. W. Wooley,et al.  Salivation to the Sight and Thought of Food: A New Measure of Appetite* , 1973, Psychosomatic medicine.

[42]  R. Wise,et al.  Brain substrates for reinforcement and drug self-administration. , 1981, Progress in neuro-psychopharmacology.

[43]  A. Dittmar,et al.  Heat loss and anticipatory finger vasoconstriction induced by a smoking of a single cigarette , 1985, Physiology & Behavior.

[44]  A. Wikler,et al.  "Craving" and relapse to drink. , 1974, Quarterly journal of studies on alcohol.

[45]  C. O'brien,et al.  Unreinforced self-injections: effects on rituals and outcome in heroin addicts. , 1979, NIDA research monograph.

[46]  A. Ludwig,et al.  Pavlov's "bells" and alcohol craving. , 1986, Addictive behaviors.

[47]  A. Wikler.  Recent progress in research on the neurophysiologic basis of morphine addiction. , 1948, The American journal of psychiatry.

[48]  M. Jarvik,et al.  Conditioned responses to a videotape showing heroin-related stimuli. , 1980, The International journal of the addictions.

[49]  R. Meyer,et al.  The Heroin Stimulus , 1979, Springer US.

[50]  C. Taylor,et al.  The measurement of opiate dependence. , 1986, British journal of addiction.

[51]  A. Bandura.  Self-efficacy: toward a unifying theory of behavioral change. , 1977, Psychological review.

[52]  R. Hodgson,et al.  Cue exposure: one approach to the extinction of addictive behaviours. , 1977, Advances in experimental medicine and biology.

[53]  R. Kaplan,et al.  Alcohol dependence and responsivity to an ethanol stimulus as predictors of alcohol consumption. , 1983, British journal of addiction.

[54]  W. McAuliffe.  A test of Wikler's theory of relapse: the frequency of relapse due to conditioned withdrawal sickness. , 1982, The International journal of the addictions.

[55]  R. Hinson,et al.  The role of Pavlovian processes in drug tolerance and dependence: implications for treatment. , 1981, Addictive behaviors.

[56]  D. W. Goodwin,et al.  Drug use by U.S. Army enlisted men in Vietnam: a follow-up on their return home. , 1974, American journal of epidemiology.

[57]  A. Wikler.  THE SEARCH FOR THE PSYCHE IN DRUG DEPENDENCE: A 35‐YEAR RETROSPECTIVE SURVEY , 1977, The Journal of nervous and mental disease.

[58]  K. Hugdahl,et al.  An electrodermal measure of arousal in opiate addicts to drug-related stimuli , 1981, Biological Psychology.

[59]  D. Abrams,et al.  Reactivity to smoking cues and relapse: two studies of discriminant validity. , 1988, Behaviour research and therapy.

[60]  S. Goldberg.  Conditioned behavioral and physiological changes associated with injections of a narcotic antagonist in morphine-dependent monkeys , 1976, The Pavlovian journal of biological science.

[61]  O. Pomerleau,et al.  Reactivity to alcohol cues in alcoholics and non-alcoholics: implications for a stimulus control analysis of drinking. , 1983, Addictive behaviors.

[62]  O. Pomerleau,et al.  Reactivity to alcohol-related cues: physiological and subjective responses in alcoholics and nonproblem drinkers. , 1985, Journal of studies on alcohol.

[63]  S. Siegel.  Classical Conditioning, Drug Tolerance, and Drug Dependence , 1983 .

[64]  S. Siegel,et al.  Evidence from rats that morphine tolerance is a learned response. , 1975, Journal of comparative and physiological psychology.

[65]  Kathleen A. O'Connell,et al.  Highly tempting situations associated with abstinence, temporary lapse, and relapse among participants in smoking cessation programs. , 1987 .

[66]  Cognitive changes after alcohol cue exposure. , 1987 .

[67]  T Stockwell,et al.  The concept of craving and its measurement. , 1979, Behaviour research and therapy.

[68]  H. Rankin.  Cue Exposure and Response Prevention in South London , 1982 .

[69]  R. Hodgson,et al.  Alcohol dependence, beliefs and the priming effect. , 1982, Behaviour research and therapy.

[70]  K. Götestam,et al.  Conditioned abstinence in alcoholics: a controlled experiment. , 1984, The International journal of the addictions.

[71]  R. Ehrman,et al.  Extinguishing conditioned responses during opiate dependence treatment turning laboratory findings into clinical procedures. , 1986, Journal of substance abuse treatment.

[72]  A. Wikler.  Opioid Dependence: Mechanisms and Treatment , 1980 .