Cue Exposure Therapy for the Treatment of Opiate Addiction: Results of a Randomized Controlled Clinical Trial

Background: Persistent cue reactivity to drug-related stimuli is a well-known phenomenon among abstinent drug users and has been found to be a predictor of relapse. Cue exposure therapy (CET) aims to reduce this cue reactivity by exposing abstinent drug users to conditioned drug-related stimuli while preventing their habitual response, i.e. drug use. Methods: 127 abstinent heroin-dependent Dutch inpatients were randomized to CET (n = 65; 55 completers) and placebo psychotherapy treatment (PPT) (n = 62; 59 completers). It was examined whether CET would lead to a decrease in drug-related cue reactivity (using mixed-design ANOVA) and subsequently to lower dropout and relapse rates (using logistic regression) compared to PPT. Results: Both groups responded with a similar decrease in self-reported cue reactivity (craving, mood). The CET group did show a significant decrease in physiological reactivity (skin conductance) compared to PPT. However, dropout and relapse rates were, contrary to our expectations, significantly higher in the CET group. Conclusions: This is the first randomized controlled trial showing that CET, compared to a non-specific psychotherapy, might increase dropout and relapse rates among abstinent heroin-dependent clients in a drug-free setting. Caution is warranted when applying CET in this specific context.

[1]  A T McLellan,et al.  An Improved Diagnostic Evaluation Instrument for Substance Abuse Patients: The Addiction Severity Index , 1980, The Journal of nervous and mental disease.

[2]  W. van den Brink,et al.  Cue exposure therapy for opiate dependent clients , 2005 .

[3]  D. Hommer,et al.  Functional Imaging of Craving , 1999, Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism.

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

[5]  K. Brown,et al.  Cue-exposure to alcohol-associated stimuli reduces autonomic reactivity, but not craving and anxiety, in dependent drinkers. , 1995, Alcohol and alcoholism.

[6]  P. Willner,et al.  A comparison of two alcohol craving questionnaires. , 1998, Addiction.

[7]  Wim van den Brink,et al.  Initial validation of two opiate craving questionnaires the obsessive compulsive drug use scale and the desires for drug questionnaire. , 2002, Addictive behaviors.

[8]  K. Hugdahl.  Psychophysiology: The Mind-Body Perspective , 1996 .

[9]  S. Glautier,et al.  A controlled trial of cue exposure treatment in alcohol dependence. , 1994, Journal of consulting and clinical psychology.

[10]  I. Franken,et al.  Cue reactivity and effects of cue exposure in abstinent posttreatment drug users. , 1999, Journal of substance abuse treatment.

[11]  J. Gray,et al.  Does post-withdrawal cue exposure improve outcome in opiate addiction? A controlled trial. , 1993, Addiction.

[12]  D J Rohsenow,et al.  Naltrexone and cue exposure with coping and communication skills training for alcoholics: treatment process and 1-year outcomes. , 2001, Alcoholism, clinical and experimental research.

[13]  I. Marks,et al.  Alternatives to Debriefing and Modifications to Cognitive Behavior Therapy for Posttraumatic Stress Disorder , 2005, Psychotherapy and Psychosomatics.

[14]  D J Rohsenow,et al.  Cue exposure with coping skills training and communication skills training for alcohol dependence: 6- and 12-month outcomes. , 2001, Addiction.

[15]  G A Marlatt,et al.  Cue exposure and relapse prevention in the treatment of addictive behaviors. , 1990, Addictive behaviors.

[16]  I Marks,et al.  Drugs and Psychological Treatments for Agoraphobia/Panic and Obsessive–Compulsive Disorders: A Review , 1988, British Journal of Psychiatry.

[17]  D. Drummond,et al.  What does cue-reactivity have to offer clinical research? , 2000, Addiction.

[18]  P. Schnabel,et al.  Drop-out in de verslavingszorg : literatuurstudie over de periode 1990-1996 , 1998 .

[19]  K. Berridge,et al.  The neural basis of drug craving: An incentive-sensitization theory of addiction , 1993, Brain Research Reviews.

[20]  G. Marlatt,et al.  Addictive behaviour: Cue exposure theory and practice. , 1995 .

[21]  M F Kuntze,et al.  Immersive Virtual Environments in Cue Exposure , 2001, Cyberpsychology Behav. Soc. Netw..

[22]  D J Rohsenow,et al.  Cue exposure with coping skills treatment for male alcoholics: a preliminary investigation. , 1993, Journal of consulting and clinical psychology.

[23]  T. P. de Barros‐Neto,et al.  Self-exposure therapy for panic disorder with agoraphobia: randomised controlled study of external v. interoceptive self-exposure. , 2001, The British journal of psychiatry : the journal of mental science.

[24]  M. Gossop,et al.  Lapse, Relapse and Survival among Opiate Addicts after Treatment , 1989, British Journal of Psychiatry.

[25]  S. Tiffany,et al.  Applying extinction research and theory to cue-exposure addiction treatments. , 2002, Addiction.

[26]  J. van Limbeek,et al.  The Addiction Severity Index: reliability and validity in a Dutch addict population. , 1989, Journal of substance abuse treatment.

[27]  David W. Hosmer,et al.  Best subsets logistic regression , 1989 .

[28]  D J Rohsenow,et al.  Cue reactivity as a predictor of drinking among male alcoholics. , 1994, Journal of consulting and clinical psychology.

[29]  M. Breteler,et al.  The validity of the Self-Efficacy List for Drug Users (SELD). , 2000, Addictive behaviors.

[30]  J. Marsden,et al.  Change and stability of change after treatment of drug misuse: 2-year outcomes from the National Treatment Outcome Research Study (UK). , 2002, Addictive behaviors.

[31]  L. Bennett.  Research Advances in Alcohol and Drug Problems , 1986 .

[32]  I. Marks.  Behavioural and drug treatments of phobic and obsessive-compulsive disorders. , 1986, Psychotherapy and psychosomatics.

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

[34]  D. Abrams,et al.  Cue exposure treatment for smoking relapse prevention: a controlled clinical trial. , 1999, Addiction.

[35]  David W. Hosmer,et al.  Applied Logistic Regression , 1991 .