Cue reactivity and its relation to craving and relapse in alcohol dependence: a combined laboratory and field study.

Jurriaan Witteman,Elizabeth De Sousa Fernandes Perna,Johannes G Ramaekers,Avalon De Bruijn,Mika Tarvainen,Reinout W Wiers,Hans Post

doi:10.1007/s00213-015-4027-6

Abstract

The present study investigated the nature of physiological cue reactivity and craving in response to alcohol cues among alcohol-dependent patients (N = 80) who were enrolled in detoxification treatment. Further, the predictive value with regard to future drinking of both the magnitude of the physiological and craving response to alcohol cues while in treatment and the degree of alcohol-cue exposure in patients’ natural environment was assessed. Physiological reactivity and craving in response to experimental exposure to alcohol and soft drink advertisements were measured during detoxification treatment using heart rate variability and subjective rating of craving. Following discharge, patients monitored exposure to alcohol advertisements for five consecutive weeks with a diary and were followed up with an assessment of relapse at 5 weeks and 3 months post-discharge. The results indicated that the presence of alcohol cues such as the portrayal of the drug and drinking behaviour induced physiological cue reactivity and craving. Additionally, cue reactivity and craving were positively correlated, and cue reactivity was larger for patients with shorter histories of alcohol dependence. Further, patients reported a substantial daily exposure to alcohol cues. The magnitude of cue reactivity and the craving response to alcohol cues at baseline and degree of exposure to alcohol cues in patients’ natural environment did not predict relapse. It is concluded that the presence of alcohol cues such as portrayal of alcoholic beverages and drinking behaviour induces cue reactivity and craving in alcohol dependence through a conditioned appetitive response.

Highlights

Alcohol dependence can be regarded as a chronic condition (Koob and Volkow 2009), characterized by high rates of relapse into problematic drinking soon after initial successful treatment (Witkiewitz and Marlat 2007)
Baseline session heart rate variability (HRV) measurements for alcohol and soft drink advertisement were available for 67 patients
For the event-related heart variability’ (EVHRV) HF power analysis, we first performed a RM-ANOVA with ads and condition as the two within-subject factors and, counterbalancing order as the between subject variable and HF spectral power for the five combined 8-s segments as the dependent, which revealed the critical significant ads × condition interaction (F(1,65)= 13.41, p=0.001) and an ads × order interaction (F(1,65)= 8.92, p=0.004)

Summary

Introduction

Alcohol dependence can be regarded as a chronic condition (Koob and Volkow 2009), characterized by high rates of relapse into problematic drinking soon after initial successful treatment (Witkiewitz and Marlat 2007). ‘incentive salience’ through classical conditioning and can evoke a response of the reward circuitry in the absence of the direct pharmacological effect. The magnitude of this conditioned reward circuitry response has subsequently been hypothesized to be associated with craving (Lit and Cooney 1999; Volkow et al 2012), promoting relapse (Niaura et al 1988; Volkow et al 2010)

Methods

Results

Discussion

Conclusion