Measures Of Cue Reactivity Research Articles

Reproducing situationally triggered urgency incontinence in a controlled environment.

Patients with lower urinary tract symptoms often report urgency and incontinence episodes which are triggered by environmental scenarios, for example, "latch-key incontinence." To better understand the extent of this phenomenon, and how best to reduce its impact, we tested ways to recreate these situational cues in a controlled environment and obtain cue reactivity measures. We developed a standardized set of urgency cue scenarios from interviews with sufferers of situational urgency urinary incontinence (UUI), personalized urgency, and safe cue sets consisting of photographs of specific locations, and measurements of cue reactivity during computer-based presentation and urodynamic monitoring. Common urgency and safe cues were identified for the standardized cue set. Exposure to these standardized cues elicited change in bladder sensation in 7 of 12 participants. Participants created personalized cue sets with photographs depicting their own urgency triggering scenarios; exposure to personalized cue photos elicited change in sensation in 11 of 12 participants. In addition, personalized cues elicited measurable detrusor overactivity and leakage during urodynamic monitoring. Safe cues reduced bladder sensation in five participants. We developed a computer-based means of displaying cue photos which elicited cue reactivity from women suffering from situational urgency incontinence. Cue reactivity was increased by personalizing photos of cue scenarios and obtaining physiological measures from urodynamics. We have developed an appropriate way to test cue reactivity in women with situational UUI.

Effects of attentional bias modification therapy on the cue reactivity and cognitive control networks in participants with cocaine use disorders

ABSTRACT Background While attentional bias modification therapy (ABMT) alters drug-related behaviors in some substance users, results have been mixed in individuals with cocaine use disorders (CUD). Objectives The current study examined whether ABMT affected brain functioning during independent measures of cue reactivity (i.e., cocaine versus food cues) and cognitive control (i.e., incongruent versus congruent trials), and whether brain activity was associated with baseline or post-intervention cocaine use. Methods 37 participants (62% male) were randomly assigned to ABMT or control therapy. Clinical and neuroimaging assessments occurred at baseline and immediately post-intervention, with additional clinical testing at 2 weeks and 3 months following intervention. Cocaine use was assessed through self-report. Results Slower reaction times and increased functional activation (prefrontal cortex, posterior parietal cortex) were observed for incongruent versus congruent stimuli and increased functional activation for cocaine relative to food videos (ventral striatum, dorsolateral prefrontal cortex and orbitofrontal cortex). The default-mode network (DMN) was not deactivated during exposure to cocaine videos. The degree of activation during cocaine relative to food cues was associated with baseline cocaine use (insula only) and reduction in use following treatment (insula and anterior DMN) above and beyond clinical variables. Cognitive control network activity was not associated with cocaine use at baseline or following treatment. ABMT therapy did not differentially affect cocaine use or functional activation during either task. Conclusion Current results suggest a relationship between cue reactivity network activation and cocaine use, but question the efficacy of ABMT in changing brain function during cue reactivity or cognitive control tasks.

Cue-elicited craving and human Pavlovian-to-instrumental transfer

Background: Drug cue-reactivity can be measured by the well-established cue-elicited craving model, or by the more recently developed Pavlovian to instrumental transfer (PIT) procedure, which quantifies the impact of drug cues on drug-seeking behaviour. It remains unclear whether these two models produce similar cue reactive effects.Method: To test this, 38 young adult beer drinkers completed an alcohol cue-elicited craving procedure followed by a specific PIT procedure with alcohol cues.Results: There was a significant effect of alcohol cues on craving (p = .007) and on alcohol-seeking behaviour in the PIT procedure (p < .001). Contrary to expectations, these two indices of cue-reactivity were not correlated (r = −.08, p = .66). However, analysis indicated that the alcohol PIT effect was correlated with the self-reported belief that alcohol cues signalled greater effectiveness of the alcohol-seeking response (r = .44, p = .008).Conclusions: These findings suggest that different measures of cue-reactivity might tap into different responses within an individual. Future research is necessary to consider whether this variance is due to which aspect of cue reactivity is being assessed and whether different types of cue-reactivity are differentially influenced by variables such as outcome expectancy.

Complexity of oxytocin׳s effects in a chronic cocaine dependent population

Behavioral and neuroplastic changes occurring in the development of addiction parallel those that occur in social bonding. This has led to speculation that drugs of abuse co-opt systems that subserve social attachment to shift attachment to drugs of abuse. Oxytocin, a neuropeptide that is important in social bonding, has been shown in rodents to decrease psychostimulant self-administration, locomotor activity, and conditioned place preference, it is unclear what role it may play in human drug addiction. In this double-blind, placebo-controlled crossover study, 23 cocaine-dependent inpatients in court-ordered treatment completed 4 task sessions measuring desire to use cocaine, cue-induced craving, monetary reward decisions and social cognition. Before each session, subjects administered 24 IU of intranasal oxytocin or placebo. Oxytocin increased desire to use cocaine and cue-induced excitability with no effect on cue-induced desire to use. Oxytocin also removed the effect of state anger on several measures of cue reactivity. Response to monetary reward increased under oxytocin and measures of social cognition worsened. The significant increase in the desire for drug and monetary reward as well as the significant decrease in measures of social cognition was small but warrant further study of the effect of oxytocin׳s effect in cocaine dependent subjects. The effect of oxytocin to modulate the relationship between state anger and cue reactivity should be explored further for potential therapeutic use of oxytocin in cocaine dependent patients. These findings are discussed in light of the human and rodent oxytocin literature.

Different associations of alcohol cue reactivity with negative alcohol expectancies in mandated and inpatient samples of young adults

Alcohol cue reactivity, operationalized as a classically conditioned response to an alcohol related stimulus, can be assessed by changes in physiological functions such as heart rate variability (HRV), which reflect real time regulation of emotional and cognitive processes. Although ample evidence links drinking histories to cue reactivity, it is unclear whether in-the-moment cue reactivity becomes coupled to a set of consolidated beliefs about the effects of alcohol (i.e., expectancies) and whether treatment helps dissociate the relation of positive versus negative expectancies to cue reactivity. This study examined the relationship between reactivity to alcohol picture cues and alcohol expectancies in two groups of emerging adults: an inpatient sample with alcohol use disorders (n=28) and a college student sample who previously were mandated to a brief intervention for violating university policies about alcohol use in residence halls (n=43). Sequential regression analysis was conducted using several HRV indices and self-report arousal ratings as cue reactivity measures. Results indicated that the relationship between cue reactivity and negative alcohol outcome expectancies differed for the two groups. Greater cue reactivity, assessed using HRV indices, was associated with more negative expectancies in the inpatient sample but with less negative expectancies in the mandated student sample, while an opposite trend was found for subjective arousal. The present findings highlight the importance of characterizing cue reactivity through multi-dimensional assessment modalities that include physiological markers such as HRV.

Individual differences in smoking-related cue reactivity in smokers: An eye-tracking and fMRI study

Measures of cue reactivity provide a means of studying and understanding addictive behavior. We wanted to examine the relationship between different cue reactivity measures, such as attentional bias and subjective craving, and functional brain responses toward smoking-related cues in smokers. We used eye-tracking measurements, a questionnaire for smoking urges-brief and functional magnetic resonance imaging to assess the responses to smoking-related and neutral visual cues from 25 male smokers after 36 h of smoking abstinence. Regression analyses were conducted to determine the correlation between cue-evoked brain responses and the attentional bias to smoking-related cues. The eye gaze dwell time percentage was longer in response to smoking-related cues than neutral cues, indicating significant differences in attentional bias towards smoking-related cues. The attentional bias to smoking-related cues correlated with subjective craving ratings (r=0.660, p<0.001). The dorsolateral prefrontal cortex, the putamen, the posterior cingulate cortex and the primary motor cortex were associated with the attentional bias to smoking-related cues, whereas the orbitofrontal cortex, the insula and the superior temporal gyrus were associated with smoking-related cue-induced craving and smoking urges. These results suggest that attentional mechanisms in combination with motivational and reward-related mechanisms play a role in smoking-related cue reactivity. We confirmed a positive correlation between different smoking-related cue reactivities, such as attentional bias and subjective craving, and functional brain responses in various individuals. Further studies in this field might contribute to a better individualized understanding of addictive behavior.

Feasibility of Using Virtual Reality to Assess Nicotine Cue Reactivity During Treatment.

Cue reactivity assessments have been widely used to assess craving and attention to cues among cigarette smokers. Cue reactivity has the potential to offer insights into treatment decisions; however, the use of cue reactivity in treatment studies has been limited. This study assessed the feasibility of using a virtual reality-based cue reactivity assessment approach (VR-NCRAS) during treatment. In a clinical smoking cessation treatment study, 46 treatment-seeking nicotine-dependent adult smokers were assessed for cue reactivity at baseline, Week 4, and Week 10 of treatment. Measures of cue reactivity included subjective craving and attention to cues after exposure to two neutral and two smoking cue environments. Overall, feasibility of using VR-NCRAS was demonstrated and these findings support the use of the cue reactivity assessment during treatment, which can inform treatment decisions.

An Acute Psychosocial Stressor Does Not Potentiate Alcohol Cue Reactivity in Non-Treatment-Seeking Alcoholics

Relapse risk factors, such as psychological stress and alcohol cues, are often encountered together. Understanding how they interact has the potential to improve alcoholism treatments. This study was conducted to examine whether an acute psychosocial stressor enhanced alcohol cue reactivity in non-treatment-seeking alcoholics. Seventy-nine alcohol-dependent individuals (39 women) randomly received either the Trier Social Stress Test or a no-stress control condition. Stress reactivity was measured with serum adrenocorticotropic hormone and cortisol, mean arterial blood pressure, and subjective distress. Immediately following the stress manipulation, participants held and sniffed a neutral cue then their preferred alcoholic beverage. Cue reactivity was measured by 2 subjective measures of craving following each cue. Additionally, general craving was assessed with the Alcohol Urge Questionnaire at the beginning and end of the laboratory procedure. The stress manipulation showed internal validity on all measures of stress reactivity. There was not a main effect of stress nor a stress × cue interaction on either cue reactivity measure. As expected, there was a main effect of cue (alcohol > neutral cue) on both measures of cue reactivity. General craving increased during the challenge, but not differently by stress group. Magnitude of stress reactivity was not associated with magnitude of cue reactivity, and all results were independent of gender. In this well-controlled clinical laboratory study of non-treatment-seeking alcoholics, an acute psychological stressor did not make an alcohol cue a more potent urge-inducing stimulus, and stress had no effect on general alcohol craving.

Neurofeedback Effects on Evoked and Induced EEG Gamma Band Reactivity to Drug-related Cues in Cocaine Addiction.

INTRODUCTION: Preoccupation with drug and drug-related items is a typical characteristic of cocaine addicted individuals. It has been shown in multiple accounts that prolonged drug use has a profound effect on the EEG recordings of drug addicts when compared to controls during cue reactivity tests. Cue reactivity refers to a phenomenon in which individuals with a history of drug abuse exhibit excessive psychophysiological responses to cues associated with their drug of choice. One of the aims of this pilot study was to determine the presence of an attentional bias to preferentially process drug-related cues using evoked and induced gamma reactivity measures in cocaine addicts before and after biobehavioral treatment based on neurofeedback. Another aim was to show that central SMR amplitude increase and frontal theta control is possible in an experimental outpatient drug users group over 12 neurofeedback sessions. METHOD: Ten current cocaine abusers participated in this pilot research study using neurofeedback combined with Motivational Interviewing sessions. Eight of them completed all planned pre- and post -neurofeedback cue reactivity tests with event-related EEG recording and clinical evaluations. Cue reactivity test represented a visual oddball task with images from the International Affective Picture System and drug-related pictures. Evoked and induced gamma responses to target and non-target drug cues were analyzed using wavelet analysis. RESULTS: Outpatient subjects with cocaine addiction completed the biobehavioral intervention and successfully increased SMR while keeping theta practically unchanged in 12 sessions of neurofeedback training. The addition of Motivational Interviewing helped retain patients in the study. Clinical evaluations immediately after completion of the treatment showed decreased self-reports on depression and stress scores, and urine tests collaborated reports of decreased use of cocaine and marijuana. Effects of neurofeedback resulted in a lower EEG gamma reactivity to drug-related images in a post-neurofeedback cue reactivity test. In particular, evoked gamma showed decreases in power to non-target and to a lesser extent target drug-related cues at all topographies (left, right, frontal, parietal, medial, inferior); while induced gamma power decreased globally to both target and non-target drug cues. Our findings supported our hypothesis that gamma band cue reactivity measures are sufficiently sensitive functional outcomes of neurofeedback treatment. Both evoked and induced gamma measures were found capable to detect changes in responsiveness to both target and non-target drug cues. CONCLUSION: Our study emphasizes the utility of cognitive neuroscience methods based on EEG gamma band measures for the assessment of the functional outcomes of neurofeedback-based biobehavioral interventions for cocaine use disorders. This approach may have significant potential for identifying both physiological and clinical markers of treatment progress. The results confirmed our prediction that EEG changes achieved with neurofeedback training will be accompanied by positive EEG outcomes in a cue reactivity and clinical improvements.

Effect of the threat of a disulfiram–ethanol reaction on cue reactivity in alcoholics

Rationale Little is known about the effect of disulfiram on subjective and autonomic nervous system cue reactivity in the laboratory. The dissuasive psychological effect manifested as a threat would seem to prevail over the pharmacological effect. Objectives The primary objective was to determine whether there was a difference in cue reactivity responses during a threat condition compared to a neutral condition during alcohol cue exposure. Methods In a crossover randomized study, participants received threat and neutral messages during two cue exposure sessions. The threat condition consisted of leading the patients to believe they had ingested 500 mg of disulfiram and the neutral condition of informing them that they had ingested a placebo, while in both condition they received the same placebo. Results Physiological cue reactivity was demonstrated by a decrease in diastolic blood pressure during the threat compared to the neutral condition ( p = 0.04). Heart rate and subjective cue reactivity measures remained unchanged. There was a negative affect (assessed by the Positive and Negative Affect Scale) by condition by exposure interaction. Conclusions The threat of a disulfiram–ethanol reaction appears to affect cue reactivity physiologically rather than subjectively. While the data does not show changes in subjective ratings, it is possible that there are alternative beneficial effects arising from other cognitive processes that are not captivated by self-reported craving scales, reflected by decreases in negative affect and blood pressure. From this perspective, disulfiram might be recast to be more acceptable to patients.

Laboratory-based, cue-elicited craving and cue reactivity as predictors of naturally occurring smoking behavior

Cigarette craving, one hallmark sign of nicotine dependence, is often measured in laboratory settings using cue reactivity methods. How lab measures of cue reactivity relate to real world smoking behavior is unclear, particularly among non-treatment seeking smokers. Within a larger study of hormonal effects on cue reactivity ( N = 78), we examined the predictive relationship of cue reactivity to smoking, each measured in several ways. Results indicated that cue-evoked craving in response to stressful imagery, and to a lesser extent, in vivo smoking cues, significantly predicted smoking behavior during the week following testing. However, this predictive relationship was absent upon controlling for reactivity to neutral cues. Nicotine dependence may moderate the relationship between cue reactivity and actual smoking, such that this predictive relationship is less robust among highly dependent smokers than among smokers low in nicotine dependence. The question of whether cue-elicited craving predicts smoking among smokers not in treatment is best answered with a qualified yes, depending on how craving is manipulated and measured. Our findings highlight important methodological and theoretical considerations for cue reactivity research.

Individual differences in food-cue reactivity. The role of BMI and everyday portion-size selections

This study sought to explore the association between sensitivity to food cues (sight and smell of food) and (i) body weight (overweight or non-overweight), (ii) typical everyday portion sizes, and (iii) the DEBQ-restraint scale. One hundred and twenty female participants (aged between 18 and 30) were exposed to the sight and smell of pizza for three minutes. Both before and after this period, three measures of food-cue reactivity were taken (ratings of desire to eat, craving, and a measure of desired portion size of the cued food). Separate regression analyses were used to explore the associations between the change in measures of cue reactivity from pre- to post-cue exposure, and (i) an overweight/non-overweight classification, (ii) a measure of participants everyday portion-size selection, and (iii) scores on the DEBQ-restraint scale. This analysis revealed that scores on the DEBQ-restraint scale were not significantly associated with changes in food-cue reactivity. However, individuals identified as overweight, and participants who reported consuming the largest everyday portion sizes, experienced a significantly greater change in their desired portion size of the cued food. The findings suggest that heightened food-cue reactivity might present an under-explored risk factor for overeating, and becoming overweight, and/or maintaining an overweight body shape.

Effect of impulsivity on cardiovascular and subjective reactivity to smoking cues

Individuals with high levels of impulsivity are more likely to smoke and may have greater difficulty quitting than other smokers. Although the specific mechanisms mediating this relationship are not explicitly known, one candidate is disproportionate cigarette craving in response to environmental smoking cues. We assessed the effect of impulsivity on three measures of cue reactivity. Regular smokers ( n = 75) were exposed to a smoking cue and a neutral cue in 2 counterbalanced experimental sessions. Cigarette craving, heart rate (HR), and mean arterial pressure (MAP) were used to index cue reactivity. More impulsive smokers exhibited a disproportionate response to the smoking cue in terms of MAP ( p = .009) but not HR or craving. Impulsive smokers may experience disproportionate cigarette craving in response to environmental smoking cues that are not reflected in self-report measures due to a relative lack of conscious awareness of the urge to smoke.

Gender specific effects of a mild stressor on alcohol cue reactivity in heavy social drinkers

Rationale Stress plays an important role in the development and maintenance of alcohol-abuse. Some of the effects of stress on alcohol-related behaviours, however, appear to be gender-dependent. Aim The present study set out to examine the effects of stress on feelings of desire for alcohol, skin conductance response and alcohol consumption in the presence of alcohol-related cues in relation to gender. Participants were heavy non-dependent alcohol drinkers. Methods Thirty-two (16 males) participants drinking more than 21 units of alcohol per week were randomly allocated to undergo the experimental stress (based on the ‘Trier Social Stress’ Test) or the non-stress procedure before the alcohol cue exposure procedure, during which participants handled and smelled their preferred drink. Mood and saliva cortisol level changes were used as indices of the stress effects, while alcohol craving, skin conductance and alcohol consumption were the cue reactivity measures. Results Self ratings of anxiety and tension increased and cortisol levels remained high in the stress compared to the non-stress condition; no gender differences were found. Stress induced gender-specific effects with regard to skin conductance response and alcohol consumption measurements. Stressed females did not show an increase from baseline in the skin conductance response during the alcohol cue-exposure session, which was observed in the non-stressed females; they also consumed less alcohol than males under stress. Conclusion Female participants respond less to alcohol-related cues when in a negative mood state. Such a finding suggests that females when in a negative mood may be less sensitive to positive incentive processes mediating cue reactivity compared to males.

Measuring Craving: An Attempt to Connect Subjective Craving with Cue Reactivity

Better insight into craving may contribute to the development of more efficient relapse prevention strategies. Inconsistent findings on the relation between craving and relapse may be due to difficulties in the measurement of craving. These difficulties are accounted for by 3 interrelated problems: lack of consensus regarding the definition of craving, the use of different time frames (craving now vs craving in the past), and lack of concordance between self-reported craving and psychophysiological measures of cue reactivity. The aim of this study is to develop and validate a new self-report questionnaire for the assessment of the core aspects of craving, taking into account different time frames and emphasizing the psychophysiological aspects of craving. It is hypothesized that this questionnaire will show higher concordance with measures of cue reactivity than existing self-report craving questionnaires. Based on a semantic mapping sentence, a 24-item self-report questionnaire was developed: the Jellinek Alcohol Craving Questionnaire (JACQ). The questionnaire was tested in 2 samples of treatment-seeking alcohol-dependent patients (sample A, n = 251; sample B, n = 48). Psychometric properties were examined in sample A and cross-validated in sample B. The associations with psychophysiological and neuroendocrine measures of cue reactivity were studied in sample B. The JACQ consists of 1 dimension with the following 4 aspects: (1) emotional urge, (2) physical sensations, (3) temptation to drink, and (4) uncontrolled thoughts. All (sub)scales had a good internal consistency (alpha = 0.77-0.95) and were highly intercorrelated (r = 0.57-0.86). Craving-past correlated low with craving-now (r = 0.32). Craving-now (sub)scales showed a moderate association with heart rate (0.46-0.49), but not with respiration rate, skin conductance, or cortisol production in saliva following cue exposure. In contrast, craving-past (sub)scales showed a moderate association with cortisol production in saliva (0.15-0.42) following cue exposure. Remarkably, the physical symptoms scale did not show stronger association with psychophysiological and neuroendocrine measures than the other subscales. The JACQ reliably measures 1 dimension including 4 aspects of craving for distinct time frames. Despite the presence of a special subscale for physical sensations, only moderate relationships were found between self-reported craving and biological indicators of cue reactivity. These findings suggest individual differences between alcoholics in the detection and/or reporting of cue-related psychophysiological signs as indicators of cue reactivity. Further research should focus on the nature of these individual differences. In addition, more research is needed on the relative predictive validity of subjective phenotypic indicators of craving (such as self-reported craving) versus objective endophenotypic indicators of craving (such as physiological measures of cue reactivity) for example in the prediction of relapse.

Subjective and physiological responses to smoking cues in smokers with schizophrenia

The prevalence of smoking is high among people with schizophrenia. Although several research groups are developing smoking treatments for these smokers, abstinence rates to date have been modest. Methodological tools such as cue exposure are useful in clinical research with smokers in general, but the value of these paradigms with smokers with schizophrenia has yet to be established. The aim of the present study was to determine the subjective and physiological effects of exposure to in vivo smoking cues in smokers with schizophrenia. A total of 25 heavy smokers with schizophrenia or schizoaffective disorder were assessed while nonabstinent and after 2-hr smoking abstinence. Urge to smoke, mood, nicotine withdrawal symptoms, heart rate, and blood pressure were measured during a precue relaxation period, after exposure to neutral cues, and after exposure to smoking cues. Results indicate that both exposure to smoking cues and brief abstinence increased urge levels, nicotine withdrawal symptom levels, and negative affect. Abstinence did not amplify the effects of cues on urges or other cue reactivity measures. These results indicate that smoking cue reactivity laboratory models may be useful for investigating potential smoking treatments for, or neurobiological contributions to, smoking behavior in smokers with schizophrenia.

Sensory evaluation of alcohol-related and neutral stimuli: Psychophysical assessment of stimulus intensity

Research on reactivity to alcohol cues yielded conflicting results. While some authors report differences in subjective or physiological responses to drug-related stimuli between addicts and healthy controls, other researchers found no group differences in response patterns. Moreover, a dissociation of self-report and psychophysiological measures of cue reactivity is often observed. To some extent, this might be due to confounding stimulus type (neutral vs. drug-related) and stimulus intensity in cue reactivity research. The purpose of the present study is to match alcoholic and nonalcoholic stimuli according to their empirically assessed intensity. Stimulus intensity is estimated by magnitude estimation. Results clearly indicate that alcohol-related cues differ considerably from water and other neutral stimuli with respect to perceived intensity. Moreover, estimation of stimulus intensity depends on mode of presentation (smell vs. combined smell and taste). Results of previous cue reactivity studies in the alcohol field might have been affected in different degrees by confounding stimulus type and intensity.

Abstention during cue reactivity assessment is associated with better outcome among women with bulimia nervosa

Objective: To compare women with bulimia nervosa who abstained from eating during pretreatment cue reactivity assessment with those who ate. Method: 135 participants in a randomized clinical trial completed an assessment of cue reactivity to individualized high-risk binge foods prior to treatment. A broad range of physiological, self-report, and behavioral measures of cue reactivity was assessed. Primary, secondary, and tertiary outcome measures of eating disorder symptomatology were evaluated at pretreatment, midtreatment, posttreatment, and 6-month follow-up. Results: As expected, women who abstained from eating during pretreatment cue reactivity assessment exhibited less cue reactivity than women who ate. This was especially evident for self-report measures of cue reactivity. Surprisingly, women who abstained from eating during pretreatment cue reactivity assessment also had significantly less eating disorder symptomatology at 6-month follow-up. Discussion: Possible psychological mechanisms contributing to the superior outcome of women who abstained from eating during the cue reactivity assessment and implications for the assessment of cue reactivity are discussed.

The role of cognitive factors in cue reactivity: extinction on demand

Cue reactivity measures have become common in addictions research for their apparent objectivity. We used an analog paradigm to examine whether such measures are subject to impression management. Students with conditioned reactions of salivation to the sight and smell of a lemon were assigned to a control group, an experimental group asked to reduce salivation, or an experimental group asked to reduce salivation and promised a reward if successful. Both experimental groups reduced salivation more than the control group; the group rewarded for reduction reduced salivation more than the group that was only asked to do so. This suggests that cue reactivity measures can be manipulated by research participants or clients in treatment. Suggestions for research and implications for treatment are addressed.

A conditioning reinterpretation of cognitive events in alcohol and drug cue exposure

Cue exposure treatments of alcohol and substance abuse disorders are based on a classical conditioning model of drug use and relapse. Recently, social learning theory has been utilized to explain the relationship of cognitive constructs (i.e., self-efficacy, outcome expectations) to measures of cue reactivity. However, social learning theory has not provided clear and testable mechanisms by which cognitions influence behavior. This paper proposes a mechanism, based on principles of classical conditioning, whereby cognitions may influence reactivity to alcohol and drug cues. This view of cognitions within a conditioning framework has several important implications for cue exposure research and treatment.