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

Psychopharmacology, Aug 2015

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.

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

Cue reactivity and its relation to craving and relapse in alcohol dependence: a combined laboratory and field study Jurriaan Witteman 0 1 2 3 4 5 Hans Post 0 1 2 3 4 5 Mika Tarvainen 0 1 2 3 4 5 Avalon de Bruijn 0 1 2 3 4 5 Elizabeth De Sousa Fernandes Perna 0 1 2 3 4 5 Johannes G. Ramaekers 0 1 2 3 4 5 Reinout W. Wiers 0 1 2 3 4 5 0 University of Eastern Finland , Kuopio , Finland 1 VICTAS Addiction centre , Utrecht , The Netherlands 2 Faculty of Humanities, Leiden University Center for Linguistics, Leiden Institute for Brain and Cognition, Leiden University , Leiden , The Netherlands 3 University of Amsterdam , Amsterdam , The Netherlands 4 Maastricht University , Maastricht , The Netherlands 5 Dutch Institute for Alcohol Policy , Utrecht , The Netherlands 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. Addiction; Alcohol; Cue reactivity; Relapse - 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). Insight into what factors promote relapse could provide a starting point for developing treatments that reduce relapse. The present study aimed to test the influence of one such factor, exposure to alcohol-related cues, by measuring the physiological and craving response to alcohol cues in the laboratory and the influence of naturally occurring alcohol cues (i.e., alcohol advertisement) in the daily environment of alcohol-dependent patients on relapse. A large evidence base suggests that an exaggerated central nervous system response to alcohol-related cues is a key phenomenon in alcohol dependence (Bechara 2005; Koob and Volkow 2009; Wiers et al. 2007). A prominent hypothesis about the mechanism behind reward circuitry hyperactivity for alcohol-related cues in alcohol dependence is the ‘incentive salience’ hypothesis (Robinson and Berridge 2008), which proposes that initially neutral cues (such as the sight of a beer bottle) by repeated pairing with the direct pharmacological effect of alcohol on the reward circuitry gain ‘incentive salience’ through classical conditioning and can ultimately also 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), ultimately promoting relapse (Niaura et al. 1988; Volkow et al. 2010). Indeed, recent meta-analyses of the neuroimaging literature of alcohol cue exposure have indicated that in alcohol dependence, there is hyperactivity of the reward system for alcoholrelated cues as compared to controls (Kühn 2011; Schacht et al. 2013). Further, studies have confirmed a relationship between the magnitude of physiological reactivity to alcohol cues during treatment and subsequent probability of relapse after discharge (Rohsenow et al. 1994; Grüsser et al. 2004; Beck et al. 2012; Garland et al. 2012; but see Heinz et al. 2007). For baseline cue-elicited craving during treatment however, results have been mixed with two studies showing a relationship between the magnitude of the craving response during treatment and subsequent relapse (Cooney et al. 1997; Papachristou et al. 2014) while another study (Rohsenow et al. 1994) did not find such a relationship. Interestingly, Rohsenow et al. (1994) measured both craving and physiological (salivation) response to alcohol cues, allowing for a direct comparison of predictive validity and found that physiological cue reactivity did but craving did not predict future drinking behaviour. This apparent differential predictive value of physiological responses to alcohol (...truncated)


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Jurriaan Witteman, Hans Post, Mika Tarvainen, Avalon de Bruijn, Elizabeth De Sousa Fernandes Perna, Johannes G. Ramaekers, Reinout W. Wiers. Cue reactivity and its relation to craving and relapse in alcohol dependence: a combined laboratory and field study, Psychopharmacology, 2015, pp. 3685-3696, Volume 232, Issue 20, DOI: 10.1007/s00213-015-4027-6