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
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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)