Meta‐analysis of cue‐reactivity in addiction research
Abstract
Aims. The cue‐reactivity procedure exposes addicts to a variety of drug‐related stimuli while self‐report of craving and physiological responses are monitored. The present review sought to determine the magnitude and overall pattern of responses typically found in cue‐reactivity research and which, if any, learning‐based model of cue reactivity is best supported by the findings. Design. Meta‐analytical techniques were used to select and evaluate results from 41 cue‐reactivity studies that compared responses of alcoholics, cigarette smokers, cocaine addicts or heroin addicts to drug‐related versus neutral stimuli. Effect sizes were calculated, separately by addict type, for self‐report of craving and physiological responses (heart rate, sweat gland activity and skin temperature). Findings. Across all addict groups, the effect size for craving was +0.92. Alcoholics had a significantly smaller craving effect size (+0.53) compared to other addict groups (+1.18 to +1.29). Relatively smaller effect sizes were found for physiological responses. The general profile of effect sizes across all addict groups was increased heart rate (+0.26) and sweat gland activity (+0.40) and decreased skin temperature (‐0.24) when addicts were presented with drug‐related stimuli. Conclusions. The cuereactivity paradigm can produce a stable profile of significant effects and, therefore, has a number of potential applications for investigating addictive phenomena. The implications of these findings for conditioning‐based models of cue‐reactivity phenomena are discussed.
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Cognitive behaviour therapy is a structured, time-limited, evidence-based psychological therapy for a wide range of emotional and behavioural disorders, including addictive behaviours.
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The targeted effect size was chosen based on findings from studies employing CIC paradigms for drug craving, food cravings, and internet gaming craving, which report medium-to-large effect sizes in cue reactivity.
“The targeted-effect size was chosen based on findings from studies employing CIC paradigms for drug craving52, food cravings25,37,53,54 and internet gaming craving27, which report medium-to-large effect sizes in cue reactivity52.”
From Acute social isolation evokes midbrain craving responses similar to hunger (2020) · cites this paper as [52]
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BackgroundThe Role of Nicotine in Smoking: A Dual-Reinforcement Model
Caggiula, A. R., Donny, E. C., Palmatier, M. I., Liu, X., Chaudhri, N., & Sved, A. F. (2008) · Nebraska Symposium on Motivation · doi:10.1007/978-0-387-78748-0_6 · Cited by 226 · see citing works
“Thus, proximal stimuli normally associated with smoking, such as a lit cigarette, can induce reports of craving in smokers but not in non-smokers (Carter & Tiffany, 1999).”
BackgroundBoileau, I., Dagher, A., Leyton, M., Welfeld, K., Booij, L., Diksic, M., & Benkelfat, C. (2007) · The Journal of Neuroscience · doi:10.1523/jneurosci.4370-06.2007 · Cited by 222 · see citing works
“, a syringe or a pill), is believed to increase the likelihood of relapse by eliciting drug-similar effects, craving, and drug-seeking behavior (Childress et al., 1988; Carter and Tiffany, 1999; Weiss, 2005).”
BackgroundGarland, E. L., Froeliger, B., & Howard, M. O. (2014) · Psychopharmacology · doi:10.1007/s00213-014-3504-7 · Cited by 216 · see citing works
“Further, our findings accord with a meta-analysis of cue-reactivity in addiction research conducted by Carter and Tiffany (1999) which showed that physiological and subjective cue responses were largely uncorrelated.”
ResultHester, R., Dixon, V., & Garavan, H. (2005) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2005.07.002 · Cited by 215 · see citing works
“While studies with active cocaine users have indicated a strong physical reaction to drug-related stimuli (Carter and Tiffany, 1999; Childress et al., 1993; Robbins et al., 2000), including activity in the limbic-based neural reward network that responds to the drug itself (Grant et al., 1996;…”
BackgroundResultHazardous drinking and alcohol use disorders
MacKillop, J. M., Agabio, R., Ewing, S. W. F., Heilig, M. A., Kelly, J. F., Leggio, L., Lingford-Hughes, A. R., Palmer, A. A., Parry, C. D. H., Ray, L. A., et al. (2022) · Nature Reviews Disease Primers · doi:10.1038/s41572-022-00406-1 · Cited by 235 · see citing works
Virtual Reality (VR) in Assessment and Treatment of Addictive Disorders: A Systematic Review
Segawa, T., Baudry, T., Bourla, A., Blanc, J.-V., Peretti, C.-S., Mouchabac, S., & Ferreri, F. (2020) · Frontiers in Neuroscience · doi:10.3389/fnins.2019.01409 · Cited by 212 · see citing works
“13:1409. doi: 10.3389/fnins.2019.01409 Virtual Reality (VR) in Assessment and Treatment of Addictive Disorders: A Systematic Review Tomoyuki Segawa 1†, Thomas Baudry 1†, Alexis Bourla 1,2*, Jean-Victor Blanc 1, Charles-Siegfried Peretti 1, Stephane Mouchabac 1 and Florian Ferreri 1 1Department of Psychiatry, Hôpital S…”
BackgroundInfluentialMcClernon, F. J., Kozink, R. V., & Rose, J. E. (2008) · Neuropsychopharmacology · doi:10.1038/sj.npp.1301618 · Cited by 202 · see citing works
Heinz, A., Löber, S., Georgi, A., Wrase, J., Hermann, D., Rey, E.-R., Wellek, S., & Mann, K. (2003) · Alcohol and Alcoholism · doi:10.1093/alcalc/agg005 · Cited by 206 · see citing works
“Craving for alcohol can be elicited by exposure to alcohol and alcohol-associated stimuli in abstinent alcoholics (Niaura et al., 1988; O’Brien et al., 1998; Carter and Tiffany, 1999).”
BackgroundFunctional brain imaging of tobacco use and dependence
BRODY, A. (2006) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2005.04.012 · Cited by 207 · see citing works
“Cigarette-related cues have been shown to reliably enhance craving during this period, when compared to neutral cues (Carter and Tiffany, 1999).”
BackgroundDrug Addiction, Relapse, and the Amygdala
See, R. E., Fuchs, R. A., Ledford, C. C., & McLaughlin, J. (2003) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.2003.tb07089.x · Cited by 212 · see citing works
Cue-Provoked Craving and Nicotine Replacement Therapy in Smoking Cessation.
Waters, A. J., Shiffman, S. S., Sayette, M. A., Paty, J. A., Gwaltney, C. J., & Balabanis, M. H. (2004) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.72.6.1136 · Cited by 201 · see citing works
Effects of cue-exposure treatment on neural cue reactivity in alcohol dependence: a randomized trial
Vollstädt-Klein, S., Loeber, S., Kirsch, M., Bach, P., Richter, A., Bühler, M., von der Goltz, C., Hermann, D., Mann, K., & Kiefer, F. (2011) · Biological Psychiatry · doi:10.1016/j.biopsych.2010.12.016 · Cited by 202 · see citing works
Brand, M., Snagowski, J., Laier, C., & Maderwald, S. (2016) · NeuroImage · doi:10.1016/j.neuroimage.2016.01.033 · Cited by 198 · see citing works
“The ventral striatum activity shown in our study could therefore considered a neural correlate of cue-reactivity, which is a main correlate of experiencing craving (Carter & Tiffany, 1999; Robinson & Berridge, 1993, 2000).”
Rabin, R. A., & George, T. P. (2015) · American Journal on Addictions · doi:10.1111/ajad.12186 · Cited by 206 · see citing works
The Effect of Tobacco Outlet Density and Proximity on Smoking Cessation
Reitzel, L. R., Cromley, E. K., Li, Y., Cao, Y., Mater, R. D., Mazas, C. A., Cofta-Woerpel, L. M., Cinciripini, P. M., & Wetter, D. W. (2010) · American Journal of Public Health · doi:10.2105/ajph.2010.191676 · Cited by 202 · see citing works
Cognitive concepts of craving.
Tiffany, S. T. (1999) · PubMed Central · Cited by 206 · see citing works
Self-citationThe effect of retail cigarette pack displays on impulse purchase
Wakefield, M. A., Germain, D., & Henriksen, L. (2007) · Addiction · doi:10.1111/j.1360-0443.2007.02062.x · Cited by 195 · see citing works
A review of the effects of perceived drug use opportunity on self-reported urge.
Wertz, J. M., & Sayette, M. A. (2001) · Experimental and Clinical Psychopharmacology · doi:10.1037/1064-1297.9.1.3 · Cited by 192 · see citing works
“In one especially popular approach, drug cue exposure, those with drug addictions are presented with their particular drug cues (Carter & Tiffany, 1999; Niaura et al., 1988).”
BackgroundInfluentialStress, habits, and drug addiction: A psychoneuroendocrinological perspective.
Schwabe, L., Dickinson, A., & Wolf, O. T. (2011) · Experimental and Clinical Psychopharmacology · doi:10.1037/a0022212 · Cited by 191 · see citing works
“During the development of addiction, drug-related habits and rituals are built up; strong stimulus–response associations are established (Carter & Tiffany, 1999).”
BackgroundAssessing reactivity to virtual reality alcohol based cues
Bordnick, P. S., Traylor, A., Copp, H. L., Graap, K. M., Carter, B., Ferrer, M., & Walton, A. P. (2008) · Addictive Behaviors · doi:10.1016/j.addbeh.2007.12.010 · Cited by 193 · see citing works
Self-citationA Systematic Review of the Relationships Between Craving and Smoking Cessation
Wray, J. M., Gass, J. C., & Tiffany, S. T. (2013) · Nicotine & Tobacco Research · doi:10.1093/ntr/nts268 · Cited by 192 · see citing works
“Further, although the most sensitive measure of cuespecific craving may be the difference in craving between a smoking and a neutral cue (Carter & Tiffany, 1999), only one study (Powell, Dawkins, West, Powell, & Pickering, 2010) used methods consistent with this definition.”
BackgroundMethodSelf-citationCue-elicited craving for food: a fresh approach to the study of binge eating
Sobik, L. E., Hutchison, K. E., & Craighead, L. W. (2005) · Appetite · doi:10.1016/j.appet.2004.12.001 · Cited by 186 · see citing works
Neurobiochemical and clinical aspects of craving in alcohol addiction: A review
Addolorato, G., Leggio, L., Abenavoli, L., & Gasbarrini, A. (2005) · Addictive Behaviors · doi:10.1016/j.addbeh.2004.12.011 · Cited by 188 · see citing works
“In 1999 Carter and Tiffany performed a study on the application of the bcue-reactivity paradigmQ in the dependence of alcohol, nicotine, heroine, and cocaine, analysing the reactions of consumption or seeking of a substance in respect to neutral stimuli ( Carter & Tiffany, 1999 ).”
BackgroundTiffany, S. T., Cox, L. S., & Elash, C. A. (2000) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.68.2.233 · Cited by 196 · see citing works
“The effect size (calculated as d +) of the difference between cigarette and neutral cues was 1.36 in Session 1 and 1.17 in Session 2. In both cases, these effect sizes greatly exceeded the convention used to describe a large effect size (0.80; Cohen, 1988 ). Moreover, these effects sizes were in line with the large cr…”
MethodResultInfluentialSelf-citation
- Authors
- Carter, B. L., & Tiffany, S. T.
- Affiliations
- Purdue University West Lafayette (US)
- Venue
- Addiction
- Publisher
- Wiley
- Published
- 1999-03
- Volume
- 94
- Issue
- 3
- Pages
- 327-340
- ISSN
- 0965-2140 (ISSN-L)
- 1360-0443
- OpenAlex
- W1988132969
- Cited by
- 1,638
- References
- 0
- Citations by year
- 2026: 41 · 2025: 50 · 2024: 38 · 2023: 59 · 2022: 53 · 2021: 73 · 2020: 145 · 2019: 61 · 2018: 59 · 2017: 58 · 2016: 83 · 2015: 85 · 2014: 90 · 2013: 86 · 2012: 97
- FWCI
- 16.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Addiction (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (2r01da004050-09a2)
- National Institute on Drug Abuse (R01DA04050)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Social Sciences › Psychology › Clinical Psychology › Gambling Behavior and Treatments
- Keywords
- cue reactivity, drug craving, alcoholism, cigarette smoking, cocaine dependence, heroin addiction, physiological responses, heart rate, sweat gland activity, skin temperature
- MeSH terms
- Adult, Cues, Female, Heart Rate, Humans, Male, Research, Skin Temperature, Sweating, Randomized Controlled Trials as Topic, Substance-Related Disorders
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