Cited by 1,638Substance Abuse Treatment and OutcomesNeurotransmitter Receptor Influence on BehaviorGambling Behavior and Treatments

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Meta‐analysis of cue‐reactivity in addiction research

Carter, Brian L., Tiffany, Stephen T.·1999·Addiction

DOI 10.1046/j.1360-0443.1999.9433273.x

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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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“For example, the cue-reactivity paradigm in addiction research suggests that drug addicts are vulnerable to relapse in the presence of familiar environmental stimuli (Carter and Tiffany 1999; Wikler 1948).”
Background
EEG biofeedback as a treatment for substance use disorders: review, rating of efficacy, and recommendations for further research
Sokhadze, T. M., Cannon, R. L., & Trudeau, D. L. (2008) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-007-9047-5 · Cited by 222
“Cue reactivity is a very sensate test of motivational relevance of drugrelated items (Carter and Tiffany 1999) that can be detected using EEG methods.”
Background
The 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
“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).”
Background
Conditioned Dopamine Release in Humans: A Positron Emission Tomography [ 11 C]Raclopride Study with Amphetamine
Boileau, 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
“, 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).”
Background
Effects of Mindfulness-Oriented Recovery Enhancement on reward responsiveness and opioid cue-reactivity
Garland, E. L., Froeliger, B., & Howard, M. O. (2014) · Psychopharmacology · doi:10.1007/s00213-014-3504-7 · Cited by 216
“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.”
Result
A consistent attentional bias for drug-related material in active cocaine users across word and picture versions of the emotional Stroop task
Hester, R., Dixon, V., & Garavan, H. (2005) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2005.07.002 · Cited by 215
“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;…”
BackgroundResult
Hazardous 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 251
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
“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…”
BackgroundInfluential
Individual Differences in Nicotine Dependence, Withdrawal Symptoms, and Sex Predict Transient fMRI-BOLD Responses to Smoking Cues
McClernon, F. J., Kozink, R. V., & Rose, J. E. (2008) · Neuropsychopharmacology · doi:10.1038/sj.npp.1301618 · Cited by 202
REWARD CRAVING AND WITHDRAWAL RELIEF CRAVING: ASSESSMENT OF DIFFERENT MOTIVATIONAL PATHWAYS TO ALCOHOL INTAKE
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 210
“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).”
Background
Functional 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
“Cigarette-related cues have been shown to reliably enhance craving during this period, when compared to neutral cues (Carter and Tiffany, 1999).”
Background
Drug 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 216
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 209
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
Ventral striatum activity when watching preferred pornographic pictures is correlated with symptoms of internet pornography addiction
Brand, M., Snagowski, J., Laier, C., & Maderwald, S. (2016) · NeuroImage · doi:10.1016/j.neuroimage.2016.01.033 · Cited by 198
“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).”
A review of co‐morbid tobacco and cannabis use disorders: Possible mechanisms to explain high rates of co‐use
Rabin, R. A., & George, T. P. (2015) · American Journal on Addictions · doi:10.1111/ajad.12186 · Cited by 210
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
Cognitive concepts of craving.
Tiffany, S. T. (1999) · PubMed Central · Cited by 206
Self-citation
The 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
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 195
“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).”
BackgroundInfluential
Stress, 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 202
“During the development of addiction, drug-related habits and rituals are built up; strong stimulus–response associations are established (Carter & Tiffany, 1999).”
Background
Assessing 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
Self-citation
A 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 202
“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-citation
Cue-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 196
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 194
“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 ).”
Background
Effects of transdermal nicotine patches on abstinence-induced and cue-elicited craving in cigarette smokers.
Tiffany, 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 195
“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
Attentional and evaluative biases for smoking cues in nicotine dependence: component processes of biases in visual orienting
Bradley, B. P., Field, M., Mogg, K., & Houwer, J. D. (2004) · Behavioural Pharmacology · doi:10.1097/00008877-200402000-00004 · Cited by 187
“Reactivity to drug-related cues is a key feature of drug dependence (for a review, see Carter and Tiffany, 1999).”
Background

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
DOI: 10.1046/j.1360-0443.1999.9433273.x
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
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor, 1159 d)
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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Meta‐analysis of cue‐reactivity in addiction research

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