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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 (CBT) is a structured, time limited, evidence based psychological therapy for a wide range of emotional and behavioural disorders, including addictive behaviours12.”
From Cognitive behavioural interventions in addictive disorders (2018) · cites this paper as [12]
In the citing paper
“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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“Other cue-conditioned effects of drugs can be assessed using subjective and physiological responses to in vivo , imaginal or pictorial representations of drug-associated cues (see Ref”
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“Although the purpose of Conklin and Tiffany's meta-analysis was not to disentangle the effects of CET on different drugs of choice and the authors therefore did not comment on drug-specific disorders, it is observable that the effects of CET targeting AUD are much more favorable than for other SUDs (Conklin & Tiffany,…”
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“Since drug cues tend to produce physiological arousal ( Carter and Tiffany 1999 ), it needs to be emphasized that arousal was specifically shown not to account for the modulation of ASR (Lang et al. 1990; Lang 1995; Witvliet and Vrana 1995).”
BackgroundCraving research: future directions
Drummond, C., Litten, R. Z., Lowman, C., & Hunt, W. A. (2000) · Addiction · doi:10.1080/09652140050111816 · Cited by 226
Does smoking cue‐induced craving tell us anything important about nicotine dependence?
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“The present results confirm previous reports that a stimulus cue that predicts the absence of drug can also have conditioned effects (Niaura et al. 1988; Carter and Tiffany 1999).”
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“Indeed, it has long been recognized that substance-dependent individuals experience craving when exposed to drug-related stimuli (Carter & Tiffany, 1999).”
BackgroundModeling the effect of alcohol on smoking lapse behavior
McKee, S. A., Krishnan‐Sarin, S., Shi, J. M., Mase, T., & O’Malley, S. S. (2006) · Psychopharmacology · doi:10.1007/s00213-006-0551-8 · Cited by 142
“…such as nicotine discrimination (Perkins et al. 1997; Perkins et al. 1999), nicotine reinforcement (Perkins et al. 2001), deprivation effects (Hatsukami et al. 1984), self-administration behavior (Hatsukami et al. 1998, 1997), and cue reactivity (see Carter and Tiffany (1999) for a review).”
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“INTRODUCTION Drug cue-reactivity—the array of psychological, physiological, and behavioral effects elicited by drug-related stimuli—has been utilized for more than two decades in an attempt to understand drug craving and dependence (Rohsenow et al., 1991; Drummond, 2001; Carter and Tiffany, 1999).”
BackgroundNicotine enhances responding with conditioned reinforcement
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“…subjective effects of drugs can enhance motivation to use a drug, and drugassociated stimuli both produce cue-induced craving (O’Brien et al. 1998; Carter and Tiffany 1999) and region-specific activation of cortico-limbic-striatal brain regions (Grant et al. 1996; Childress et al. 1999; Volkow…”
BackgroundAnnual research review: on the developmental neuropsychology of substance use disorders
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“An extensive literature shows that drug-dependent individuals exhibit attentional biases to drug-related stimuli (Franken, 2003) which predicts drug craving and relapse (Carter & Tiffany, 1999).”
BackgroundFood Addiction: Implications for the Diagnosis and Treatment of Overeating
Adams, R. C., Sedgmond, J., Maizey, L., Chambers, C., & Lawrence, N. (2019) · Nutrients · doi:10.3390/nu11092086 · Cited by 158
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“Laboratory paradigms have been developed to model the effect of naturally occurring temptations and craving episodes (Abrams et al. 1988; Niaura et al. 1992, 1998; Sayette and Hufford 1994; Carter and Tiffany 1999), and these may allow testing of the effect of acute NRT on craving”
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“One explanation for this moderate relationship is that craving reflects cue reactivity of the reward system but also additional processes, such as the (verbal) interpretation of the physiological response (Rohsenow et al. 1994; Carter and Tiffany 1999; Drummond 2000).”
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BackgroundHow does food-cue exposure lead to larger meal sizes?
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BackgroundSmoking Patterns and Stimulus Control in Intermittent and Daily Smokers
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BackgroundMechanisms of Shared Vulnerability to Post-traumatic Stress Disorder and Substance Use Disorders
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“Cue reactivity to drug-related stimuli also predicts relapse in patients with SUD (Rohsenow et al., 1990; Carter and Tiffany, 1999; Janes et al., 2010).”
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“Although several theories have been proposed to explain cue reactivity, most evidence favours a positive incentive account (Carter and Tiffany 1999; Drummond 2000).”
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“…stimuli without regard to the negative consequences (Moeller et al., 2001a), while cue reactivity is conceptualized as the sensitivity to cues linked with the drug-taking experience that are known to trigger craving in humans (Carter and Tiffany, 1999; O’Brien et al., 1988; O’Brien et al., 1998).”
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“, 2000), conditioned stimuli (Childress et al., 1988, 1993; Carter and Tiffany, 1999), and re-exposure to drug (Jaffe et al.”
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“These smoking-related cues readily elicit craving in both laboratory and naturalistic studies (Carter & Tiffany 1999; Warthen & Tiffany 2009).”
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Heavy drinking is associated with deficient response inhibition in women but not in men
Nederkoorn, C., Baltus, M., Guerrieri, R., & Wiers, R. W. H. J. (2009) · Pharmacology Biochemistry and Behavior · doi:10.1016/j.pbb.2009.04.015 · Cited by 139
“For example, alcohol-related stimuli elicit enhanced craving (Carter and Tiffany, 1999) and faster approach responses than control stimuli in alcoholics, compared to control participants (Field et al., 2008), as well as in heavy drinkers, especially when carrying a g-allele in the OPRM1 gene (Wiers…”
The DRD4 VNTR polymorphism influences reactivity to smoking cues.
Hutchison, K. E., LaChance, H., NIAURA, R. S., Bryan, A. D., & Smolen, A. (2002) · Journal of Abnormal Psychology · doi:10.1037//0021-843x.111.1.134 · Cited by 134
“Although there has been some controversy over the definition of craving and its clinical relevance (see Sayette et al., 2000; Tiffany, 1990), numerous studies have indicated that exposure to smoking cues (e.g., the sight and smell of a lit cigarette) markedly increases craving for tobacco (see Carter & Tiffany, 1999;…”
BackgroundGaming Increases Craving to Gaming-Related Stimuli in Individuals With Internet Gaming Disorder
Dong, G., Wang, L., Du, X., & Potenza, M. N. (2017) · Biological Psychiatry Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2017.01.002 · Cited by 132
Haughey, H. M., Marshall, E. C., Schacht, J. P., Louis, A., & Hutchison, K. E. (2008) · Addiction · doi:10.1111/j.1360-0443.2008.02292.x · Cited by 126
Amlung, M. T., & MacKillop, J. M. (2014) · Alcoholism Clinical and Experimental Research · doi:10.1111/acer.12423 · Cited by 124
“Thus, again, the putative mechanism of cue effects is subjective craving, and there is considerable support that drug cues elicit significant increases in craving (Carter and Tiffany, 1999).”
BackgroundCue reactivity and its inhibition in pathological computer game players
Lorenz, R. C., Krüger, J., Neumann, B., Schott, B. H., Kaufmann, C., Heinz, A., & Wüstenberg, T. (2012) · Addiction Biology · doi:10.1111/j.1369-1600.2012.00491.x · Cited by 125
“Moreover, these findings expand the concept of cue reactivity (Carter & Tiffany 1999) in PCGPs. Cue reactivity appears in this group to be faster and more ‘pre-reflexive’.”
BackgroundTrotzke, P., Starcke, K., Müller, A., & Brand, M. (2015) · PLoS ONE · doi:10.1371/journal.pone.0140296 · Cited by 129
“, heart rate, skin conductance, or skin temperature) towards addiction-related cues [37,38].”
BackgroundAvoidance of alcohol-related stimuli in alcohol-dependent inpatients.
Townshend, J. M., & Duka, T. (2007) · Alcoholism: Clinical and Experimental Research · doi:10.1111/j.1530-0277.2007.00429.x · Cited by 140
Assessment of Substance Cue Reactivity: Advances in Reliability, Specificity, and Validity.
Stritzke, W. G. K., Breiner, M. J., Curtin, J. J., & Lang, A. R. (2004) · Psychology of Addictive Behaviors · doi:10.1037/0893-164x.18.2.148 · Cited by 124
The effects of alcohol on cigarette craving in heavy smokers and tobacco chippers.
Sayette, M. A., Martin, C. S., Wertz, J. M., Perrott, M. A., & Peters, A. (2005) · Psychology of Addictive Behaviors · doi:10.1037/0893-164x.19.3.263 · Cited by 126
“It has been suggested that drug-cue-specific urge is best assessed by contrasting urge during drug cue exposure with urge during a control cue exposure (Carter & Tiffany, 1999).”
Applying laboratory research: Drug anticipation and the treatment of drug addiction.
Siegel, S., & Ramos, B. M. C. (2002) · Experimental and Clinical Psychopharmacology · doi:10.1037/1064-1297.10.3.162 · Cited by 123
Extending the Role of Associative Learning Processes in Nicotine Addiction
Bevins, R. A., & Palmatier, M. I. (2004) · Behavioral and Cognitive Neuroscience Reviews · doi:10.1177/1534582304272005 · Cited by 123
“…of drug dependence refl ect the translation of laboratory research and theory in Pavlovian conditioning into drug abuse intervention techniques (Carter & Tiff any, 1999; Dadds, Bovb- jerg, Redd, & Cutmore, 1997; Niaura et al., 1999; O’Brien, Childress, McLellan, & Ehrman, 1992; Siegel & Ramos,…”
Cognitive Processes in Alcohol Binges: A Review and Research Agenda
Field, M., Schoenmakers, T. M., & Wiers, R. W. H. J. (2008) · Current Drug Abuse Reviews · doi:10.2174/1874473710801030263 · Cited by 121
Löf, E., Olausson, P., de Bejczy, A., Stomberg, R., Mcintosh, J., Taylor, J., & Söderpalm, B. (2007) · Psychopharmacology · doi:10.1007/s00213-007-0899-4 · Cited by 126
“In alcoholics, alcohol-associated stimuli can elicit craving (Spanagel and Zieglgansberger 1997; Carter and Tiffany 1999) and precipitate relapse (Niaura et al.”
Brandon, T. H., Herzog, T. A., Irvin, J. E., & Gwaltney, C. J. (2004) · Addiction · doi:10.1111/j.1360-0443.2004.00737.x · Cited by 119
Smoker reactivity to cues: Effects on craving and on smoking behavior.
Shiffman, S. S., Dunbar, M. S., Kirchner, T., Li, X., Tindle, H. A., Anderson, S., & Scholl, S. (2012) · Journal of Abnormal Psychology · doi:10.1037/a0028339 · Cited by 119
“…a wider range of smoking behavior than is usually seen in reactivity studies: whereas most reactivity studies were done on relatively heavy smokers (Carter & Tiffany, 1999), the subjects in our study smoked as little as five CPD, and their average smoking rate approximated the national average…”
Gonzalez, V. M., & Dulin, P. L. (2015) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0038620 · Cited by 118
Does reducing withdrawal severity mediate nicotine patch efficacy? A randomized clinical trial.
Ferguson, S. G., Shiffman, S., & Gwaltney, C. J. (2006) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.74.6.1153 · Cited by 117
Fatseas, M., Serre, F., Alexandre, J., Debrabant, R., Auriacombe, M., & Swendsen, J. (2015) · Addiction · doi:10.1111/add.12882 · Cited by 117
The DRD4 VNTR polymorphism influences reactivity to smoking cues.
Hutchison, K. E., LaChance, H., NIAURA, R. S., et al. (2002) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.111.1.134 · Cited by 116
Miranda, R., MacKillop, J. M., Monti, P. M., Rohsenow, D. J., Tidey, J. W., Gwaltney, C. J., Swift, R. M., Ray, L. A., & McGeary, J. E. (2008) · Alcoholism Clinical and Experimental Research · doi:10.1111/j.1530-0277.2007.00592.x · Cited by 115
“Indeed, the cue reactivity paradigm has demonstrated substantial utility in eliciting urge to drink (e.g., Monti et al., 1987; for a review, see Carter and Tiffany, 1999 ) and reactivity to alcohol cues has been shown to predict treatment outcome (Monti et al., 2000).”
BackgroundSmoking cues in a virtual world provoke craving in cigarette smokers.
Baumann, S. B., & Sayette, M. (2006) · Psychology of Addictive Behaviors · doi:10.1037/0893-164x.20.4.484 · Cited by 132
Saladin, M. E., Brady, K. T., Graap, K. M., & ROTHBAUM, B. O. (2006) · Addictive Behaviors · doi:10.1016/j.addbeh.2006.01.004 · Cited by 114
Attentional orienting towards smoking-related stimuli
Hogarth, L., Mogg, K., Bradley, B., Duka, T., & Dickinson, A. (2003) · Behavioural Pharmacology · doi:10.1097/00008877-200303000-00007 · Cited by 127
Assessing craving for alcohol.
Drobes, D. J., & Thomas, S. E. (1999) · PubMed Central · Cited by 116
Habitual Alcohol Seeking: Neural Bases and Possible Relations to Alcohol Use Disorders
Corbit, L. H., & Janak, P. H. (2016) · Alcoholism Clinical and Experimental Research · doi:10.1111/acer.13094 · Cited by 110
“…craving, alcohol should be highly valued; the dissociation of habitual behavior from value suggests is unlikely that habitual behaviors are associated with craving, and acamprosate may not be effective for altering habits, which could relate to its modest efficacy (Carter & Tiffany, 1999).”
Background
Metadata
- 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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