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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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“This phenomenon is known as ‘cue-reactivity’ and has been observed in several studies focusing on behavioral, subjective and physiological levels (Carter & Tiffany 1999; Drummond 2000).”
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Conklin, C. A., Perkins, K. A., Robin, N., McClernon, F. J., & Salkeld, R. P. (2010) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2010.03.017 · Cited by 87
Immersive Virtual Environments in Cue Exposure
Kuntze, M. F., Stoermer, R., Mager, R., Roessler, A., Müller-Spahn, F., & Bullinger, A. H. (2001) · CyberPsychology & Behavior · doi:10.1089/109493101750527051 · Cited by 87
“In 1999, Carter et al. 4 re-ported on a meta-analysis study of 41 studies using both drug-related and neutral-control stimuli.”
Measuring alcohol craving: development of the Alcohol Craving Experience questionnaire
Statham, D. J., Connor, J. P., Kavanagh, D. J., Feeney, G. F. X., Young, R. M., May, J., & Andrade, J. (2011) · Addiction · doi:10.1111/j.1360-0443.2011.03442.x · Cited by 86
Kambouropoulos, N., & Staiger, P. K. (2004) · Psychology of Addictive Behaviors · doi:10.1037/0893-164x.18.3.275 · Cited by 86
DRD4 VNTR polymorphism is associated with transient fMRI-BOLD responses to smoking cues
McClernon, F. J., Hutchison, K. E., Rose, J. E., & Kozink, R. V. (2007) · Psychopharmacology · doi:10.1007/s00213-007-0860-6 · Cited by 87
“Among smokers, exposure to cues previously associated with smoking results in a cascade of physiological, behavioral, and subjective reactions, including craving (Carter and Tiffany 1999).”
BackgroundModeling cocaine relapse in rodents: Behavioral considerations and circuit mechanisms
Farrell, M. R., Schoch, H., & Mahler, S. V. (2018) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2018.01.002 · Cited by 90
“If this is also true in humans, it could have important implications for treating patients that vary in their susceptibility to the relapse-promoting properties of drug priming, stress, or cues (Carter and Tiffany, 1999; Flagel et al., 2009; Mahler and de Wit, 2010; Sinha et al., 2011).”
Smoking motives of daily and non-daily smokers: A profile analysis
Shiffman, S. S., Dunbar, M. S., Scholl, S. M., & Tindle, H. A. (2012) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2012.05.037 · Cited by 84
“Although DS are also thought to be influenced by cues (Carter and Tiffany, 1999; Ferguson and Shiffman, 2009; Niaura et al., 1988; Shiffman et al., 2012a, 2002), the fact that such motives are particularly prominent in ITS’ profiles is consistent with a stimulus-control account of ITS’ smoking…”
ResultJones, A., Christiansen, P., Nederkoorn, C., Houben, K., & Field, M. (2013) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2013.00140 · Cited by 93
“It is wellestablished that exposure to substance-related cues elicits a range of responses include physiological changes (such as increased heart rate and skin conductance), increased subjective craving, and increased drug self-administration (62).”
BackgroundMorrow, J. D., Maren, S., & Robinson, T. E. (2011) · Behavioural Brain Research · doi:10.1016/j.bbr.2011.02.013 · Cited by 84
“In the case of substance abuse, “cue reactivity” is well-documented and includes psychological cravings, physiological responses, and engagement in actual drug use behaviors in response to drug-related cues or contexts [16,17].”
BackgroundUrge to Gamble in Problem Gamblers Exposed to a Casino Environment
Kushner, M. G., Abrams, K. B., Donahue, C. B., THURAS, P. D., Frost, R. O., & Kim, S. W. (2007) · Journal of Gambling Studies · doi:10.1007/s10899-006-9050-4 · Cited by 84
“Carter and Tiffany (1999) conducted a meta-analysis of cue-reactivity studies across a number of addiction types including alcohol, nicotine, cocaine, and heroin.”
BackgroundInfluentialWiers, C. E., Ludwig, V. U., Gladwin, T. E., Park, S. Q., Heinz, A., Wiers, R. W. H. J., Rinck, M., Lindenmeyer, J., Walter, H., & Bermpohl, F. (2015) · Addiction Biology · doi:10.1111/adb.12221 · Cited by 90
“…the paradoxical behavior typical for addiction: automatic or impulsive processes that cause a strong motivational tendency to approach drugs (after repeated use) and reflective processes that may motivate to refrain from drugs for long-term reasons (Carter & Tiffany 1999; Bechara 2005; Wiers et al .”
BackgroundMucha, R. F., Geier, A., & Pauli, P. (1999) · Psychopharmacology · doi:10.1007/s002130051172 · Cited by 84
“In the dependent human, cues producing craving may elicit physiological responses, but the magnitudes appear to be small, not specific to different classes of abused substances and not consistent with predictions of any single notion of drug conditioning ( Carter and Tiffany 1999 ).”
BackgroundResultSmoking-related videos for use in cue-induced craving paradigms
Tong, C. C. L., Bovbjerg, D. H., & Erblich, J. (2007) · Addictive Behaviors · doi:10.1016/j.addbeh.2007.07.010 · Cited by 90
“…across a variety of modalities, including in vivo exposures (e.g., handling one’s cigarette) and imaginal exposures (e.g., imaging a scenario involving smoking) (Burton & Tiffany, 1997; Carter & Tiffany, 1999; Drobes & Tiffany, 1997; Erblich & Bovbjerg, 2004; Shadel et al., 1998; Tiffany, 1990).”
BackgroundResultEffects of smoking opportunity on cue-elicited urge: A facial coding analysis.
Sayette, M. A., Wertz, J. M., Martin, C. S., Cohn, J. F., Perrott, M. A., & Hobel, J. (2003) · Experimental and Clinical Psychopharmacology · doi:10.1037/1064-1297.11.3.218 · Cited by 84
“Carter and Tiffany (1999) also concluded that drug cue exposure affected nonverbal responding.”
Cyders, M. A., Džemidžić, M., Eiler, W. J. A., Coskunpinar, A., Karyadi, K. A., & Kareken, D. A. (2013) · Alcoholism Clinical and Experimental Research · doi:10.1111/acer.12266 · Cited by 83
Huys, Q. J. M., Guitart‐Masip, M., Dolan, R. J., & Dayan, P. (2015) · Clinical Psychological Science · doi:10.1177/2167702614562040 · Cited by 85
“Overly strong Pavlovian influences covary positively with addictive traits (Carter & Tiffany, 1999; Everitt & Robbins, 2005; Flagel et al., 2011; Meyer et al., 2012) and are predictive of relapse in alcohol addiction (Gruesser et al., 2004).”
BackgroundCue Reactivity in Alcohol and Tobacco Dependence
Drobes, D. J. (2002) · Alcoholism Clinical and Experimental Research · doi:10.1111/j.1530-0277.2002.tb02506.x · Cited by 84
Bartholow, B. D., Lust, S. A., & Tragesser, S. L. (2010) · Psychology of Addictive Behaviors · doi:10.1037/a0017705 · Cited by 84
“…(e.g., Glautier & Drummond, 1994), likelihood of relapse among abstinent alcoholics (e.g., Heinz, Beck, Grusser, Grace, & Wrasse, 2009), and drinking frequency and quantity among social drinkers (e.g., Greeley, Swift, Prescott, & Heather, 1993), among other factors (see Carter & Tiffany, 1999).”
BackgroundResultInfluentialEffects of alcohol sensitivity on P3 event-related potential reactivity to alcohol cues.
Bartholow, B. D., Henry, E. A., & Lust, S. A. (2007) · Psychology of Addictive Behaviors · doi:10.1037/0893-164x.21.4.555 · Cited by 83
“A dominant theoretical perspective on cue reactivity holds that exposure to substance-related cues elicits an appetitive/approach motivational state in substance users (see Carter & Tiffany, 1999; Stewart, DeWitt, & Eikelboom, 1984; see also A. Lang, Yegiyan, & Bradley, 2006).”
BackgroundResultInfluentialLaboratory-induced cue reactivity among individuals with prescription opioid dependence
Back, S. E., Gros, D. F., McCauley, J. L., Flanagan, J. C., Cox, E., Barth, K. S., & Brady, K. T. (2014) · Addictive Behaviors · doi:10.1016/j.addbeh.2014.04.007 · Cited by 81
Prisciandaro, J. J., Joseph, J. E., Myrick, H., McRae‐Clark, A. L., Henderson, S., Pfeifer, J. G., & Brady, K. T. (2014) · Addiction · doi:10.1111/add.12666 · Cited by 83
“, recent use, subjective craving) (30).”
BackgroundLi, X., Malcolm, R. J., Huebner, K., Hanlon, C. A., Taylor, J. J., Brady, K. T., George, M. S., & See, R. E. (2013) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2013.08.012 · Cited by 85
“…as an intense subjective urge to acquire and ingest drug(s), and may be elicited even after periods of sustained abstinence by exposure to stress, to a priming dose of the drug, or to environmental cues previously associated with use of the drug (Carter and Tiffany, 1999; Mahoney et al., 2007).”
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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