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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“In their metaanalytic review of 41 alcohol, nicotine, cocaine, and opiate cue reactivity studies, Carter and Tiffany (1999) reported a large effect size (i.e., .92) for craving and smaller effect sizes for physiological indices (i.e., .26 for heart rate and .24 for skin temperature).”
It's the Product: Do Risky Products Compel Attention and Elicit Arousal in Media Users?
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“Carter and Tiffany (1999) conducted a meta-analysis on cue reactivity in addiction research and found that participants showed significant increases in sweat-gland activity when exposed to drug-related compared to nondrug-related stimuli.”
Background
Methods of assessing craving to gamble: A narrative review.
Ashrafioun, L., & Rosenberg, H. (2011) · Psychology of Addictive Behaviors · doi:10.1037/a0026367 · Cited by 54
Older Men’s Social Integration After Prison
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“In these cases, recidivism may be facilitated by interaction with criminally engaged friends and neighbors, and/or exposure to environmental “triggers” for substance use that encourage relapse (Carter & Tiffany, 1999; Kirk, 2009, 2012).”
Background
Adverse childhood experiences predict autonomic indices of emotion dysregulation and negative emotional cue-elicited craving among female opioid-treated chronic pain patients
Garland, E. L., Reese, S. E., Bedford, C. E., & Baker, A. K. (2019) · Development and Psychopathology · doi:10.1017/s0954579419000622 · Cited by 51
“The subjective experience of craving is associated with autonomic changes (Carter & Tiffany, 1999), as well as activation in attentional, interceptive, and reward-related brain networks (Koob & Volkow, 2016; Naqvi, Gaznick, Tranel, & Bechara, 2014).”
Background
Olanzapine attenuates cue-elicited craving for tobacco
Hutchison, K. E., Goodworth, M.-C. R., NIAURA, R. S., Swift, R. M., Pickworth, W. B., & Sobik, L. E. (2003) · Psychopharmacology · doi:10.1007/s00213-004-1837-3 · Cited by 48
“A number of studies have indicated that exposure to smoking cues (e.g. the sight and smell of a lit cigarette) markedly increases craving for tobacco (Niaura et al. 1988, 1992, 1998; Carter and Tiffany 1999; Hutchison et al. 1999; Tiffany et al. 2000; Sayette et al. 2001).”
Background
How long does craving predict use of methamphetamine? Assessment of use one to seven weeks after the assessment of craving: Craving and ongoing methamphetamine use.
Galloway, G. P., & Singleton, E. G. (2009) · PubMed Central · Cited by 51
Drug-related cues exacerbate decision making and increase craving in heroin addicts at different abstinence times
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Acute effects of brisk walking on urges to eat chocolate, affect, and responses to a stressor and chocolate cue. An experimental study
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“Thewissen, Snijders, Havermans, van den Hout, & Jansen, 2006), but also by a wide range of proximal cues (for a review see Carter & Tiffany, 1999), both external (e.g., Niaura, Abrams, Pedraza, Monti, & Rohsenow, 1992) and internal (e.g., Conklin & Perkins, 2005).”
Background
The influence of music on emotions and cravings in clients in addiction treatment: A study of two clinical samples
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Effect of deactivation of activity patterns related to smoking cue reactivity on nicotine addiction
Bu, J., Young, K. D., Hong, W., Ma, R., Song, H., Wang, Y., Zhang, W., Hampson, M., Hendler, T., & Zhang, X. (2019) · Brain · doi:10.1093/brain/awz114 · Cited by 43
Examining the relationship between cue-induced craving and actual smoking.
Conklin, C. A., Vella, E. J., Joyce, C. J., Salkeld, R. P., Perkins, K. A., & Parzynski, C. S. (2015) · Experimental and Clinical Psychopharmacology · doi:10.1037/a0038826 · Cited by 46
“…studies demonstrating that confrontation with smoking cues significantly increases cue-induced craving among smokers and moderately alters autonomic reactivity (see Carter & Tiffany, 1999 for review), but few demonstrating an increase in actual smoking in direct response to smoking cue exposure.”
BackgroundInfluential
Correlates of Smoking Cessation Self-efficacy in a Community Sample of Smokers
Martinez, E., Tatum, K. L., Glass, M., Bernath, A., Ferris, D., Reynolds, P., & Schnoll, R. (2009) · Addictive Behaviours · doi:10.1016/j.addbeh.2009.09.016 · Cited by 59
In vivo versus imaginal smoking cue exposures: Is seeing believing?
Erblich, J., & Bovbjerg, D. H. (2004) · Experimental and Clinical Psychopharmacology · doi:10.1037/1064-1297.12.3.208 · Cited by 47
Reliability and validity of the Tobacco Craving Questionnaire and validation of a craving‐induction procedure using multiple measures of craving and mood
Singleton, E. G., Anderson, L. M., & Heishman, S. J. (2003) · Addiction · doi:10.1046/j.1360-0443.2003.00449.x · Cited by 47
To Drink or Not to Drink: The Role of Automatic and Controlled Cognitive Processes in the Etiology of Alcohol-Related Problems
Wiers, R. W., Houben, K., Smulders, F. T. Y., Conrod, P. J., & Jones, B. T. (2006) · Handbook of Implicit Cognition and Addiction · doi:10.4135/9781412976237.n22 · Cited by 47
The Prevention and Treatment of Gambling Disorders: Some Art, Some Science
Derevensky, J. L. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.024 · Cited by 45
Going beyond the individual level in self-control research
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“For instance, laboratory experiments 53–55 , field observations 56,57 and field experiments 58,59 show how variations in stimulus microenvironments affect the desire for and the choice and consumption of products.”
Reactivity to Alcohol Cues: Isolating the Role of Perceived Availability.
MacKillop, J., & Lisman, S. A. (2005) · Experimental and Clinical Psychopharmacology · doi:10.1037/1064-1297.13.3.229 · Cited by 46
“…however, it is notable that availability information was confounded with substance type (nicotine vs. alcohol) and significant differences in the degree of cue reactivity have been demonstrated between these two substances in a meta-analysis of cue reactivity research (Carter & Tiffany, 1999).”
Background
Sign-tracking to an appetitive cue predicts incubation of conditioned fear in rats
Morrow, J. D., Saunders, B. T., Maren, S., & Robinson, T. E. (2014) · Behavioural Brain Research · doi:10.1016/j.bbr.2014.04.002 · Cited by 44
D-cycloserine to enhance extinction of cue-elicited craving for alcohol: a translational approach
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The effect of phosphodiesterase inhibitors on the extinction of cocaine-induced conditioned place preference in mice
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“Extinction learning by ‘exposure therapy’ is thought to be essential for the management of drug addiction (Carter and Tiffany, 1999; Powell et al., 1993; Siegel and Ramos, 2002).”
Background
How do dysfunctional eating and hazardous drinking women perform on behavioural measures of reward and punishment sensitivity?
Loxton, N. J., & Dawe, S. (2006) · Personality and Individual Differences · doi:10.1016/j.paid.2006.09.031 · Cited by 46
The effects of chronic food restriction on cue-induced heroin seeking in abstinent male rats
D’Cunha, T. M., Sedki, F., Macri, J., Casola, C., & Shalev, U. (2012) · Psychopharmacology · doi:10.1007/s00213-012-2810-1 · Cited by 46
“In abstinent addicts, drug craving and relapse can be triggered by exposure to the self-administered drug (de Wit 1996; Meyer and Mirin 1979), drug-associated cues (Carter and Tiffany 1999; Childress et al. 1992), or stressful life events (Sinha 2001).”
Drug cue reactivity involves hierarchical instrumental learning: evidence from a biconditional Pavlovian to instrumental transfer task
Hardy, L., Mitchell, C. J., Seabrooke, T., & Hogarth, L. (2017) · Psychopharmacology · doi:10.1007/s00213-017-4605-x · Cited by 46
“Drug cue reactivity is a central construct in addiction research, and there have been numerous attempts to elucidate the underlying learning mechanisms (e.g. Carter and Tiffany 1999).”
Background
Development of an effective virtual environment in eliciting craving in adolescents and young adults with internet gaming disorder
Shin, Y., Kim, J., Kim, M.-K., Kyeong, S.-H., Jung, Y. H., Eom, H., & Kim, E. J. (2018) · PLoS ONE · doi:10.1371/journal.pone.0195677 · Cited by 48
Cue-reactivity in the natural environment of cigarette smokers: The impact of photographic and in vivo smoking stimuli.
Wray, J. M., Godleski, S. A., & Tiffany, S. T. (2011) · Psychology of Addictive Behaviors · doi:10.1037/a0023687 · Cited by 48
“Drug cues consistently increase craving across all major substance-use disorders (Carter & Tiffany, 1999); however, all of this research has Correspondence concerning this article should be addressed to Stephen T. Tiffany, Ph.D., Department of Psychology, Park 228, University at Buffalo, The State…”
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Laboratory-induced stress and craving among individuals with prescription opioid dependence
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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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