Cue reactivity

Cue reactivity is a phenomenon of addiction found in numerous laboratory studies showing that drug addicts have significant physiological and subjective reactions to presentations of drug-related stimuli. In investigations of these reactions, addicts are exposed to both drug-related cues (e.g., cigarettes, bottles of alcohol, drug paraphernalia) and drug-neutral cues (e.g., pencils, glasses of water, a set of car keys) while changes in craving self-report, physiological responses, and, less frequently, drug-use behaviors are monitored.

Scientific Findings
A recent meta-analysis of over 40 cue-reactivity studies with cigarette smokers, alcoholics, heroin addicts or cocaine addicts strongly supports the finding that addicts have significant cue-specific reactions to drug-related stimuli. In general, addicts, regardless of drug of abuse, report robust increases in craving and exhibit modest changes in autonomic responses, such as increases in heart rate and skin conductance and decreases in skin temperature, when exposed to drug-related versus neutral stimuli. Surprisingly, despite their obvious clinical relevance, drug use or drug seeking behaviors are seldom measured in cue reactivity studies. However, when drug use measures are used in cue reactivity studies the typical finding is a modest increase in drug-seeking or drug use behavior.

Theoretical Background
Interpretations of an addict’s reactivity to drug-related stimuli have historically been derived from the framework of classical conditioning. During an individual’s history of drug use, certain stimuli, such as environmental contexts or drug paraphernalia, reliably accompany drug administration. It is assumed that these stimuli, by virtue of their pairing with the unconditioned drug stimulus, become conditioned stimuli capable of eliciting conditioned responses in the form of reactions such as increased craving and heart rate. Presumably, these cue-specific reactions reflect motivational processes responsible for continuing drug use in addicts as well as relapse in addicts attempting to remain abstinent.

Clinical Implications
Because addicts are highly reactive to environmental cues previously associated with drug use, a common treatment strategy is to advise addicts to avoid people and situations formerly associated with drug use. For example, a smoker attempting to quit should avoid other smokers and places (like bars) where smoking is prevalent. Although the relationship between cue reactivity in the laboratory and relapse to drug use in the real world is still poorly understood, considerable anecdotal evidence from drug treatment programs and smoking cessation counselors suggests that addicts in treatment are more successful at remaining abstinent if they take special care to avoid cues associated with prior drug use.