Physiological and subjective responding to alcohol cue exposure in alcoholics and control subjects: evidence for appetitive responding
Article First Online: 11 April 2006 Received: 16 June 2005 Accepted: 20 December 2005 Summary.
36 alcoholic patients, recruited from a treatment program, and 20 non-alcohol abusing control subjects were tested for their reactions to alcohol and non-alcohol cues. The cue exposure paradigm included audio-visual (video), tactile, olfactory, and guided imagery cue components related to alcohol and non-alcohol beverages. Response measures were analyzed for significant difference based on alcohol and non-alcohol cue and patient type. Among the subjective ratings, alcohol cue specific increases in alcohol craving, desire to drink, alcohol-like high, positive drinking expectancies and alcohol-like withdrawal were seen in alcoholic subjects. Among the physiological measures, alcohol cue specific increases in salivation were seen in alcoholic subjects. Changes in heart rate, skin conductance and temperature were not specific to alcohol cues, or to alcoholic patients. The smelling of alcohol had the greatest impact on alcohol craving and skin conductance in alcoholic subjects. These findings demonstrate robust subjective effects, and weak physiological effects, in response to a multidimensional alcohol cue exposure paradigm. The response profile indicates cue reactivity in alcoholics as an appetitive based form of alcohol craving.
Keywords: Alcohol, craving, withdrawal, cue reactivity. References American Psychiatric Association 1994Diagnostic and statistical manual of mental disorder DSM-IVfourth American Psychiatric Association Washington DC Google Scholar Anton, RF, Moak, DH, Latham, P 1995 The obsessive-compulsive drinking scale: a self-rated instrument for the quantification of thoughts about alcohol and drinking behavior Alcohol Clin Exp Res 19 92 99 PubMed CrossRef Google Scholar Beck, AT 1978Beck Depression Inventory Harcourt Brace & Company San Antonio Google Scholar Berger, SP, Hall, SM, Mickalian, JD, Reid, MS, Crawford, CA, Delucchi, KL, Carr, K, Hall, S 1996 Haloperidol antagonism of cue-elicited cocaine craving Lancet 347 504 508 PubMed CrossRef Google Scholar
Binkoff JA, Abrams DB, Collins RL, Liepman MR, Monti PM, Nirenberg TD, Zwick WR (1984) Exposure to alcohol cues. Comunicación pre- sentada en The Association for Advancement of Behavior Therapy, Filadelfia
Google Scholar Bohn, MJ, Krahn, DD, Staehler, BA 1995 Development and initial validation of a measure of drinking urges in abstinent alcoholics Alcohol Clin Exp Res 3 600 606 CrossRef Google Scholar Braus, DF, Wrase, J, Grusser, S, Herman, D, Ruf, M, Flor, H, Mann, K, Heinz, A 2001 Alcohol associated stimuli activate ventral striatum in abstinent alcoholics J Neural Transm 108 887 894 PubMed CrossRef Google Scholar Childress, AR, Mozley, D, McElgin, W, Fitzgerald, J, Reivich, M, O’Brien, CP 1999 Limbic activation during cue-induced cocaine craving Am J Psychiatry 156 11 18 PubMed Google Scholar Cooney, NL, Gillespie, RA, Baker, LH, Kaplan, RF 1987 Cognitive changes after alcohol cue exposure J Consult Clin Psychol 55 150 155 PubMed CrossRef Google Scholar Drummond, DC 1990 The relationship between alcohol dependence and alcohol-related problems in a clinical population Br J Addict 85 357 366 PubMed CrossRef Google Scholar Drummond, DC, Cooper, T, Glautier, SP 1990 Conditioned learning in alcohol dependence: implications for cue exposure treatment Br J Addict 85 725 743 PubMed CrossRef Google Scholar Flannery, BA, Volpicelli, JR, Pettinati, HM 1999 Psychometric properties of the Penn Alcohol Craving Scale Alcohol Clin Exp Res 23 1289 1295 PubMed CrossRef Google Scholar George, MS, Raymond, RF, Bloomer, C, Teneback, C, Drobes, DJ, Lorberbaum, JP, Nahas, Z, Vincent, DJ 2001 Activation of prefrontal cortex and anterior thalamus in alcoholic subjects on exposure to alcohol-specific cues Arch Gen Psychiatry 58 345 352 PubMed CrossRef Google Scholar Glautier, S, Drummond, DC 1994 Alcohol dependence and cue reactivity J Stud Alcohol 55 224 229 PubMed Google Scholar Grant, S, London, ED, Newlin, DB, Villemagne, VL, Liu, X, Contoreggi, C, Phillips, RL, Kimes, AS, Margolin, A 1996 Activation of memory circuits during cue-elicited cocaine craving Proc Natl Acad Sci USA 93 12040 12045 PubMed CrossRef Google Scholar Grusser, SM, Wrase, J, Klain, S, Hermann, D, Smolka, MN, Ruf, M, Weber-Fahr, W, Flor, H, Mann, K, Braus, DF, Heinz, A 2004 Cue-induced activation of the striatum and medial prefrontal cortex is associated with subsequent relapse in abstinent alcoholics Psychopharmacology 175 296 302 PubMed CrossRef Google Scholar Heinz, A, Lober, S, Georgi, A, Wrase, J, Herman, D, Rey, ER, Wellek, S, Mann, K 2003 Reward craving and withdrawal relief craving: assessment of different motivational pathways to alcohol intake Alcoholism Alcohol 38 35 39 CrossRef Google Scholar Heinz, A, Siessmer, T, Wrase, J, Buchholz, HG, Grunder, G, Kumakura, Y, Cumming, P, Schreckenberger, M, Smolka, MN, Rosch, F, Mann, K, Bartenstein, P 2005 Correlation of alcohol craving with striatal dopamine synthesis capacity and D2/D3 receptor availability: a combined (18F) DOPA and (18F) DMFP PET study in detoxified alcoholic patients Am J Psychiatry 162 1515 1520 PubMed CrossRef Google Scholar Johnson, CN, Fromme, K 1994 An experimental test of affect, subjective craving, and alcohol outcome expectancies as motivators of young adult drinking Addict Behav 19 631 641 PubMed CrossRef Google Scholar Kambouropoulos, N, Staiger, PK 2004 Reactivity to alcohol cues: relationship among cue types, motivation process and personality Psychol Addict Behav 18 275 283 PubMed CrossRef Google Scholar Kaplan, RF, Meyer, RF, Stroebel, CF 1983 Alcohol dependence and responsivity to an ethanol stimulus as predictors of alcohol consumption Br J Addict 78 259 267 PubMed CrossRef Google Scholar Laberg, JC 1990 What is presented, and what prevented, in cue exposure and response prevention in alcohol dependent patients? Addict Behav 15 367 386 PubMed CrossRef Google Scholar Laberg, JC, Ellertson, B 1987 Psychophysiological indicators of craving in alcoholics: effects of cue exposure Br J Addict 82 1341 1348 PubMed CrossRef Google Scholar Litt, MD, Cooney, NL 1999 Inducing craving for alcohol in the laboratory Alcohol Res and Health 23 174 178 Google Scholar Litt, MD, Cooney, NL, Morse, P 2000 Reactivity to alcohol-related stimuli in the laboratory and in the field: predictors of craving in treated alcoholics Addiction 95 889 900 PubMed CrossRef Google Scholar Ludwig, AM, Wikler, A, Stark, LH 1974 The first drink. Physiological aspects of craving Arch Gen Psychiatry 30 539 547 PubMed Google Scholar Marlatt, GA 1985 Cognitive factors in the relapse process Marlatt, GA Gordon, JR eds. Relapse prevention: maintenance strategies in the treatment of addictive behaviors Guilford Press New York 128 200 Google Scholar Marlatt, GA, Gordon, JR 1985Relapse prevention: maintenance strategies in the treatment of addictive behaviors Guilford Press New York 3 70 Google Scholar McCaul, ME, Turkkan, JS, Stitzer, ML 1989a Psychophysiological effects of alcohol-related stimuli. I. The role of stimulus intensity Alcoholism Clin Exp Res 13 386 398 CrossRef Google Scholar McCaul, ME, Turkkan, JS, Stitzer, ML 1989b Conditioned opponent responses: effects of placebo challenge in alcoholic subjects Alcoholism Clin Exp Res 13 631 635 CrossRef Google Scholar McCusker, CG, Brown, K 1990 Alcohol-predictive cues enhance tolerance to and precipitate “craving” for alcohol in social drinkers J Studies Alcohol 51 494 499 Google Scholar McCusker, CG, Brown, K 1995 Cue-exposure to alcohol-associated stimuli reduces autonomic reactivity, but not craving and anxiety, in dependent drinkers Alcohol Alcoholism 30 319 327 Google Scholar McLellan, AT, Luborsky, L, O’Brien, CP, Woody, GE 1980 An improved evaluation instrument for substance abuse patients: the Addiction Severity Index J Nerv Ment Dis 168 26 33 PubMed Google Scholar Miller, NS, Gold, MS 1994 Dissociation of “conscious desire” (craving) from and relapse in alcohol and cocaine dependence Ann Clin Psych 6 99 106 Google Scholar Modell, JG, Glaser, FB, Mountz, JM, Schmaltz, S, Cyr, L 1992a Obsessive compulsive characteristics of alcohol abuse and dependence: quantification by a newly developed questionnaire Alcohol Clin Exp Res 16 266 271 CrossRef Google Scholar Modell, JG, Glaser, FB, Cyr, L, Mountz, JM 1992b Obsessive and compulsive characterisitics of craving in alcohol abuse and dependence Alcohol Clin Exp Res 16 272 274 CrossRef Google Scholar Modell, JG, Mountz, JM 1995 Focal cerebral blood flow change during craving for alcohol measured by SPECT J Neuropsychiatr Clin Neurosci 7 15 22 Google Scholar Monti, PM, Binkoff, JA, Abrams, DB, Zwick, WR, Nirenberg, TD, Liebman, MR 1987 Reactivity of alcoholics and non-alcoholics to drinking cues J Abnorm Psychol 96 122 126 PubMed CrossRef Google Scholar Mucha, RF, Geier, A, Pauli, P 1999 Modulation of craving by cues having differential overlap with pharmacological effect: evidence for cue approach in smokers and social drinkers Psychopharmacol 147 306 313 CrossRef Google Scholar Mucha, RF, Geier, A, Stuhlinger, M, Mundle, G 2000 Appetitive effects of drug cues modeled by pictures of the intake ritual: generally of cue-modulated startle examined with inpatient alcoholics Psychopharmacol 151 428 432 CrossRef Google Scholar O’Brien, CP, Childress, AR, Ehrman, R, Robbins, SJ 1998 Conditioning factors in drug abuse: can they explain compulsion? J Psychopharm 12 15 22 Google Scholar Pommerleau, OF, Fertig, J, Baker, L, Cooney, N 1983 Reactivity to alcohol cues in alcoholics and non-alcoholics: implications for a stimulus control analysis of drinking Addict Behav 8 1 10 CrossRef Google Scholar Rather, BC, Goldman, MS, Roehrich, L, Brannick, M 1992 Empirical modeling of an alcohol expectancy memory network using multidimensional scaling J Abnorm Psychol 101 174 183 PubMed CrossRef Google Scholar Reid, MS, Mickalian, JD, Delucchi, KL, Hall, SM, Berger, SP 1998 An acute dose of nicotine enhances cue-induced cocaine craving Drug Alcohol Depend 49 95 104 PubMed CrossRef Google Scholar Reid, MS, Prichep, L, O’Leary, S, Ciplet, D, Tom, ML, Howard, B, Rotrosen, J, John, R 2003 Quantitative electroencephalographic studies of cue-induced cocaine craving Clinical EEG 34 110 123 Google Scholar Reid, MS, Mickalian, JD, Delucchi, KL, Berger, SP 1999 A nicotine antagonist, mecamylamine, reduces cue-induced cocaine craving in cocaine-dependent subjects Neuropsychopharmacology 20 297 307 PubMed CrossRef Google Scholar Rohsenow, DJ, Monti, PM, Abrams, DB, Rubonis, AV, Niaura, RS, Sirota, AD, Colby, SM 1992 Cue elicited urge to drink and salivation in alcoholics: relationship to individual differences Adv Behav Res Ther 14 195 210 CrossRef Google Scholar Rohsenow, DJ, Monti, PM, Rubonis, AV, Sirota, AD, Niaura, RS, Colby, SM, Wunschel, SM, Abrams, DB 1994 Cue reactivity as a predictor of drinking among male alcoholics J Consult Clin Psychol 62 620 626 PubMed CrossRef Google Scholar Rohsenow, DJ, Monti, PM 1999 Does urge to drink predict relapse after treatment? Alcohol Res Health 23 225 232 PubMed Google Scholar Rubonis, AV, Colby, SM, Monti, PM, Rohsenow, DJ, Gulliver, SB, Sirota, AD 1994 Alcohol cue reactivity and mood induction in male and female alcoholics J Stud Alcohol 55 487 494 PubMed Google Scholar Sellers, EM, Kalant, H 1976 Alcohol intoxication and withdrawal N Engl J Med 294 757 762 PubMed CrossRef Google Scholar Siegel, S 1979 The role of conditioning in drug tolerance and addiction Keehn, DJ eds. Psychopathology in animals: research and clinical implications Academic Press New York 143 168 Google Scholar Sinha, R, Fuse, T, Aubin, LR, O’Malley, SS 2000 Psychological stress, drug-related cues and cocaine craving Psychopharmacol 152 140 148 CrossRef Google Scholar Stasiewicz, PR, Gulliver, SB, Bradizza, CM, Rohsenow, DJ, Torrisi, R, Monti, PM 1997 Exposure to negative emotional cues and alcohol cue reactivity with alcoholics: a preliminary investigation Behav Res Ther 35 1143 1149 PubMed CrossRef Google Scholar Stewart, J, de Wit, H, Eikelboom, R 1984 Role of unconditioned and conditioned drug effects on the self-administration of opiates and stimulants Psychol Rev 91 251 268 PubMed CrossRef Google Scholar Stockwell, T, Hodgson, R, Edwards, G, Taylor, C, Rankin, H 1979 The development of a questionnaire to measure severity of alcohol dependence Br J Addict 74 79 87 CrossRef Google Scholar Stormark, KM, Laberg, JC, Bjerland, T, Nordby, H, Hugdahl, K 1995 Autonomic cued reactivity in alcoholics: the effect of olfactory stimuli Addict Behav 20 571 584 PubMed CrossRef Google Scholar Streeter, CC, Gulliver, SB, Baker, E, Blank, SR, Meyer, AA, Ciraulo, DA, Renshaw, PF 2002 Videotaped cue for urge to drink alcohol Alcohol Clin Exp Res 26 627 634 PubMed CrossRef Google Scholar Sullivan, JT, Sykora, K, Schneiderman, J, Naranjo, CA, Sellers, EM 1989 Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar) Br J Addict 84 1353 1357 PubMed CrossRef Google Scholar Szegedi, A, Lorch, B, Scheurich, A, Ruppe, A, Hautzinger, M, Wetzel, H 2000 Cue exposure in alcohol dependent patients: preliminary evidence for different types of cue reactivity J Neural Transm 107 721 730 PubMed CrossRef Google Scholar Tiffany, ST, Carter, BL, Singleton, EG 2000 Challenges in manipulation, assessment and interpretation of craving relevant variables Addiction 95 S177 S187 PubMed CrossRef Google Scholar Turkkan, JS, McCaul, ME, Stitzer, ML 1989 Psychophysiological effects of alcohol-related stimuli. II. Enhancement with alcohol availability Alcohol Clin Exp Res 13 392 398 PubMed CrossRef Google Scholar Westerberg, VS 2000 Constituents of craving in a clinical alcohol sample J Subst Abuse 12 415 423 PubMed CrossRef Google Scholar Wikler, A 1965 Conditioning factors in opiate addiction and relapse Wiher, DI Kassebaum, G eds. Narcotics McGraw Hill New York Google Scholar Wrase, J, Grusser, SM, Klein, S, Diener, C, Hermann, D, Flor, H, Mann, K, Braus, DF, Heinz, A 2002 Development of alcohol-associated cues and cue-induced brain activation in alcoholics Eur Psychiatry 17 287 291 PubMed CrossRef Google Scholar Verheul, R, Van den Brink, W, Geerlings, P 1999 A three-way psychobiological model of craving for alcohol Alcohol Alcoholism 34 197 222 CrossRef Google Scholar Zack, M, Toneatto, T, MacLeod, CM 2002 Anxiety and explicit alcohol-related memory in problem drinkers Addict Behav 27 331 343 PubMed CrossRef Google Scholar