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Appetitive startle modulation in the human laboratory predicts Cannabis craving in the natural environment

A Correction to this article was published on 07 July 2018

This article has been updated



Drug-related cues evoke craving and stimulate motivational systems in the brain. The acoustic startle reflex captures activation of these motivational processes and affords a unique measure of reactivity to drug cues.


This study examined the effects of cannabis-related cues on subjective and eye blink startle reactivity in the human laboratory and tested whether these effects predicted youth’s cue-elicited cannabis craving in the natural environment.


Participants were 55 frequent cannabis users, ages 16 to 24 years (M = 19.9, SD = 1.9; 55% male; 56% met criteria for cannabis dependence), who were recruited from a clinical trial to reduce cannabis use. Eye blink electromyographic activity was recorded in response to acoustic probes that elicited startle reactivity while participants viewed pleasant, unpleasant, neutral, and cannabis picture cues. Following the startle assessment, participants completed an ecological momentary assessment protocol that involved repeated assessments of cue-elicited craving in real time in their real-world environments.


Multilevel models included the presence or absence of visible cannabis cues in the natural environment, startle magnitude, and the cross-level interaction of cues by startle to test whether cue-modulated startle reactivity in the laboratory was associated with cue-elicited craving in the natural environment. Analyses showed that cannabis-related stimuli evoked an appetitive startle response pattern in the laboratory, and this effect was associated with increased cue-elicited craving in the natural environment, b = − 0.15, p = .022, 95% CI [− 0.28, − 0.02]. Pleasant stimuli also evoked an appetitive response pattern, but in this case, blunted response was associated with increased cue-elicited craving in the natural environment, b = 0.27, p < .001, 95% CI [0.12, 0.43].


Our findings support cue-modulated startle reactivity as an index of the phenotypic expression of cue-elicited cannabis craving.

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  • 07 July 2018

    The name of Hayley Treloar Padovano was incorrectly tagged in the original version of this article. Instead of Padovano as family name and Hayley Treloar as given name, it should be Hayley as given name and Treloar Padovano as family name. Correct presentation of author name when online should be Treloar Padovano H.


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The National Institute on Drug Abuse (R01 DA026778) and the National Institute on Alcohol Abuse and Alcoholism (R01 AA007850, K08 AA025011, K23 AA024808) at the National Institutes of Health supported this work. The authors wish to thank Alexander Blanchard for his contribution to the data collection and database management supporting this work.

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Correspondence to Robert Miranda Jr.

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Ethan H. Mereish and Hayley Treloar Padovano were equal first-author contributors.

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Mereish, E.H., Padovano, H.T., Wemm, S. et al. Appetitive startle modulation in the human laboratory predicts Cannabis craving in the natural environment. Psychopharmacology 235, 1933–1943 (2018).

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  • Startle response
  • Cues
  • Craving, Cannabis
  • Youth