Introduction The cue reactivity paradigm allows for systematic evaluation of motivational responses to drug-related cues that may elicit drug use. The literature on this topic has grown substantially in recent decades, and the methodology used to study cue reactivity has varied widely across studies. The present research provided a meta-analytic investigation of variables that have an impact on cue reactivity effects to enhance our understanding of this key feature of tobacco use disorders. Methods A total of 128 publications yielded 249 effect sizes, which were analyzed to investigate the magnitude of the cue reactivity effect and potential moderators. Results Craving generated a moderate-to-large effect size (Hedges’ g=0.71, p<.001), indicating that drug cues produced significantly greater craving than neutral cues. However, physiological variables yielded significantly lower or non-significant effect sizes. Analyses of a variety of empirically and theoretically-relevant moderator variables showed that cue modality, cue personalization, cue reactivity environment, and the use of multiple assessments of cue reactivity were significantly associated with the magnitude of cue-specific craving effects (ps<.001). Effect sizes were not significantly related to abstinence status, gender, CPD, and treatment seeking status. Conclusions The results underscored the strength of self-reported craving as an index of cue reactivity across studies, which support theories that posit cue reactivity is core to the addictive process for daily tobacco cigarette smokers. The present research further elucidates the variables that alter the cue reactivity effects across studies and provides recommendations for future cue reactivity research. Implications A core feature of addiction is that drug-related cues can have a major impact on motivational responses across multiple substance use disorders, including tobacco cigarettes. This paper describes a meta-analysis updating and synthesizing cue reactivity research with tobacco cigarette smokers over the last 20 years, a time of rapid growth for this literature. The study leads to a better understanding of the cue reactivity paradigm across different self-report and physiological variables, and identifies factors that may modulate addictive motivation for tobacco cigarettes.

Purpose Cannabis use among young adults is increasing, despite being associated with several negative consequences. Protective behavioral strategies (PBSs) are a potential mechanism of behavior change for reducing substance use, yet PBS use for cannabis is not well understood. The purpose of this paper is to further define and measure the PBS construct for cannabis. Design/methodology/approach A community sample of cannabis users (n=54) participated in eight focus groups discussing the use of PBSs. Participants completed surveys regarding demographics, cannabis use habits and cannabis problems. The authors also administered an existing measure of cannabis PBS and asked them to generate new or unique protective strategies that they had used or had heard of others using. Findings Thematic analysis of qualitative focus group data provided information about cannabis users’ reasons for regulating cannabis use (e.g. health or legal problems, interpersonal) as well as strategies to moderate cannabis use or attenuate their risk for experiencing adverse consequences (e.g. distraction, existential/spiritual strategies). Analyses of quantitative survey data revealed that use of PBSs was negatively correlated with cannabis outcomes. Perceived helpfulness of strategies was an important predictor of decreased cannabis use and adverse consequences. Research limitations/implications Findings expand the understanding of the definition and measurement of strategies for regulating cannabis use and reducing related risk of experiencing adverse consequences. Originality/value This is the first study to examine cannabis-related PBS using both qualitative and quantitative methods, which provide insights into the definition of PBS and for future refinements of PBS measurement.

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