A Meta-Analysis of Cue Reactivity in Tobacco Cigarette Smokers

Abstract

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.

Combined smoking and alcohol cues: Effects on craving, drug‐seeking, and consumption

“…Consistent with prior research, cue elicited craving did not vary depending on rates of substance use (Perkins, 2009;Sayette et al, 2001) and instead emerged across a broad range from relatively light to heavy smoking and drinking. Our inclusion of reliable, multitrial cue reactivity assessments provides a sensitive test of these potential moderating effects (Betts et al, 2021). Additionally, heavier alcohol and tobacco use, respectively, were associated with stronger craving overall irrespective of cue type, consistent with "tonic" or "background" craving (Wray et al, 2013).…”

How laboratory studies of cigarette craving can inform the experimental alcohol craving literature

“…So how big of a deal is this concern? Betts et al (2021) review studies that suggest that multitrial smoking cue studies are more effective in eliciting cued craving responses than their single-trial counterpart (suggesting the opposite of carryover effects). We are less confident of this conclusion for three reasons.…”

“…First, as noted by , most studies that use a multitrial approach fail to provide the data necessary (main effects or interactions with order) to address the question of carryover properly. Second, studies that have provided relevant information suggest that it can be a concern (Field et al, 2009;Monti et al, 1987;Rohsenow & Niaura, 1999;Waters et al, 2005;Wilson et al, 2007. Third, some of the single-trial studies that provide relevant data supporting their effectiveness were not included in the Betts et al (2021) review (see Sayette et al, 2021). These omitted studies reveal robust effects of smoking cues using single-trial designs.…”

“…Further discussion of the Betts et al (2021) meta-analysis extends beyond the scope of this article. We suspect the carryover issue will continue to be debated and hope that moving forward, investigators choosing to use a multitrial approach will provide the raw data (e.g., include order as a factor and offer adequate power to detect trial order interactions and not simply main effects) needed to sensitively evaluate possible carryover concerns (for additional consideration see .…”

The influence of Conditioned Stimuli on [11C]-(+)-PHNO PET Binding in Tobacco Smokers after a One Week Abstinence

“…In particular, cues are believed to be critical for the maintenance of nicotineseeking responses 3,4 . In human smokers, drug-related cues produce greater ratings of 'craving' as compared to neutral cues 5 . Converging evidence implicates dopamine (DA) and DA receptors as critical in the development of substance use disorders 6 , and in behaviors mediated by drug-paired cues.…”