Effects of extinction context and retrieval cues on renewal of alcohol-cue reactivity among alcohol-dependent outpatients.

Abstract

Pavlovian conditioning models have led to cue-exposure treatments for drug abuse. However, conditioned responding to drug stimuli can return (be renewed) following treatment. Animal research and a previous study of social drinkers indicated that extinction is highly context dependent but that renewal could be reduced by the inclusion of a cue from the extinction context. This study extends this research to a clinical sample. Alcohol-dependent outpatients (N = 143) completed an extinction trial to reduce craving and salivation responses to alcohol cues. They were then randomized to renewal tests in either the same context as extinction, a different context, the different context containing an extinction cue, or the different context with cue plus a manipulation to increase the salience of the cue. Contrary to predictions, the different context did not produce the expected renewal effect. Although the generalization of extinction effects beyond the cue-exposure context is a positive clinical finding, it is inconsistent with basic research findings on the context dependence of extinction. Possible explanations for this inconsistency are discussed.

Drug Addiction: Updating Actions to Habits to Compulsions Ten Years On

“…Cue exposure therapy-that is, extinction of the CS through repeated nonreinforced presentations-has been frequently attempted, but a metaanalysis of a substantial literature has indicated that overall it results in little benefit (Myers & Carlezon 2012), in part because of the contextual specificity of extinction learning (Conklin & Tiffany 2002); however, the view is perhaps less pessimistic for alcoholics (Glautier et al 1994, MacKillop & Lisman 2008, Stasiewicz et al 2007). Attempts to enhance drug CS extinction with the glutamate receptor agonist D-cycloserine, following demonstrations of enhanced Pavlovian fear extinction (Davis 2002, Lee et al 2006b), have also generally been unsuccessful (Myers & Carlezon 2012) and may even result in an increase, not a decrease, in craving elicited by later exposure to the CS (Price et al 2013), an explanation for which is discussed below.…”

Progress in Cue Exposure Therapy for the Treatment of Addictive Disorders: A Review Update

“…Among the clinical efficacy trials reviewed, at least one [21] attempted to address the issue of renewal by having participants practice CET procedures at home as part of a homework assignment, though individuals in the CET group did not fare better than the comparison control group with respects to clinical outcome. Taken together, while later studies failed to replicate earlier positive findings regarding renewal effects [18,19], or failed to find enhanced efficacy of CET when taking renewal into account [21], the body of research in this area remains small. Thus, there is arguably enough positive evidence to merit further systematic investigation of this phenomenon.…”

“…In an attempt to replicate and extend the findings of Brandon and Collins, Staciewicz, and colleagues [18] also tested whether conducting cue exposure trials in a novel context would result in renewal and whether an extinction reminder would moderate this finding. In addition, however, these investigators assessed whether the extinction reminder would be more effective if the saliency of the extinction reminder was increased.…”

Design and implementation of a study evaluating extinction processes to food cues in obese children: The Intervention for Regulations of Cues Trial (iROC)

“…During Study 1 and Study 2, we will test 4 concepts related to Pavlovian extinction literature that are salient to human food intake: 1) number of extinction trials, 2) single vs. multiple foods in exposures, 3) extinction training in multiple contexts and 4) the use of an enhanced partial reinforcement schedule. (See Figure 1 ) All of the trials will incorporate extinction cues 2223 (bracelets) to remind the children of their new learning and thus help to bridge extinction between contexts. Following an exposure learning session, the children will verbalize what they have learned as a result of the session to enhance inhibitory processes.…”

“…132021 Furthermore, extinction may be bridged across two or more contexts by increasing the number of contexts in which extinction occurs 16 and the use of extinction cues. 2223 …”