Cue exposure in alcohol dependent patients: preliminary evidence for different types of cue reactivity

Craving is considered to be an important phenomenon in addictive behaviours. However, there is still an unresolved debate on what craving for alcohol means, how it is best measured and which clinical and therapeutical consequences its presence or absence may imply. Cue reactivity paradigms have been developed to elicit craving under standardized experimental conditions. Here we present preliminary results characterizing alcohol-dependent patients with regard to subjective and psychophysiological aspects of exposure to alcohol-associated cues in a cue reactivity paradigm. Thirty-six patients fulfilling at least 5 criteria of alcohol dependence according to DSM-IV criteria were studied after detoxification. Cue reactivity was assessed as subjective (by visual analogue scales) and neurophysiological response (by ECG, EMG, electrodermal activity, respiratory frequency, salivation) to the presentation of the favourite alcoholic beverage or water. While 22% of the patients were both subjective and physiological responders, 42% of the subjects showed only a physiological reaction without subjective response, and 31% of the patients were neither a subjective nor a physiological reaction. Subjective responders to alcohol cues had significantly higher state anxiety levels than subjective non-responders. These results suggest that alcohol dependent patients may be divided into typological subgroups with respect to cue reactivity. Different types of cue reactivity might be important for treatment strategies involving repeated cue exposure or so-called anti-craving drugs.