What does cue-reactivity have to offer clinical research?

This paper examines the application of the cue-reactivity paradigm as a means of studying alcohol dependence in clinical populations. Three main areas of application will be examined: cue-reactivity as a means of understanding the nature of alcohol dependence; cue-reactivity as a predictor of relapse; and cue-reactivity as a method of studying treatment effects. The study of cue exposure and cue-reactivity has a long history but it is only relatively recently that the potential of cue-reactivity as a means of understanding and treating addictive behaviours has been studied in depth. The principal advantage of cue-reactivity over other existing paradigms to study addictive behaviour is in having a solid basis in widely studied general theories of behaviour. Cue-reactivity also provides a means of measuring and unpacking the concept of craving. Craving has long been believed to represent the underlying basis for addictive behaviour, and in the majority of research studies craving has been conceptualized and measured in relatively simplistic ways. Craving has generally been viewed as a unitary phenomenon and measured using self-reported questionnaires. Such approaches have had limited explanatory value, particularly in recent psychopharmacology research. There is clearly a need to develop new paradigms to study the effects of pharmacological agents aimed at attenuating drinking behaviour. It is in this area that cue-reactivity currently offers the greatest potential. In particular, the cue-reactivity paradigm draws an important distinction between cue mediated craving and withdrawal craving. This can be viewed as similar to the distinction between generalised anxiety and anxiety provoked by phobic stimuli. However, while much is now known about the phenomenon of cue-reactivity, several aspects require further elucidation and research investment.