Subjective craving for opiates: evaluation of a cue exposure protocol for use with detoxified opiate addicts

Cue exposure has been advocated as an intervention for reducing relapse rates in detoxified addicts, by extinguishing classically conditioned drug effects/craving which may have developed. Several studies with alcoholics have found cue exposure to be associated with reductions in craving, but no controlled study has yet shown such an effect in opiate addicts. The present controlled group design evaluates a protocol which draws from experience in the treatment of anxiety and requires that each stimulus exposure should be continued until within-session habituation has occurred. It also explores whether there is any benefit of using a 'cognitive aversion' strategy during cue exposure, based on the social learning analysis that craving derives from expectancies of positive drug effects. A total of 21 detoxified in-patients were randomized to routine ward treatment plus two sessions of either cue exposure (Group E) or cue exposure and cognitive aversion (Group E/CA), or to routine treatment alone (Group C). A specially designed Craving Test was carried out before and after treatment, to assess change in cue-elicited reactions. The two treated groups showed significantly greater reductions in craving than Group C, but did not differ from each other. The cue exposure protocol has therefore been adopted for use in an ongoing clinical trial.