Cue Exposure Therapy for the Treatment of Opiate Addiction: Results of a Randomized Controlled Clinical TrialMarissen M.A.E.a · Franken I.H.A.c · Blanken P.b · van den Brink W.c · Hendriks V.M.b
aCentre for Personality Disorders PsyQ and bParnassia Addiction Research Centre, Parnassia Mental Health Institute, The Hague, cErasmus University Rotterdam, Institute of Psychology, Rotterdam, and dAmsterdam Institute of Addiction Research, Amsterdam and Academic Medical Centre University of Amsterdam, Amsterdam, The Netherlands
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Background: Persistent cue reactivity to drug-related stimuli is a well-known phenomenon among abstinent drug users and has been found to be a predictor of relapse. Cue exposure therapy (CET) aims to reduce this cue reactivity by exposing abstinent drug users to conditioned drug-related stimuli while preventing their habitual response, i.e. drug use. Methods: 127 abstinent heroin-dependent Dutch inpatients were randomized to CET (n = 65; 55 completers) and placebo psychotherapy treatment (PPT) (n = 62; 59 completers). It was examined whether CET would lead to a decrease in drug-related cue reactivity (using mixed-design ANOVA) and subsequently to lower dropout and relapse rates (using logistic regression) compared to PPT. Results: Both groups responded with a similar decrease in self-reported cue reactivity (craving, mood). The CET group did show a significant decrease in physiological reactivity (skin conductance) compared to PPT. However, dropout and relapse rates were, contrary to our expectations, significantly higher in the CET group. Conclusions: This is the first randomized controlled trial showing that CET, compared to a non-specific psychotherapy, might increase dropout and relapse rates among abstinent heroin-dependent clients in a drug-free setting. Caution is warranted when applying CET in this specific context.
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De Weert-van Oene GH, Schnabel P, Schrijvers AJP: Drop-out in de verslavingszorg. Literatuurstudie over de periode 1990–1996. (Drop-out in addiction treatment. A review of the period 1990–1996). Maandblad Geestelijke Volksgezondheid 1998;53:388–402.
- Gossop M, Marsden J, Stewart D, Treacy S: Change and stability of change after treatment of drug misuse: 2-year outcomes from the National Treatment Outcome Research Study (UK). Addict Behav 2002;27:155–166.
Drummond DC, Tiffany ST, Glautier S, Remington B: Addictive behaviour: cue exposure theory and practice. Chichester, Wiley, 1995.
- Franken IHA, de Haan HA, van der Meer CW, Haffmans PJM, Hendriks VM: Cue reactivity and the effects of cue exposure in post-treatment drug users. J Subst Abuse Treat 1999;16:81–85.
- Rohsenow DJ, Monti PM, Rubonis AV, Sirota AD, Niaura RS, Colby SM, Wunschel SM, Abrams DB: Cue reactivity as a predictor of drinking among male alcoholics. J Consult Clin Psychol 1994;62:620–626.
- Drummond DC, Glautier S: A controlled trial of cue exposure treatment in alcohol dependence. J Consult Clin Psychol 1994;62:809–817.
- Ito LM, De Araujo LA, Tess VLC, De Barros Neto TP, Asbahr FR, Marks I: Self-exposure therapy for panic disorder with agoraphobia. Br J Psychiatry 2001;178:331–336.
- Marks I, O’Sullivan G: Drugs and psychological treatments for agoraphobia/panic and obsessive-compulsive disorders: a review. Br J Psychiatry 1988;153:650–658.
- Marks I: Behavioural and drug treatments of phobic and obsessive-compulsive disorders. Psychother Psychosom 1986;46:35–44.
- Rohsenow DJ, Monti PM, Rubonis AV, Gulliver SB, Colby SM, Binkoff JA, Abrams DB: Cue exposure with coping skills training and communication skills training for alcohol dependence: 6- and 12-month outcomes. Addiction 2001;96:1161–1174.
- Conklin CA, Tiffany ST: Applying extinction research and theory to cue-exposure addiction treatments. Addiction 2002;97:155–167.
- Marissen MAE, Franken IHA, Blanken P, Van den Brink W, Hendriks VM: Cue exposure therapy for opiate-dependent clients. J Subst Use 2005;10:97–105.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4. Washington, American Psychiatric Association, 1994.
- McLellan AT, Luborsky L, Woody GE, O’Brien CP: An improved diagnostic evaluation instrument for substance abuse patients: the Addiction Severity Index. J Nerv Ment Dis 1980;168:26–33.
- Hendriks VM, Kaplan CD, Van Limbeek J, Geerlings P: The Addiction Severity Index: reliability and validity in a Dutch addict population. J Subst Abuse Treat 1989;6:133–141.
- Love A, James D, Willner P: A comparison of two alcohol craving questionnaires. Addiction 1998;93:1091–1102.
- Franken IHA, Hendriks VM, Van den Brink W: Initial validation of two opiate craving questionnaires: The Obsessive Compulsive Drug Use Scale (OCDUS) and the Desires for Drug Questionnaire (DDQ). Addict Behav 2002;27:675–685.
McNair D, Lorr M, Droppelman LF: Profile of Mood States. San Diego, Educational and Industrial Services, 1992.
Wald FD, Mellenbergh GJ: The shortened version of the Dutch translation of the Profile of Mood States (POMS). Ned Tijdschr Psychol 1990;45:86–90.
- De Weert-van Oene GH, Breteler MHM, Schippers GM, Schrijvers AJP: The validity of the Self-Efficacy List for Drugs Users (SELD). Addict Behav 2000;25:599–605.
Hughdal K: Psychophysiology: The Mind-Body Perspective. London, Harvard University Press, 1995.
- Hugdahl K, Ternes JW: An electrodermal measure of arousal in opiate addicts to drug-related stimuli. Biol Psychol 1981;12:291–298.
- Drummond DC: What does cue-reactivity have to offer clinical research? Addiction 2000;95(suppl 2):S129–S144.
- Gossop M, Green L, Phillips G, Bradley BP: Lapse, relapse and survival among opiate addicts after treatment: a prospective follow-up study. Br J Psychiatry 1989;154:348–353.
Hosmer DW, Lemeshow S: Applied logistic regression. New York, Wiley, 1989.
- McCusker CG, Brown K: Cue-exposure to alcohol-associated stimuli reduces autonomic reactivity, but not craving and anxiety, in dependent drinkers. Alcohol Alcohol 1995;30:319–327.
- Monti PM, Rohsenow DJ, Rubonis AV, Niaura RS, Sirota AD, Colby SM, Goddard P, Abrams DB: Cue exposure with coping skills treatment for male alcoholics: a preliminary investigation. J Consult Clin Psychol 1993;61:1011–1019.
- Dawe S, Powell JH, Richards D, Gossop M, Marks I, Strang J, Gray J: Does post-withdrawal cue exposure improve outcome in opiate addiction? A controlled trial. Addiction 1993;88:1233–1245.
- Niaura R, Abrams DB, Shadel WG, Rohsenow DJ, Monti PM, Sirota AD: Cue exposure treatment for smoking relapse prevention: a controlled clinical trial. Addiction 1999;95:685–695.
- Robinson TE, Berridge KC: The neural basis of drug craving: an incentive-sensitization theory of addiction. Brain Res Rev 1993;18:247–291.
- Belaise C, Fava GA, Marks IM: Alternatives to debriefing and modifications to cognitive behavior therapy for posttraumatic stress disorder. Psychother Psychosom 2005;74:212–217.
- Marlatt GA: Cue exposure and relapse prevention in the treatment of addictive behaviors. Addict Behav 1990;15:395–399.
Siegel S: Classical conditioning, drug tolerance, and drug dependence; in Israel Y, Glaser FB, Kalant H, et al (eds): Research Advances in Alcohol and Drug Problems. New York, Plenum Press, 1983, pp 207–246.
- Hommer DW: Functional imaging of craving. Alcohol Res Health 1999;23:187–196.
- Kuntze MF, Stoermer R, Mager R, Roessler A, Mueller-Spahn F, Bullinger AH: Immersive virtual environments in cue exposure. Cyberpsychol Behav 2001;4:497–501.
- Monti PM, Rohsenow DJ, Swift RM, Gulliver SB, Colby SM, Mueller TI, Brown RA, Gordon A, Abrams DB, Niaura RS, Asher MK: Naltrexone and cue exposure with coping and communication skills training for alcoholics: treatment process and 1-year outcomes. Alcohol Clin Exp Res 2001;25:1634–1647.
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