Utilizing virtual reality to standardize nicotine craving research: a pilot study

Traditional cue reactivity provides a methodology for examining drug triggers and stimuli in laboratory and clinical settings. However, current techniques lack standardization and generalization across research settings. Improved methodologies using virtual reality (VR) cue reactivity extend previous research standardizing exposure to stimuli and exploring reactions to drug cues in a controlled VR setting. In a controlled pilot trial, 13 nicotine-dependent participants were allowed to smoke ad libitum then exposed to VR smoking and VR neutral cues and compared on craving intensity. VR smoking cues significantly increased craving compared to VR neutral cues. On average, craving intensity increased 118% during exposure to VR smoking cues. Implications for substance abuse research and treatment using VR to assess cessation and anticraving medications are discussed.     

Laboratory-based,cue-elicited craving and cue reactivity as predictors of naturally occurring smoking behavior

Cigarette craving, one hallmark sign of nicotine dependence, is often measured in laboratory settings using cue reactivity methods. How lab measures of cue reactivity relate to real world smoking behavior is unclear, particularly among non-treatment seeking smokers. Within a larger study of hormonal effects on cue reactivity (N = 78), we examined the predictive relationship of cue reactivity to smoking, each measured in several ways. Results indicated that cue-evoked craving in response to stressful imagery, and to a lesser extent, in vivo smoking cues, significantly predicted smoking behavior during the week following testing. However, this predictive relationship was absent upon controlling for reactivity to neutral cues. Nicotine dependence may moderate the relationship between cue reactivity and actual smoking, such that this predictive relationship is less robust among highly dependent smokers than among smokers low in nicotine dependence. The question of whether cue-elicited craving predicts smoking among smokers not in treatment is best answered with a qualified yes, depending on how craving is manipulated and measured. Our findings highlight important methodological and theoretical considerations for cue reactivity research.     

Effect of impulsivity on craving and behavioral reactivity to smoking cues

Introduction Nearly 25% of American adults remain regular smokers. Current smokers may be especially likely to possess characteristics that impair their ability to quit, such as impulsivity. Impulsive individuals may be overly prone to smoke because they are particularly drawn to rewarding stimuli and related cues. The aim of this study was to test the hypothesis that more impulsive smokers are more responsive to cigarette cues than other smokers. Materials and methods In a repeated measures design, 60 euthymic, adult smokers (50% female) were exposed to a smoking cue and a neutral cue in two experimental sessions. Cue reactivity was operationalized as changes in cigarette craving and preference for immediate vs delayed smoking after cue exposure. Results Impulsivity predicted a heightened craving response to both cues but particularly the smoking cue (t [161] = 3.21, p = 0.002). Smokers with high levels of impulsivity exhibited a greater preference for immediate rewards over larger, delayed rewards in terms of both hypothetical (t [58] = 5.99, p = 0.001) and actual (z = 3.02, p = 0.003) rewards. Conclusion These data suggest that increased reactivity to environmental smoking cues contributes to the link between impulsivity and smoking.     

Neurophysiological effects of modafinil on cue-exposure in cocaine dependence: A randomized placebo‐controlled cross-over study using pharmacological fMRI

Objective

Enhanced reactivity to substance related cues is a central characteristic of addiction and has been associated with increased activity in motivation, attention, and memory related brain circuits and with a higher probability of relapse. Modafinil was promising in the first clinical trials in cocaine dependence, and was able to reduce craving in addictive disorders. However, its mechanism of action remains to be elucidated. In this functional magnetic resonance imaging (fMRI) study therefore, cue reactivity in cocaine dependent patients was compared to cue reactivity in healthy controls (HCs) under modafinil and placebo conditions.

Methods

An fMRI cue reactivity study, with a double-blind, placebo-controlled cross-over challenge with a single dose of modafinil (200 mg) was employed in 13 treatment seeking cocaine dependent patients and 16 HCs.

Results

In the placebo condition, watching cocaine-related pictures (versus neutral pictures) resulted in higher brain activation in the medial frontal cortex, anterior cingulate cortex, angular gyrus, left orbitofrontal cortex, and ventral tegmental area (VTA) in the cocaine dependent group compared to HCs. However, in the modafinil condition, no differences in brain activation patterns were found between cocaine dependent patients and HCs. Group interactions revealed decreased activity in the VTA and increased activity in the right ACC and putamen in the modafinil condition relative to the placebo condition in cocaine dependent patients, whereas such changes were not present in healthy controls. Decreases in self-reported craving when watching cocaine-related cues after modafinil administration compared to the placebo condition were associated with modafinil‐induced increases in ACC and putamen activation.

Conclusions

Enhanced cue reactivity in the cocaine dependent group compared to healthy controls was found in brain circuitries related to reward, motivation, and autobiographical memory processes. In cocaine dependent patients, these enhanced brain responses were attenuated by modafinil, mainly due to decreases in cue‐ reactivity in reward‐related brain areas (VTA) and increases in cue reactivity in cognitive control areas (ACC). These modafinil‐induced changes in brain activation in response to cocaine-related visual stimuli were associated with diminished self-reported craving. These findings imply that in cocaine dependent patients, modafinil, although mainly known as a cognitive enhancer, acts on both the motivational and the cognitive brain circuitry.     

Evidence for greater cue reactivity among low-dependent vs. high-dependent smokers

Introduction

Cue reactivity paradigms are well-established laboratory procedures used to examine subjective craving in response to substance-related cues. For smokers, the relationship between nicotine dependence and cue reactivity has not been clearly established. The main aim of the present study was to further examine this relationship.

Methods

Participants (N = 90) were between the ages 18–40 and smoked ≥10 cigarettes per day. Average nicotine dependence (Fagerström Test for Nicotine Dependence; FTND) at baseline was 4.9 (SD = 2.1). Participants completed four cue reactivity sessions consisting of two in vivo cues (smoking and neutral) and two affective imagery cues (stressful and relaxed), all counterbalanced. Craving in response to cues was assessed following each cue exposure using the Questionnaire of Smoking Urges-Brief (QSU-B). Differential cue reactivity was operationally defined as the difference in QSU scores between the smoking and neutral cues, and between the stressful and relaxed cues.

Results

Nicotine dependence was significantly and negatively associated with differential cue reactivity scores in regard to hedonic craving (QSU factor 1) for both in vivo and imagery cues, such that those who had low FTND scores demonstrated greater differential cue reactivity than those with higher FTND scores (β = −.082; p = .037; β = −.101; p = .023, respectively). Similar trends were found for the Total QSU and for negative reinforcement craving (QSU factor 2), but did not reach statistical significance.

Discussion

Under partially sated conditions, less dependent smokers may be more differentially cue reactive to smoking cues as compared to heavily dependent smokers. These findings offer methodological and interpretative implications for cue reactivity studies.     

Alcohol cue reactivity task development

Background

The physiological and cognitive reactions provoked by alcohol cues, as compared to non-alcohol cues, can predict future drinking. Alcohol cue reactivity tasks have been developed; however, most were created for use with alcohol use disordered individuals and utilize limited or only partially standardized stimuli. This project systematically created an alcohol cue reactivity task for studies with non-drinkers, using well-characterized stimuli.

Objectives

We comprehensively standardized 60 alcohol and 60 non-alcohol beverage pictures using ratings from young non-drinkers (N = 82) on affective and perceptual features.

Results

A statistical matching approach yielded 26 matched alcohol–non-alcohol picture pairs matched on valence, arousal, image complexity, brightness, and hue. The task was piloted and further refined to 22 picture pairs. An 8-minute, 32-second event-related task was created using a random stimulus function for optimized condition timing and systematic presentation of the images.

Conclusions

The long-term objectives of this project are to utilize this task with non-drinking youth to investigate how reactivity to alcohol stimuli may predict alcohol use initiation and escalation, to help identify the role of exposure to alcohol stimuli on the subsequent development of alcohol-related problems.     

Diurnal variation in cue-induced responses among protracted abstinent heroin users

Objectives

The physiological and psychological responses to drug cue exposure have been assessed in substance abusers. However, there is no study to demonstrate whether the responses to drug cue exposure are diurnal dependence. The present study was to examine whether there was a variation in drug-related cue reactivity across the diurnal cycle among recently abstinent opiate addicts.

Methods

Four groups of 20 abstinent heroin dependent patients (n = 80) were exposed to both neutral and drug-related videos at four separate times during the day: 8:00, 12:00, 16:00, and 20:00 h. Physiological and psychological responses, including heart rate, blood pressure, heroin craving, and subjective anxiety were assessed before and after each cue exposure.

Results

Drug cue significantly increased craving ratings compared to neutral cues across all the four separate times of day. Drug cue-induced craving was greater in the morning (8:00 am) than noon (12:00 pm), but was similar to evening assessments (8 pm). Drug cues also significantly increased anxiety, which positively correlated with cue-induced craving. Drug cues increased heart rate, systolic and diastolic blood pressures, which were not correlated with cue-induced craving or anxiety. However, no time effects were found on the three physiological measures.

Conclusions

Cue-induced craving could be profoundly affected by the time points of cue exposure, using cue-reactivity paradigm. The relative sensitivity of morning and evening assessments of drug craving suggests a need for replication and further research on mechanisms contributing to these diurnal variations.     

Effect of impulsivity on cardiovascular and subjective reactivity to smoking cues

Individuals with high levels of impulsivity are more likely to smoke and may have greater difficulty quitting than other smokers. Although the specific mechanisms mediating this relationship are not explicitly known, one candidate is disproportionate cigarette craving in response to environmental smoking cues. We assessed the effect of impulsivity on three measures of cue reactivity. Regular smokers (n=75) were exposed to a smoking cue and a neutral cue in 2 counterbalanced experimental sessions. Cigarette craving, heart rate (HR), and mean arterial pressure (MAP) were used to index cue reactivity. More impulsive smokers exhibited a disproportionate response to the smoking cue in terms of MAP (p=.009) but not HR or craving. Impulsive smokers may experience disproportionate cigarette craving in response to environmental smoking cues that are not reflected in self-report measures due to a relative lack of conscious awareness of the urge to smoke.     

Motivation to quit smoking and startle modulation in female smokers: context specificity of smoking cue reactivity

Rationale  

Cue reactivity and startle reflex modulation paradigms have been used in addiction research to determine the affective motivational state of craving induced by viewing drug-related cues. However, recent studies suggest that cue reactivity and startle reflex modulation in people with addictions can be suppressed, or even reversed, depending on context.     

Decision-making and inhibitory control after smoking-related priming in nicotine dependent smokers and never-smokers

Impaired decision-making and inhibitory control are important characteristics of nicotine dependence (ND). We aimed to test 1) the effects of smoking-related priming cues on subsequent decision-making and inhibitory control in ND and 2) how these priming effects are related to valence ratings, nicotine deprivation and craving. A sample of 27 smokers with ND according to DSM-IV and a control group of 33 never-smokers performed an intertemporal choice task and a go/no-go task. Before each trial of the tasks, a priming cue appeared that was either smoking-related or neutral. Valence ratings, nicotine deprivation and craving were assessed with self-reports. After smoking-related compared to neutral primes, the ND group exhibited increased delay discounting (β = 0.07, 95% confidence-interval (CI): 0.01–0.14) and shorter go reaction times (β = −0.13, CI: −0.32 to −0.01) compared to the never-smoker group. The speed-up in go trials after smoking-related compared to neutral cues was significantly related to more pleasant valence ratings (β = 0.07, CI:0.01–0.13), a longer time since last cigarette (β = −0.17, CI:−0.30 to −0.03), and increased craving (β = −0.19, CI: −0.33 to −0.06) within the ND group. We found evidence for small group effects indicating that individuals with ND compared to never-smokers decide more dysfunctional and react faster after smoking-related compared to neutral cues. Faster reactions after smoking-related cues within the ND group, especially in states of increased nicotine deprivation and craving, without more errors could be explained by an increased attentional focus. Cue-induced alterations in decision-making and inhibitory control in ND highly depend on the temporal sequence of cue presentation.     

Can't stop the craving: the effect of impulsivity on cue-elicited craving for alcohol in heavy and light social drinkers

Rationale  

A robust finding in the alcohol literature is that heavy and alcohol-dependent drinkers show stronger reactions to alcohol-related cues than light drinkers. However, there are individual differences in the degree of cue-elicited craving. Personality factors appear to be involved in cue reactivity and impulsivity is a possible candidate.     

Response inhibition toward alcohol-related cues using an alcohol go/no-go task in problem and non-problem drinkers

Background

Previous results suggested that alcohol abusers and alcohol dependent patients show cognitive biases in the treatment of alcohol-related cues, especially approach and inhibition deficit biases. Response inhibition was often tested using the go/no-go task in which the participants had to respond as quickly as possible to a class of stimuli (go stimuli) while refraining from responding to another class of stimuli (no-go stimuli). Previous studies assessing specific response inhibition deficits in the process of alcohol-related cues obtained conflicting results. The aims of the present study were to clarify response inhibition for alcohol cues in problem and non-problem drinkers, male and female and to test the effect of alcohol brand logos.

Methods

Thirty-six non-problem drinker and thirty-five problem drinker undergraduate students completed a modified alcohol go/no-go task using alcohol and neutral object pictures, with or without brand logos, as stimuli. An additional control experiment was carried out to check whether participants' awareness that the study tested their response to alcohol might have biased the results.

Results

All participants, whether problem or non-problem drinkers, showed significantly shorter mean reaction times when alcohol pictures are used as go stimuli and significantly higher percentages of commission errors (false alarms) when alcohol pictures are used as no-go stimuli. Identical effects were obtained in the control experiment when participants were unaware that the study focused on alcohol. Shorter reaction times to alcohol-related cues were observed in problem drinkers relative to non-problem drinkers but only in the experimental condition with no brand logos on alcohol pictures. The addition of alcohol brand logos further reduced reaction times in light drinkers, thereby masking group differences. There was a tendency for female problem drinkers to show higher rates of false alarms for alcohol no-go stimuli, although this effect was only very close to statistical significance.

Conclusions

All participants exhibited a cognitive bias in the treatment of alcohol cues that might be related to the positive emotional value of such alcohol-related cues. Stronger cognitive biases in the treatment of alcohol cues were observed in problem drinkers, although differences between problem and non-problem drinkers were relatively small-scale and required specific experimental parameters to be uncovered. In particular, the presence of alcohol brand logos on visual alcohol cues was an important experimental parameter that significantly affected behavioral responses to such stimuli.     

Attentional bias to alcohol stimuli predicts elevated cue-induced craving in young adult social drinkers

Considerable evidence has identified biased cognitive processing of alcohol-related stimuli as an important factor in the maintenance of alcohol-seeking and relapse among individuals suffering from alcohol use-disorders (AUDs). In addition, a large body of research has demonstrated that exposure to alcohol cues can elicit powerful alcohol cravings. Little is known, however, about the possible relationship between attentional bias and cue-induced cravings, and even less is known about these processes in social drinkers without a personal history of AUDs. The goal of this study was to examine the possibility that attentional biases toward alcohol-related stimuli would predict elevated cue-induced alcohol craving in this population. Young adult social drinkers (N = 30, Mean age = 22.8 ± 1.9, 61% female) recruited from an urban university population completed a visual dot probe task in which they were presented with alcohol and neutral stimulus pictures that were immediately followed by a visual probe replacing one of the pictures. Attentional bias was measured by calculating reaction times to probes that replaced alcohol stimuli vs. neutral stimuli. Participants then completed a classic alcohol cue-exposure task and reported cravings immediately before and after alcohol and neutral cue-exposures. Not surprisingly, exposure to alcohol cues elicited significant cravings. Consistent with the study hypothesis, larger attentional biases toward alcohol stimuli predicted higher levels of alcohol craving. Findings demonstrate that heightened attention to alcohol stimuli can significantly impact motivation to consume in healthy young adults, and suggest a possible pathway linking cognitive processes early in the drinking trajectory to the later development of AUDs.     

Drug-related stimuli impair inhibitory control in cocaine abusers

Background

Cocaine users show impaired inhibitory control on cued go/no-go tasks and attention bias to drug-related stimuli in the emotional Stroop task. The results of a previous study suggested that there is a relationship between inhibitory control and attention bias in alcohol drinkers such that the presentation of alcohol-related images as a go cue in a cued go/no-go task significantly impaired inhibitory control compared to neutral images as a go cue. The present study determined the generality of these previous findings by assessing inhibitory control in cocaine users utilizing a modified cued go/no-go task with cocaine or neutral images as the cues.

Methods

Non-treatment seeking cocaine users (N = 30) completed the modified task after completing detailed measures of demographics and drug use. Participants were matched on basic demographic factors and were assigned to groups in which they saw either a cocaine or neutral image as the go cue.

Results

Participants assigned to the cocaine image go cue condition had a significantly higher proportion of inhibitory failures to the no-go target than their counterparts assigned to the neutral cue condition, but there were no group differences on reaction time (i.e., accuracy was not traded for speed).

Conclusions

Cocaine users were less able to inhibit pre-potent responses when a cocaine-related image served as the go cue than when a neutral image served as the go cue, consistent with previous research in alcohol users. The outcomes suggest that cocaine-related cues produce disinhibition, perhaps contributing to the high incidence of relapse or continued cocaine use.     

Alcohol cue reactivity in alcohol-dependent adolescents

OBJECTIVE: There is substantial evidence that adults with alcohol dependence show different responses (increased craving, increased salivation, changes in heart rate) to alcohol-related stimuli (i.e., alcohol cue reactivity) than nonalcoholics. Alcohol cue reactivity appears to be related to dependence severity and has been used to predict treatment outcomes, where more reactive alcoholics have poorer outcomes than less reactive alcoholics. Adolescents may also develop alcohol dependence, though it is uncertain whether they experience craving and cue reactivity in the presence of alcohol-associated stimuli. METHOD: To examine whether adolescents with alcohol dependence show alcohol cue reactivity, 28 alcoholic adolescents and 25 nonalcoholic adolescents (ages 14-19 years) were compared using a standard cue reactivity procedure, where participants view, hold and sniff different beverages, one of which is their preferred alcoholic beverage. Cue reactivity was assessed with subjective craving ratings, salivation (grams), and heart rate (beats per minute). Analyses were conducted by covarying response to control beverages. RESULTS: Alcoholics responded with both greater craving and greater salivation to the alcohol cue (controlling for response to control cues) than did nonalcoholics, supporting the hypothesis that adolescent alcoholics show alcohol cue reactivity. Heart rate showed no differential cue effect between alcoholics and controls. CONCLUSIONS: Findings support that adolescent alcoholics experience alcohol cue reactivity, as evidenced by increased salivation and subjective craving in the presence of alcohol-related stimuli. Investigation of treatments that may reduce alcohol craving and cue reactivity in adolescents with alcohol dependence is warranted.     

Reactivity to in vivo marijuana cues among cannabis-dependent adolescents

IntroductionCannabis dependence is a common but poorly understood condition in adolescents. Marijuana craving has been posited as a potential contributing factor to continued use and relapse, but relatively few studies have focused on the measurement of craving and reactivity to marijuana cues. The present work sought to explore reactivity to marijuana cues within this age group.MethodsThirty treatment-seeking cannabis-dependent adolescents (age 13–20) completed a cue reactivity session, consisting of exposure to and manipulation of in vivo marijuana cues (“joint” and lighter) and matching neutral cues (pencil and eraser), in counterbalanced order. Subjective craving and physiological reactivity were assessed.ResultsParticipants demonstrated increased craving and skin conductance reactivity in response to marijuana cues, relative to neutral cues.ConclusionIn vivo marijuana cues appear to elicit significant subjective and physiological reactivity among treatment-seeking cannabis-dependent adolescents. Further work is needed with a larger sample and with a wider variety of cues.     

Higher levels of trait impulsiveness and a less effective response inhibition are linked to more intense cue-elicited craving for alcohol in alcohol-dependent patients

Rationale

Cue-elicited craving is a well-researched phenomenon in alcohol literature. However, not all alcohol-dependent people display the same reactivity to alcohol cues. Personality factors such as multiple impulsivity traits may be responsible for individual differences in cue reactivity by modulating its intensity. Nevertheless, there has been a scarcity of empirical studies testing this assumption in alcohol literature.

Objectives

The aim of the present study was to investigate the effects of response inhibition and trait impulsiveness on cue-elicited craving for alcohol in alcohol-dependent drinkers.

Methods

Participants (n?=?41) were inpatients of the private clinic U-Center, Netherlands. Alcohol exposure took place in a real bar–restaurant close to the premises of the clinic, and participants were exposed to real alcohol cues. Response inhibition was assessed with the stop-signal task and trait impulsiveness with the Barratt impulsivity scale version 11.

Results

The cue exposure was successful as alcohol-dependent patients experienced higher craving for alcohol when exposed to alcohol rather than to neutral cues. Additionally, both response inhibition and trait impulsiveness predicted cue-elicited craving for alcohol. Trait impulsiveness predicted both the absolute craving in the bar–restaurant and the increase in cue-elicited craving during the whole alcohol cue exposure, while response inhibition predicted only the former.

Conclusions

The results clearly implicate both trait impulsiveness and response inhibition in the modulation of cue-elicited craving in alcohol dependence. Theoretical and methodological issues in the findings and their clinical implications in alcohol treatment and relapse are discussed.     

Affect and craving: Positive and negative affect are differentially associated with approach and avoidance inclinations

Background

Research on reactivity to alcohol and drug cues has either ignored affective state altogether or has focused rather narrowly on the role of negative affect in craving. Moreover, until recently, the relevant analyses of affect and craving have rarely addressed the ambivalence often associated with craving itself. The current study investigated how both negative and positive affect moderate approach and avoidance inclinations associated with cue-elicited craving in a clinical sample diagnosed with substance use disorders.

Methods

One hundred forty-four patients (age range of 18–65, mean 42.0; n = 92 males) were recruited from an inpatient detoxification unit for substance abuse. Participants completed a baseline assessment of both positive and negative affect prior to completing a cue-reactivity paradigm for which they provided self-report ratings of inclinations to approach (use) and avoid (not use) alcohol, cigarettes, and non-psychoactive control substances (food and beverages).

Results

Participants with elevated negative affect reported significantly higher approach ratings for cigarette and alcohol cues, whereas those high in positive affect showed significantly higher levels of avoidance inclinations for both alcohol and cigarette cues and also significantly lower approach ratings for alcohol cues, all relative to control cues.

Conclusions

Results for negative affect are consistent with previous cue reactivity research, whereas results for positive affect are unique and call attention to its clinical potential for attenuating approach inclinations to substance use cues. Further, positive affect was related to both approach and avoidance inclinations, underscoring the utility of a multidimensional conceptualization of craving in the analysis.     

Effect of positive and negative affective stimuli and beverage cues on measures of craving in non treatment-seeking alcoholics

RATIONALE: Laboratory paradigms are useful for investigating mechanisms of human alcohol cue reactivity in a highly controlled environment. A number of studies have examined the effects of beverage exposure or negative affective stimuli on cue reactivity independently, but only a few have reported on interaction effects between beverage cue and affective stimuli, and none have evaluated the effects of positive stimuli on beverage cue reactivity. OBJECTIVES: To assess independent and interactive effects of both positive and negative affective stimuli and beverage cue on psychophysiological and subjective measures of reactivity in alcohol dependence. MATERIALS AND METHODS: A total of 47 non-treatment-seeking paid volunteers with current alcohol dependence participated in a within-subjects trial where each was exposed to a standardized set of pleasant, neutral, or unpleasant visual stimuli followed by alcohol or water cues. Psychophysiological cue-reactivity measures were obtained during beverage presentation, and subjective reactivity measures were taken directly following beverage presentation. RESULTS: Mixed-effect models revealed a significant main effect of beverage and positive (but not negative) affective stimuli on subjective strength of craving and significant main effects of both positive and negative affective stimuli on ratings of emotionality. Despite the power to detect relatively small interaction effects, no significant interactions were observed between affect and beverage conditions on any reactivity measure. CONCLUSIONS: A key finding of this study is that positive affective stimuli commonly associated with drinking situations can induce craving in the absence of alcohol cues. Main effects of beverage cue replicated results from previous studies. Beverage and affective cues showed no interaction effects.     

Alcohol craving in adolescents: bridging the laboratory and natural environment

Rationale

Initial lab studies suggest that adolescent drinkers crave alcohol when presented with alcohol cues. Whether this effect generalizes to the natural environment, however, remains unknown, and studies have not examined whether craving predicts drinking among youths.

Objectives

This study builds on existing research by pairing controlled lab-based cue reactivity assessments (CRAs) with data collected in the natural environment using ecological momentary assessment (EMA) methods. We examined whether alcohol cues evoke craving among adolescent drinkers in the lab and natural environment, and tested the clinical relevance of craving during adolescence by examining the prospective association between craving and alcohol use.

Methods

Non-treatment-seeking adolescent drinkers (N?=?42; ages 15 to 20 years) completed a lab-based CRA followed by a 1-week EMA monitoring period. During the EMA period, youth were prompted randomly throughout the day to record momentary data on craving and contextual factors (e.g., alcohol cues, peers present).

Results

Alcohol cues elicited craving in the lab, and this effect generalized to the natural environment, especially among adolescents with more alcohol problems. In addition, craving predicted subsequent drinking levels in the natural environment.

Conclusions

This study demonstrates the utility of pairing lab paradigms with EMA methods to better characterize adolescents' reactivity to alcohol cues. Results implicate craving as a clinically meaningful motivator for drinking among adolescents and highlight a potentially important target of pharmacological or behavioral intervention.