Cue Reactivity in Adolescents: Measurement

Objective: There were two specific goals for the current study: (I) to demonstrate that adolescents display drug-specific cue reactivity to alcohol and cigarette visual cues that varies based on druguse history and (2) to test the unique contribution of adolescents' avoidance reactions to alcohol and cigarette cues, independent of approach/craving reaction. Method: Adolescents (N = 143; age 13-20 years; 58 males) with varied substance-use histories were recruited from school and community sites. Adolescents were presented with a series of alcohol, cigarette, and nondrug comparison visual cues and reported their approach/cmving and avoidance reactions. They also completed individual difference measures related to their alcohol and cigarette use and experiences. Results: When adolescents were grouped according to their current alcohol or cigarette use (no use, low use, high use), increased use of alcohol or cigarettes was associated with stronger reactions (increased approach, decreased avoidance) to cues for that substance but not to nondrug control cues. Simultaneous regression analyses demonstrated that after controlling for approach/craving reactions, avoidance cue reactions predicted unique and/or incremental variance in measures of alcohol and cigarette usage, recent change in patterns of use, alcohol expectancies, alcohol restraint and parental alcohol problems. Conclusions: Adolescents displayed robust alcohol and cigarette cue-specific reactions that varied systematically with their current use of these drugs. Across numerous clinically relevant individual difference variables, predictive power was greatly enhanced through the inclusion of both avoidance and approach reactions. (J Stud. Alcohol 66: 332-343, 2005) N UMEROUS THEORISTS have observed that repeated drinking or drug use in the pr senc of specific environmental stimuli, or cues, can lead to a set of conditioned responses when in the presence of those stimuli, responses that can be called cue reactivity (e.g., Abrams and Niaura, 1987; Carter and Tiffany, 1999; Drummond et al., 1995). The most common alcohol cue is the sight of the beverage itself in its usual container, the final common pathway for most drinking. Cue reactivity can be an important marker of alcohol problems in that such reactions are stronger for alcoholics than nonalcoholics (Cooney et al., 1984; Monti et al., 1987), are predicted by depressed mood and various beliefs (Rohsenow et al., 1992) and have been found to predict drinking after treatment for alcoholics (Drummond and Glautier, 1994; Monti et al., 1993, 2001; Rohsenow et al., 1994, 2001). More directly, many theorists have suggested that implicit and explicit reactions prompted by substance-related cues result from both positive and negative reinforcement mechanisms,and play an important etiologic role in the development of substance use disorders (e.g., Received: August, 17, 2004. Revision: December 20, 2004. *Research for this article was supported by grants from the National Cancer Institute (R01 CA80255) and the National Institute onAlcoholAbuse and Alcoholism (ROI AA09892). tCorrespondence may be addressed to John J. Curtin at the above address, or via e-mail at: [email protected]. Nancy P. Barnett, Suzanne M. Colby, Damaris J. Rohsenow and Peter M. Monti are at Brown University Center for Alcohol and Addiction Studies, Brown University, Providence, RI. Baker et al., 2004; Curtin et al., in press; Robinson and Berridge, 1993). Finally, studies of alcohol cue reactivity have also led to the development of cue-exposure-based treatments (e.g., Drummond and Glautier, 1994; Monti et al., 1993, 2001; Rohsenow et al., 2001). Although numerous studies of alcohol cue reactivity have been conducted among adults in treatment for alcohol dependence, little is known about the alcohol cue reactivity of adolescents. Finding a methodology that reliably elicits alcohol cue reactivity in this population should result in the ability to use the methodology as heuristically as has been done for adults. Modest but reliable relationships have been observed between exposure to alcohol cues through advertising and levels of alcohol use among adolescents, suggesting that alcohol cue exposure may affect motivation to use alcohol (Adlaf and Kohn, 1989; Martin et al., 2002). Research on tobacco advertising demonstrates a similar relationship between exposure to tobacco products in advertising and movies and smoking-related behaviors and attitudes among adolescents (Goldberg, 2003; Henriksen et al., 2003). Although it is possible that adolescents may display cue reactivity much like their adult counterparts, cue reactivity in adolescents has received relatively little attention. Only two studies have directly examined cue reactivity among adolescents, one with alcohol and the other with cigarettes. Tapert et al. (2003) used functional magnetic resonance imaging to examine the brain response to alcoholic and nonalcoholic beverage cues in adolescents with 332 ----------------------------