What is presented, and what prevented, in cue exposure and response prevention with alcohol dependent subjects?

The following questions, pertaining to cue reactivity in alcoholics, are discussed: (a) What cues are relevant to alcoholics' drinking? Previous research has been concerned with the obvious: bottles, glasses, pub/bar environments, and other visual cues. Presumably more potent cues, that is, smell, taste and internal effects, subtle stimuli like social climate, shifts in conversations, also influence drinking. The effects of mood states on alcoholics' urges and behavior are rarely integrated into experimental studies. (b) What is the CR? Given that drinking is a very complex social behavior, "the drug effect" becomes problematic to disentangle from the effects of other factors, such as bio-medical states, social setting and learning history. This is further complicated by the fact that drugs affect physiological and cognitive systems differently at different dose levels and with rising and falling Blood Alcohol Levels. Moreover, it has been found that alcohol cues may elicit responses that are in the same and in the opposite direction to the drug response. (c) If such responses are reliably tied to alcohol cues (as opposed to novelty of the experimental situation), the impact of the conditioned responses on craving for alcohol and relapse becomes an issue. (d) Another question relates to the analogy between fear in phobias and craving in substance abuse since, unlike phobics, substance abusers do not fear the substance they are responding to. (e) A further issue is the effectiveness of extinction procedures, as opposed to changes in efficacy expectations, as a therapeutic mechanism for the cue exposure paradigm. Examples of recent research at the Hjellestad Clinic are presented.