Cue exposure therapy for the treatment of opiate addiction: results of a randomized controlled clinical trial.
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.
Marissen
Marlies A E
MA
Centre for Personality Disorders PsyQ, The Hague, The Netherlands. m.marissen@psyq.nl
Franken
Ingmar H A
IH
Blanken
Peter
P
van den Brink
Wim
W
Hendriks
Vincent M
VM
D000328:Adult; D001143:Arousal; D003463:Cues; D003887:Desensitization, Psychologic; D005260:Female; D005712:Galvanic Skin Response; D003932:Heroin / Q000009:adverse effects; D006556:Heroin Dependence / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D009426:Netherlands; D010352:Patient Dropouts / Q000523:psychology; D011613:Psychotherapy; D055502:Secondary Prevention; D020377:Self Efficacy; D015819:Substance Abuse, Intravenous / Q000523:psychology / Q000534:rehabilitation; D013375:Substance Withdrawal Syndrome / Q000523:psychology / Q000534:rehabilitation; D017211:Treatment Failure
D003932:Heroin