Smokers who want to quit use often report craving. One study addresses the question of whether retrieval-extinction training can help maintain abstinence or reduce use.
Research question: Key stimuli (“cues”) play an important role with regard to learning behavior and memory processing in addictive disorders. Smokers who want to quit often report craving triggered by conditioned stimuli, such as an ashtray or lighter. Can “retrieval-extinction” (RE) training [1] help maintain abstinence or reduce use?
Background: Exposure therapies, in which the patient is repeatedly exposed to a key stimulus, show little or only brief effect in addiction disorders, in contrast to anxiety disorders. In particular, maladaptive reward memories, which play a major role in addictive behaviors, show resistance to long-term extinction. However, prior research on memory processing in addictive behaviors indicates that RE training can attenuate or eliminate the effects of key stimuli. For example, a study of formerly heroin-dependent patients showed that RE training significantly reduced craving triggered by “cues” [2]. In RE training, the subject is first presented with the unconditioned stimulus, e.g., cigarette smoke or pictures of people smoking, and then exposure therapy is initiated with the conditioned stimulus. It is thought that reward memories can be destabilized by reactivation (“retrieval”) and thus “overwritten” or altered for a period of time.
PATIENTS AND METHODS: This prospective randomized trial examined the impact of RE training on 88 nicotine-dependent patients. These were divided equally into two groups. The RE training group was first shown a video with smokers, then extinction training was started regarding new and known key stimuli. The control group watched a neutral video followed by the same extinction training. Primary endpoint: Craving to key stimuli (by questionnaires and physiological response) was assessed in test sessions after 24h, two weeks, and one month. Secondary endpoint: Furthermore, smoking behavior was assessed in both groups.
Results: One-month follow-up showed that mean craving was significantly lower in the RE group (p<0.05). Likewise, craving after exposure to smoking videos and the newly presented key stimuli was more attenuated in the RE group than in the non-RE group (p=0.4). The average number of cigarettes smoked was also significantly lower in the RE group. Specifically, significantly more patients achieved a 60% reduction in the RE group (51.5%) compared with the non-RE group (25.6%). At 1-month follow-up, this difference was significant (p=0.6; 2-week and 1-month follow-up, p=0.18 and p=0.04, respectively).
Conclusion: RE training provides an easy-to-implement, low-risk brief intervention in the treatment of addictive disorders. Future studies should examine the effect of RE training as part of a multimodal approach to addiction treatment.
InFo NEUROLOGY & PSYCHIATRY 2017; 15(3): 33.
