Conditioned responses to drug-related stimuli: is context crucial?

Research into the elicitation of conditioned responses (CRs) by drug-related stimuli in drug and alcohol addicts has produced apparently conflicting results in relation both to the form of the CR (drug-like or drug-opposite) and to its importance in influencing relapse rates after detoxification. Most studies looking at cue-elicited responses directly have taken place with recently detoxified addicts in a laboratory setting. The present study examined cue-elicited reactions in eight currently dependent opiate users (receiving prescribed physeptone) during their drug preparation rituals. Seven were seen in their own homes and one in hospital. Subjects rated their mood and physical state before getting out the drug and paraphernalia, during preparation to inject, and after injection. By contrast with the withdrawal-like reactions, which are the most common finding in laboratory exposure studies where drugs are not subsequently accessible for use, these subjects showed a significant reduction in subjectively rated withdrawal symptoms during the pre-injection drug preparation ritual. The results are discussed in relation to the impact of the context of exposure in influencing subjective expectancies, with perception of drug availability seen as a critical part of the conditioned stimulus complex.