Cue Exposure Therapy for Alcohol Use Disorders: What Can Be Learned from Exposure Therapy for Anxiety Disorders?

Autor:	Vickie Giannopolous, Simon P. Byrne, Andrew Baillie, Kirsten C. Morley, Paul S. Haber
Rok vydání:	2019
Předmět:	Health (social science) Cue exposure medicine.medical_treatment media_common.quotation_subject Exposure therapy Implosive Therapy 030508 substance abuse Medicine (miscellaneous) Alcohol use disorder 03 medical and health sciences 0302 clinical medicine mental disorders medicine Humans 030212 general & internal medicine Limited evidence media_common business.industry Addiction Public Health Environmental and Occupational Health Fear medicine.disease Anxiety Disorders Alcoholism Psychiatry and Mental health Treatment Outcome Anxiety Cues Substance use medicine.symptom 0305 other medical science business Psychosocial Clinical psychology
Zdroj:	Substance Use & Misuse. 54:2053-2063
ISSN:	1532-2491 1082-6084
DOI:	10.1080/10826084.2019.1618328
Popis:	Background: Cue Exposure Therapy (CET) has shown efficacy for treating alcohol use disorders (AUDs). Exposure therapy is highly effective for treating anxiety. Both techniques involve repeated, controlled exposures to alcohol or fear-related stimuli. Objectives: We considered the mechanisms of CET for AUDs by comparing it to exposure therapy for anxiety. Method: We conducted a narrative review contrasting theoretical literature examining the mechanisms of CET versus exposure therapy for anxiety. We reviewed RCTs and acute laboratory paradigms examining CET for AUDs. We considered common areas of emerging research, including the use of d-Cycloserine (DCS) and virtual reality (VR). Results: We found evidence that exposure therapy and CET at least partially achieve their effects through extinction learning. We found evidence that CET for AUDs is effective, with comparable benefits to other effective psychosocial treatments. DCS and VR have shown some limited success for augmenting CET for AUDs, so further research is needed to determine their value. Conclusions: There are theoretical and practical similarities between exposure to fear cues and cues of addiction, especially regarding extinction learning. However, these processes are also unique, particularly regarding the differing motivational properties of fear versus reward-related stimuli. We propose that unlike exposure for anxiety, CET takes effect by increasing self-control with each unreinforced exposure. We consider reasons for CET's limited use for AUDs, including its lower acceptability to clients and clinicians. We also note the limited evidence for CET for other substance use disorders, highlighting the need for continued investigation into its mechanisms and efficacy.
Databáze:	OpenAIRE
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