Women Inmate Substance Abusers’ Reactivity to Visual Alcohol, Cigarette, Marijuana, and Crack-Cocaine Cues: Approach and Avoidance as Separate Dimensions of Reactivity

Abstract

Despite the growing recognition for multidimensional assessments of cue-elicited craving, few studies have attempted to measure multiple response domains associated with craving. The present study evaluated the Ambivalence Model of Craving (Breiner et al., 1999; Stritzke et al., 2007) using a unique cue reactivity methodology designed to capture both the desire to use (approach inclination) and desire to not consume (avoidance inclination) in a clinical sample of incarcerated female substance abusers. Participants were 155 incarcerated women who were participating in or waiting to begin participation in a nine-month drug treatment program. Results indicated that all four substance cue-types (alcohol, cigarette, marijuana, and crack cocaine) had good reliability and showed high specificity. Also, the validity of measuring approach and avoidance as separate dimensions was supported, as demonstrated by meaningful clinical distinctions between groups evincing different reactivity patterns and incremental prediction of avoidance inclinations on measures of stages of change readiness. Taken together, results continue to highlight the importance of measuring both approach and avoidance inclinations in the study of cue-elicited craving.

Individual Differences in Approach and Avoidance Inclinations Moderate the Effect of Self‐Control Depletion on Ad‐Lib Drinking

“…This may be particularly important given the relatively low scores on avoidance inclinations. This is not surprising because avoidance inclinations are believed to develop as a result of problems associated with use (e.g., Breiner et al, 1999; Schlauch et al, 2013), and standard screening procedures for alcohol administration studies require one to rule out problematic alcohol use. Nevertheless, avoidance inclinations did significantly moderate the relationship between approach inclinations, self-control depletion, and alcohol consumption.…”

“…Schlauch et al, 2013a; Curtin et al, 2005; Stritzke et al, 2004). Further, avoidance moderates the effect of approach inclinations on drinking (Schlauch et al, 2013c), is incrementally related to taking steps to make a change (Klein et al, 2007; Schlauch et al, 2013a; Schlauch et al, 2012; Schlauch et al, 2013c), and may be more predictive of relapse among alcoholics, rather than increases in approach inclinations (Stritzke et al, 2007). This is important as it suggests that once internal or external cues trigger urges to use, resisting such urges takes effort (Tiffany, 1990).…”

Ambivalence Model of Craving: A Latent Profile Analysis of Cue-Elicited Alcohol Craving in an Inpatient Clinical Sample

“…Nine appetitive substance categories were represented: alcoholic beverages (n = 15; 6 beer, 6 distilled spirits, 3 wine), cigarettes (n = 6), marijuana (n = 6), stimulant drugs (n = 12; 6 crack cocaine, 6 cocaine), prescription medication (n = 12; 6 benzodiazepines, 6 opiates), heroin (n = 6), food (n = 6), and nonalcoholic beverages (n = 6). The alcoholic beverage slides were from the Normative Appetitive Picture System , which have been previously validated for measuring both approach and avoidance inclinations in three independent samples (Curtin et al, 2005;Schlauch et al, 2013a;Stritzke et al, 2004). Alcohol cues varied by setting (e.g., bar, restaurant, home, neutral background) and activity state (e.g., substance sitting untouched on table, held in hand, or actively consumed).…”

“…Further, avoidance inclinations are positively related to taking steps to make a change, demonstrating congruence between desire to not consume alcohol and self-reported behaviors to abstain from or reduce alcohol use (Klein et al, 2007;Schlauch et al, 2012Schlauch et al, , 2013a. They also distinguish between clinically significant subgroups of smokers trying to quit (high approach, high avoidance) and not quit (high approach, low avoidance), differentiating among those craving cigarettes smokers who are also ready to change and who may benefit from intervention .…”

“…Studies examining avoidance inclinations have provided support for its incremental validity in predicting substancerelated variables in both nonclinical and clinical samples, and findings from cue-reactivity studies indicate that approach and avoidance can be independently measured as separate dimensions (Curtin et al, 2005;Schlauch et al, 2013a;Stritzke et al, 2004). Further, avoidance inclinations are positively related to taking steps to make a change, demonstrating congruence between desire to not consume alcohol and self-reported behaviors to abstain from or reduce alcohol use (Klein et al, 2007;Schlauch et al, 2012Schlauch et al, , 2013a.…”