Using cue reactivity to evaluate medications for treatment of cocaine dependence: a critical review

Aims. The aim of this article is to examine the validity of a cue-reactivit y paradigm for evaluating medications to treat cocaine dependence and to cr itically review cocaine pharmacotherapy studies that use this method Method s. A Medline computerized search was performed to identify randomized contr olled medication studies for cocaine dependence that employed a cue-reactiv ity paradigm. Relevant bibliographies of these articles were also reviewed. Eleven placebo-controlled studies were identified in the English language literature. Four of these studies used agents that block dopaminergic neuro transmission, two studies used agents that modify the serotonergic system, and two studies used nicotinergic agents. The other three studies employed a mood stabilizer, an opioid antagonist or a psychostimulant. Results. Ther e has been little research examining the theoretical basis of the cue-react ivity model, as applied to the screening of medications to treat cocaine de pendence. From a methodological viewpoint, most studies have shown that exp osure to cocaine-related stimuli increases subjective and physiological rea ctivity in cocaine-dependent patients, but methods used to present the cues and to measure cue reactivity have not been consistent across studies. Sim ilarly, the observed increase in subjective and physiological reactivity to cocaine cues has varied within and across studies. Conclusions, If a cocai ne cue-reactivity paradigm is to be used to evaluate medications for treatm ent of cocaine dependence, the validity of the model must first be demonstr ated and a consistent methodology far cue presentation and measurement of r esponses must be developed.