Cocaine cues used in experimental research: a systematic review

Abstract

Aims: cue exposure therapy (CET) is a promising treatment approach for
cocaine substance use disorder (SUD). CET specifically targets the
psychological and physiological responses elicited by drug-related cues, aiming
to reduce their motivational impact. To advance understanding of CET for
cocaine treatment, this systematic review aims to categorise the range of
cocaine cues used in research.

Methods: a systematic review of the existing literature with searches conducted
on PubMed and Web of Science bibliographic databases with no time
constraints in August 2024 (PROSPERO: CRD42024554361). Three reviewers
were independently involved in the screening, review and data extraction
process, in line with PRISMA guidelines. Data extracted included participant
demographics, study design, data on the cocaine cue task, and examples (if
provided). Each study was appraised and received a quality score. The
secondary outcome was to summarise examples for each category type
identified. The data are presented as a narrative synthesis.

Results: 3,600 articles were identified and screened. 235 articles were included
in the analysis. Cues identified included images, paraphernalia, drug-related
words, cocaine smell, auditory stimuli presented via audiotapes, video
recordings, scripts, and virtual reality environments, often combining multiple
modalities. Included studies recruited cocaine-dependent individuals,
recreational users, polydrug users, and non-cocaine-using controls. The sample
sizes of the studies ranged from a single case study to a study including 1,974
participants.

Conclusions: this review found that studies employed a wide range of cue
categories, but detailed examples were often lacking, limiting replication. The
number and combination of cues varied: some studies used only cocaine-
related images, while others included images, videos, physical items, and
audiotapes. The level of immersion and personalisation also differed
considerably. All studies used cocaine-specific cues, most commonly images or
representations of cocaine substance, cocaine use or drug paraphernalia, drug
preparation items, or conversations of cocaine use and its effects. The overall
quality of the included studies was deemed good, with all adhering to standard
research norms. While this review highlights the breath of cue types used in the
literature, further research should focus on enhancing cue exposure techniques
by incorporating more immersive and personalised stimuli, and by providing
clearer documentation of cue characteristics to support replication and clinical
translation.

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Identifiers

ORCID for Steven Glautier: orcid.org/0000-0001-8852-3268

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