Subliminal Drug Stimuli Activate Craving
> 2/6/2008 2:22:52 PM

Addiction programs often focus on conscious decisions to stay away from drugs. However, there is a riptide lurking beneath awareness that can pull unsuspecting addicts back into substance abuse; the limbic system works behind the scenes with the rewards and emotions that trigger craving. A study by Dr. Anna Childress, released online last week by the Public Library of Science, found that the limbic system can be activated by "unseen" cues.

It has long been known that the sight of someone using a drug triggers craving in addicts— the same principle has made itself known to millions of dieters who have had to watch their friends feast in front of them . In 2000, Dr. Inmar Franken determined that heroin addicts experienced strong attention biases after exposure to supraliminal, but not subliminal, stimuli. However, the belief that subliminal cues can trigger craving persists among many researchers. The National Institute on Drug Abuse seems to support this belief on its website by warning addicts to avoid "encountering streets, objects, or even smells associated with drug use."

Dr. Childress discovered that precise fMRI scans can capture a neural response to subliminal drug stimuli. The experimenters showed 22 male cocaine addicts images of cocaine paraphernalia flashed for a mere 33 milliseconds. For extra precaution, these images were masked by a more prominent follow-up picture, and subjects were tested later to confirm that they were not aware that they had seen the masked images. Numerous brain regions showed activation, including the amygdala, the ventral striatum and ventral pallidum, the insula, and the temporal poles.

All of the activated brain regions have some relation to pleasure seeking behavior, and while subjects were not actually tested to see if they were more likely to use after watching the images, there is certainly a link between activation and behavior. Interestingly, the immediate activation was able to predict the strength of a subject's response to a supraliminal picture two days later.

The discovery of the effects of subliminal drug cues is important for treatment. Patients who are trying to quit should be made aware of these potential triggers, indeed they should be aware that virtually anything may set off a crazing. A murmured reference to cocaine by doctors in the hall, the faintest smell of smoke— any of these could trigger a craving and eventually lead to a relapse.

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