Psychology Ph.D. Dissertations


An Evaluation of the Impact of Cue Exposure on the Relationship Between Pain Level and Craving For Prescription Opiods

Date of Award


Document Type


Degree Name

Doctor of Philosophy (Ph.D.)



First Advisor

Harold Rosenberg

Second Advisor

Rebecca Pobocik (Committee Member)

Third Advisor

Robert Carels (Committee Member)

Fourth Advisor

Richard Anderson (Committee Member)


Researchers have suggested that craving is one factor that maintains prescription opioid use in opioid-addicted pain patients. Additional research assessing craving in opioid addicted patients as a function of pain severity could provide evidence that those experiencing greater pain also experience greater craving. I designed the current study to assess the impact of exposure to opioid cues versus control cues on craving as a function of pain severity among a sample of prescription opioid-addicted patients. I also assessed whether drug use characteristics were associated with craving for prescription opioids. I recruited patients who preferred prescription opioids as their primary drug of choice from three different drug treatment centers. Prior to and following cue exposure, participants completed the multi-dimensional Desire for Drugs Questionnaire (DDQ) and the dot probe task to assess craving and attentional bias, respectively. Participants were then randomly assigned to listen to either a recording of a narrated scenario in which prescription opioids were mentioned (i.e., active cue exposure) or a recording of a narrated scenario in which prescription opioids were not mentioned (i.e., control cue exposure). Contrary to my hypotheses, prescription opioid-related cue exposure did not enhance craving. In addition, although participants showed attentional bias to opioid-related words at baseline, there was no significant impact of cue exposure on attentional bias. Multiple regression analyses revealed that pain severity was significantly associated with desire-and-intention to use prescription opioids, but not with craving for relief from negative states. Furthermore, preoccupation and intrusive thoughts about prescription opioids, negative meta-cognitions about craving, and outcome expectancies of pain relief from taking prescription opioids were significantly associated with craving. The DDQ seems to provide a more sophisticated measurement of craving relative to single-item rating scale. In addition, these results may help clinicians and researchers to define craving as an urge to achieve euphoria from the drug, rather than urge to avoid dysphoria in individuals who experience both pain and opioid addiction. Tailoring cue exposure and opioid-related stimuli used in the dot probe task could show more robust effects of cue exposure on craving and attentional bias.