Memory Retrieval and Extinction Reduces Craving For Cigarettes Interview with:

Michael E. Saladin, Ph.D. Professor, Department of Health Sciences and Research College of Health Professions Medical University of South Carolina Charleston, SC

Dr. Michael Saladin

Michael E. Saladin, Ph.D.
Professor, Department of Health Sciences and Research
College of Health Professions
Medical University of South Carolina
Charleston, SC What is the background for this study?

Response: To the extent that learning and memory processes govern all aspects of behavior, they also govern dysregulated or maladaptive behaviors such as addiction and anxiety states. In the former case, stimuli associated with drug administration can acquire the ability to control drug-related motivational states (urges and craving) as well as drug seeking behavior. To illustrate the point, the simple act of observing a person light up a cigarette will cause the typical smoker to desire a cigarette and engage in smoking. A nonsmoker, by contrast, would not be similarly affected because they have no history where stimuli associated with smoking (e.g., sight of a lighter, cigarettes, plumes of smoke) are reliably paired with, or followed by, the rewarding effects of nicotine.

The research we conducted recently was based on neuroscience research showing that retrieved drug-associated memories (prompted with drug-paired cues) can be updated with information that decreases drug craving and/or administration. One such study showed that heroin craving in heroin addicts can be decreased by retrieving memories for heroin use via a brief heroin cue presentation (video of people using heroin) and then, a short time later, presenting an extensive variety of heroin cues (video, pictures and heroin use paraphernalia) over a 1-hour period. The logic of this intervention was that once the heroin memories were prompted into a labile state by the brief video presentation, the extensive heroin cue exposure would serve to update the content of the original memories with new information (i.e., cues are not followed by heroin reward) that is inconsistent with the original cue-drug contingency (i.e., cues are followed with heroin reward). Remarkably, just two sessions of this type of training, which we call retrieval-extinction training, resulted in significant reductions in heroin craving that persisted for six months. This study was done with heroin addicts who were inpatients so there was no way to assess the effects of this treatment on actual heroin use. What are the main findings?

Response: Based on these findings, we conducted a study in which a group of cigarette smokers were administered two treatment sessions in which a brief 5-min. video depicting individuals smoking (served to retrieve smoking-related memories) was followed 10- min. later by an extensive 1-hour series of smoking-related cue exposures consisting of video, pictures and smoking paraphernalia. The “retrieval-extinction training” in this group was contrasted with the training administered to a control group, which was identical with one important exception; the initial 5-min. video did not contain any smoking-related content. Consequently, members of the control group would not be expected to have their smoking-related memories retrieved and enter into the critical malleable state.

The results indicated that while both groups evidenced decreased craving during the 2-week and 1-month follow-up test sessions, the craving of the group that received retrieval-extinction training was significantly more reduced at the 1-month test. More importantly, the number of cigarettes smoked per day over the 1-month follow-up was significantly lower (25% lower) in the group that received retrieval-extinction training. What should readers take away from your report?

Response: It is essential to note that the differences in craving and smoking observed in this study were the products of a very brief and simple experimental manipulation involving the presentation of a 5-min. video with smoking-related content. Additionally, this study the first to demonstrate a reduction in human drug use behavior following an intervention that was specifically designed to target key addiction-related memory processes.

Lastly, because retrieval-extinction training can be used target a wide variety of aberrant memory processes, it could easily be adapted to treat addiction to any substance, as well as some anxiety disorders (e.g., PTSD). What recommendations do you have for future research as a result of this study?

Response: With respect to smoking, I believe there are at least two avenues of research that could be advanced. One is related to replication and extension of the existing findings. Here, I think it would be reasonable to understand how increasing the dose of treatment (number of sessions) might affect craving and smoking outcomes. Related to this, it would be important to document the longevity of the treatment effects via longer follow-up.

Lastly, I think it would be invaluable to identify possible neural processes associated with retrieval-extinction training (i.e., use imaging methods to determine if treatment-induced changes in neural activity predict clinical outcomes). A second line of research that needs to be undertaken is more clinical in nature. In this case, it will be important to determine if the addition of retrieval-extinction training to a course of pharmacotherapy (nicotine patch, varenicline, bupropion) improves smoking cessation outcomes.

On a final note, I think it will be desirable to assess the clinical utility of retrieval-extinction training when it is applied to other substance use disorders (e.g., prescription opioid misuse) and behavioral disorders (e.g., PTSD). Thank you for your contribution to the community.


Germeroth, L. J., Carpenter, M. J., Baker, N. L., Froeliger, B., LaRowe, S. D. and Saladin, M. E., (2017, Online). A Brief Memory Updating Intervention Significantly Attenuates Smoking Behavior. JAMA: Psychiatry, February 1, 2017, E1-10.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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