It should also be noted that cue-elicited craving may be accentuated in individuals experiencing negative emotional states, particularly in high risk situations. In the context of the cognitive behavioral relapse prevention model (Marlatt & Gordon, 1985), under situations of stress (Larimer, Palmer, & Marlatt, 1999; Hendershot, Witkiewitz, George, & Marlatt, 2011), the anticipatory pleasure (i.e. positive reinforcement, preexisting expectancies) associated with drug-taking is heightened, intensifying craving. In fact, stress-induced craving has been found to be a more potent predictor of relapse than drug-cue induced craving (Sinha, Garcia, Paliwal, Kreek, & Rounsaville, 2006; Sinha et al., 2011). Therefore, our association signals in dopamine pathway genes, which have previously been implicated in cue-induced craving, may have shown modest p-values for self-reported craving, in part, due to the well-documented variations between cue-induced, stress-induced and self-reported craving.
