When trauma triggers craving: meta-analytic evidence for the mediating role of negative affect among trauma-exposed individuals who use substances

Background: In experimental studies using the cue reactivity paradigm (CRP), classically conditioned substance craving is well-documented among individuals who use substances with trauma histories. However, the magnitude of this effect has not yet been quantified, nor have moderators of this relationship been identified [DeGrace, S., Romero-Sanchiz, P., Standage, C., & Stewart, S. H. (2022). A scoping review of the literature on trauma cue-induced drug craving in substance users with trauma histories or PTSD. IntechOpen. https://doi.org/10.5772/intechopen.103816].Objective: While the mechanism driving these trauma cue-induced craving effects has been suggested to involve trauma cue-induced negative affect [Baker, T. B., Piper, M. E., McCarthy, D. E., Majeskie, M. R., & Fiore, M. C. (2004). Addiction motivation reformulated: An affective processing model of negative reinforcement. Psychological Review, 111(1), 33-51. https://doi.org/10.1037/0033-295X.111.1.33], this remains largely untested.Method: We conducted a meta-analysis to quantify the trauma cue-induced craving effect size, as well as possible moderators of these effects. Moreover, we utilized two-step meta-analytic structural equation modelling (TS-MA-SEM) to test the indirect effect of trauma (vs. neutral) cue exposure on substance craving through negative affect as the mediator. Our literature search returned n = 32 studies involving a total of k = 21 unique datasets that were included in our analyses.Results: Results supported our hypothesis that trauma cues would induce greater substance craving relative to other cue types/controls (neutral cues, substance cues, pre-cue baseline), with small to medium effect sizes (d = 0.259 - 0.526). We found a few theoretically relevant moderators (CRP method, study quality, and % of sample with PTSD) that varied by comparator condition. Additionally, results supported our proposed mediational model with negative affect indirectly explaining the relationship between trauma cue exposure and substance craving.Conclusions: Results suggest that trauma cue-elicited substance craving is a robust phenomenon that may be explained through trauma cue-induced negative affect driving increased craving.