The role of Pavlovian processes in drug tolerance and dependence: Implications for treatment

Evidence for the crucial role of Pavlovian conditional compensatory responses in tolerance to opiates and alcohol is presented. Furthermore, an analysis of the motivational role of Pavlovian conditional compensatory responses to craving and relapse is discussed, and supportive experimental and epidemiological evidence are presented. Given the role ascribed to Pavlovian processes in tolerance, craving, and relapse, it is proposed that extinction of cues which elicit conditional compensatory responses is an essential factor for treatment. Additionally, it is suggested that by virtue of prior Pavlovian conditioning, stress and depression may serve as cues to elicit conditional compensatory responses and attendant craving and these cues can also be extinguished by Pavlovian procedures. Finally, it is suggested that explication of this conditioning analysis to the patient may itself be an important cognitive adjunct to treatment.