Assessment of substance cue reactivity: Advances in reliability, specificity, and validity

An arousal-control and cross-over design was used to evaluate the reliability, specificity, and validity of the Normative Appetitive Picture System (NAPS), a cue exposure protocol with sets of visual alcohol, cigarette, and control cues. The authors also examined the utility of conceptualizing cue reactivity as a multidimensional phenomenon involving independent approach and avoidance dimensions. University student participants (n = 369) rated multiple cue images in terms of arousing properties and capacity to elicit separate approach and avoidance inclinations. They also completed a battery of substance-related individual-difference measures. Results indicated that NAPS protocol reactivity profiles had good reliability and high specificity across cue types and individuals with different substance use histories. Avoidance reactivity independently predicted self-reports of substance-related behaviors, after controlling for approach reactivity.