Psychological Medicine, 2000, 30, 169–175. Printed in the United Kingdom  2000 Cambridge University Press Attentional bias for drug cues in opiate dependence D. I. LUBMAN, L. A. PETERS, K. MOGG, B.P.BRADLEY,  J. F. W. DEAKIN From the Neuroscience and Psychiatry Unit, University of Manchester ; and Department of Experimental Psychology, University of Cambridge ABSTRACT Background. In a number of theories of compulsive drug use conditioned responses to stimuli associated with drug taking play a pivotal role. For example, according to incentive-sensitization theory (Robinson & Berridge, 1993), drug-related stimuli selectively capture attention, and the neural mechanisms underlying this attentional bias play a key role in the development and maintenance of drug dependence, and in relapse. However, there has been little work that assesses attentional biases in addiction. Methods. We used a pictorial probe detection task to investigate whether there is an attentional bias to stimuli associated with drug use in opiate dependence. Stimuli presented included pairs of drug- related and matched neutral pictures. Methadone-maintained opiate addicts (N  16) were compared with age-matched controls (N  16). Results. A mixed design analysis of variance of response times to probes revealed a significant three- way interaction of groupdrug picture locationprobe location. Opiate addicts had relatively faster reaction times to probes that replaced drug pictures rather than neutral pictures, consistent with the predicted attentional bias to drug-related stimuli. Conclusions. These results support the idea that an attentional bias for drug-related stimuli occurs in opiate dependence. This is consistent with the concept of a central role for such salient stimuli in compulsive drug use. INTRODUCTION Drug-related stimuli can become powerful con- ditioned reinforcers that maintain drug use in animals (Stewart et al. 1984; see review in Altman et al. 1996). Drug cues that reliably predict drug reward are likely to be of motiva- tional salience to an addicted individual, and may come to control behaviour by capturing attention. Recent cognitive and behavioural theories of addiction support the idea of an attentional bias for drug stimuli. In their incentive-sensitization theory of addiction, Robinson & Berridge (1993) propose that stimuli associated with drug-taking become ‘ wanted ’ and ‘ grab attention ’. The presumed mechanism for this incentive effect is mediated by dopamine. An important feature of Robinson & Berridge’s  Address for correspondence : Dr Karin Mogg and Dr Brendan Bradley, Department of Experimental Psychology, University of Cambridge, Cambridge CB2 3EB. model is that there are individual differences in susceptibility to sensitization. That is, indi- viduals vary in the extent to which the dopamine- related system is prone to transforming the perception of drug-associated stimuli into at- tractive, ‘ wanted ’ attention-grabbing stimuli. If so, the attentional bias for drug-related cues may provide a cognitive index of susceptibility to opiate dependence and resistance to attempts at abstinence. An attentional bias is also likely to result in increased likelihood of noticing drug-relevant stimuli in the environment ; increased preoccu- pation and intrusive thoughts concerning the drug ; and increased distractibility and difficulty concentrating on everyday tasks (i.e. impaired ability to focus attention on drug-unrelated activities). Thus, such an attentional bias may directly lead to renewed drug taking or relapse. An alternative theoretical view of addiction was put forward by Tiffany (1990), who pro- posed, from a cognitive perspective, that drug 169