# Out of Sight, Easier to Bear

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- Last updated: 2026-09-05
- Page title: Out of Sight, Easier to Bear | Assoc. Prof. Dr. Alişan Burak Yaşar

> One in five soldiers returning from Vietnam had an opiate addiction; after their return, the rate fell below 1%. The role of environment and conditioned cu

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# Out of Sight, Easier to Bear

September 5, 2026Recent Articles

One in five soldiers returning from Vietnam had an opiate addiction during their deployment. After their return, this rate fell below 1%.

In this classic follow-up study of a sample of 943 enlisted men, most did not even seek treatment. What changed was not their determination. It was their environment (Robins et al., *American Journal of Epidemiology*, 1974).

In addiction, the brain learns to associate not just the substance itself, but also the environment in which it is used. The shape of a glass, a smell, a particular street, a particular friend. These are called conditioned cues. A meta-analysis of 51 studies involving 1,787 participants found that these cues elicited consistent brain activation, and that lower activation at the start of treatment was associated with better outcomes (Evohr et al., *JAMA Network Open*, 2025). In 36 patients with stimulant use disorder, the brain's response to cues predicted relapse months later (MacNiven et al., 2018).

It can be misleading to assume that craving fades in the first few weeks. Among 80 patients with alcohol dependence, cue-induced craving was highest on day 60 (Li et al., *Addiction Biology*, 2014). The same increase was not demonstrated in clinical studies of opioids, so this finding does not apply to every substance (Bergeria et al., 2024).

But making avoidance the sole strategy does not improve outcomes. In a study that followed 461 people for 16 years, those who relied more heavily on avoidance were both less likely to achieve remission and more likely to relapse (Moos & Moos, *Addiction*, 2006). The strongest predictor of successfully navigating a relapse crisis was the number of coping strategies used (Moser & Annis, 1996).

In short: modifying the environment reduces risk; adding skills and treatment makes the benefits last. Neither can replace the other.

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