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Only one study has investigated pupillometry as a measure of response to substance cue exposure in humans and found that pupillary bias toward alcohol versus neutral cues, but not subjective craving reports, predicted relapse to alcohol use in a sample of detoxified patients with alcohol dependence [40].
JMIR Serious Games 2024;12:e54220
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Pupillometry assesses pupil constriction and dilation changes that reflect autonomic nervous system (ANS) alterations relevant to ANS balance–imbalance [15-21]. Another physiological marker, heart rate variability (HRV), also reflects ANS status [22], with high HRV indicative of healthy states and low HRV signaling chronic disruption and pathology [23,24]. This study used both physiological markers to assess PTSD treatment efficacy.
JMIR Ment Health 2022;9(2):e26479
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Lastly, pupillometry represents an additional potential objective craving correlate. Pupil dilation is an indirect measure of norepinephrine (NE) release from the locus coeruleus and is associated with reward processing [45], including sensitivity to rewards [46], and engagement of cognitive resources [47].
JMIR Serious Games 2022;10(1):e32243
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