Epidemiological, clinical, and preclinical evidence indicate that the setting of drug use can exert a powerful modulatory influence on drug reward and that this influence is substance-specific. When heroin and cocaine co-abusers, for example, report on the circumstances of drug use, they indicate distinct settings for the two drugs: heroin being used preferentially at home and cocaine being used preferentially outside the home. Similar results were obtained in laboratory rats. These findings will be interpreted in the light of a novel model of drug reward, based on the emotional appraisal of central and peripheral drug effects as a function of environmental context. I argue here that drug addiction research has not paid sufficient attention to the substance-specific aspects of drug abuse and this may have contributed to the present dearth of effective treatments. Pharmacological and cognitive-behavioral therapy, for example, should be tailored so as to allow the addict to anticipate, and cope with, the risks associated, in a substance-specific manner, to the different settings of drug use.
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