Abstract
Rationale
Effects of an intervention cannot be understood without precise knowledge of the baseline behavior on which the intervention is superimposed. For misusers of illicit drugs, patterns of daily activities and moods have not been studied in a way that is amenable to statistical aggregation.
Objective
The aim of the study was to compare hour-by-hour daily activities in cocaine-dependent outpatients during urine-verified periods of use and abstinence.
Methods
In a cohort design, a volunteer sample of 112 methadone-maintained cocaine- and heroin-abusing outpatients provided ecological momentary assessment (EMA) data on handheld computers for 10,781 person-days. EMA responses to questions about current location, activities, companions, moods, and recent exposure to putative drug-use triggers were compared across periods of use and abstinence using SAS Proc Glimmix (for binary outcomes) and Proc Mixed (for continuous outcomes).
Results
Periods of cocaine use were associated with idle, solitary, affectively negative afternoons but, unexpectedly, were also associated with a greater likelihood of early-morning or late-evening work. The whole-day concomitants of cocaine use were often distinct from the acute predecessors of use seen in prior analyses from the same sample. Several measures of negative mood increased during abstinence.
Conclusions
Weeks of cocaine use and abstinence in outpatients are associated with distinct patterns of mood and behavior; the detailed hourly data reported here should help inform treatment interventions aimed at changing daily activities. The findings also argue against the contention that cocaine abstinence symptoms decrease monotonically from the day of cessation.
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References
American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, fourth edition, text revision. American Psychiatric Association, Washington
Coffey SF, Dansky BS, Carrigan MH, Brady KT (2000) Acute and protracted cocaine abstinence in an outpatient population: a prospective study of mood, sleep and withdrawal symptoms. Drug Alcohol Depend 59:277–286
Epstein DH, Willner-Reid J, Vahabzadeh M, Mezghanni M, Lin J-L, Preston KL (2009) Real-time electronic-diary reports of cue exposure and mood in the hours before cocaine and heroin craving and use. Arch Gen Psychiat 66:88–94
Epstein DH, Marrone GF, Heishman SJ, Schmittner J, Preston KL (2010) Tobacco, cocaine, and heroin: craving and use during daily life. Addict Behav 35:318–324
Foltin RW, Fischman MW (1997) A laboratory model of cocaine withdrawal in humans: intravenous cocaine. Exp Clin Psychopharmacol 5:404–411
Foltin RW, Fischman MW (1998) Effects of “binge” use of intravenous cocaine in methadone-maintained individuals. Addiction 93:825–836
Fox S (2006) Demographics, degrees of Internet access, and health. Presented at Pew Internet & American Life Project meeting (Identifying and Disseminating Best Practices for Health eCommunities), Chapel Hill, NC. http://www.pewinternet.org/∼/media//Files/Presentations/2006/Fox_UNC_June_2006[1].pdf. Accessed 26 Oct 2009
Gawin FH, Kleber HD (1986) Abstinence symptomatology and psychiatric diagnosis in cocaine abusers: clinical observations. Arch Gen Psychiatry 43:107–113
Heather N, Stallard A, Tebbutt J (1991) Importance of substance cues in relapse among heroin users: comparison of two methods of investigation. Addict Behav 16:41–49
Marlatt GA, Gordon JRE (1985) Relapse prevention: maintenance strategies in the treatment of addictive behaviors. Guilford, New York
Palij M, Rosenblum A, Magura S (2003) Daily activities of cocaine-dependent methadone patients. J Maintenance Addict 2:65–85
Preston KL, Vahabzadeh M, Schmittner J, Lin JL, Gorelick DA, Epstein DH (2009) Cocaine craving and use during daily life. Psychopharmacology 207:291–301
Robins LN, Cottler LB, Bucholz KK, Compton WM III (1995) The diagnostic interview schedule, version IV. Washington University, St. Louis
Satel SL, Price LH, Palumbo JM, McDougle CJ, Krystal JH, Gawin F, Charney DS, Heninger GR, Kleber HD (1991) Clinical phenomenology and neurobiology of cocaine abstinence: a prospective inpatient study. Am J Psychiatry 148:1712–1716
Shiffman S, Hufford M, Hickcox M, Paty JA, Gnys M, Kassel JD (1997) Remember that? A comparison of real-time versus retrospective recall of smoking lapses. J Consult Clin Psychol 65:292–300
Shiffman S, Stone AA, Hufford MR (2008) Ecological momentary assessment. Annu Rev Clin Psychol 4:1–32
Sidman M (1960) Tactics of scientific research: evaluating experimental data in psychology. Basic Books, New York
Skinner BF (1938) The behavior of organisms: an experimental analysis. Appleton-Century, Oxford
Vahabzadeh M, Epstein DH, Mezghanni M, Lin J-L, Preston KL (2004) An electronic diary software for ecological momentary assessment (EMA) in clinical trials. Proceedings of the 17th IEEE Symposium on Computer-Based Medical Systems (CBMS), pp 167–172
Waldorf D, Reinarman C, Murphy S (1992) Cocaine changes: the experience of using and quitting. Temple University Press, Philadelphia
Weddington WW, Brown BS, Haertzen CA, Cone EJ, Dax EM, Herning RI, Michaelson BS (1990) Changes in mood, craving, and sleep during short-term abstinence reported by male cocaine addicts: a controlled, residential study. Arch Gen Psychiatry 47:861–868
Acknowledgments
This research was supported the Intramural Research Program (IRP) of the National Institute on Drug Abuse (NIDA), National Institutes of Health. We wish to thank the NIDA IRP Archway Clinic staff for data collection.
Funding/support
This research was supported by the NIDA Intramural Research Program.
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Figure S1
Left panels: time course of responses to the multiple-choice question “Who were you with when the beep occurred?” from 6 A.M. to 12 P.M. in 112 participants during periods of cocaine use or abstinence. These panels are identical to the figures in the main paper. Right panels: same data from the subset of 34 participants who contributed data to both the “abstinence” line and the “use” line (JPEG 448 kb)
Figure S2
Time course of responses to the multiple-choice question “Where were you when the beep occurred?” Details are the same as for Figure S1 (JPEG 374 kb)
Figure S3
Time course of responses to the multiple-choice question “What were you doing when the beep occurred?” Details are the same as for Figure S1 (JPEG 530 kb)
Figure S4
Time course of responses to yes/no questions beginning “During the past hour...” and assessing putative triggers of drug craving/use. Details are the same as for Figure S1 (JPEG 558 kb)
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Epstein, D.H., Preston, K.L. Daily life hour by hour, with and without cocaine: an ecological momentary assessment study. Psychopharmacology 211, 223–232 (2010). https://doi.org/10.1007/s00213-010-1884-x
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DOI: https://doi.org/10.1007/s00213-010-1884-x