Abstract
Rationale
Quantitative real-time data on the stress experienced by drug misusers in their daily lives may provide additional insight into stress’s role in drug use.
Objective
The purpose of this study is to evaluate stress in relation to craving, mood, relapse-trigger exposure, and cocaine use in cocaine-dependent outpatients.
Methods
Methadone-maintained cocaine- and heroin-abusing outpatients (N = 114) provided ecological momentary assessment data on handheld computers. Ratings of stress were compared to those of craving and mood and past-hour exposure to putative drug-use triggers in randomly prompted entries and in the 5 h prior to participant-initiated cocaine use reports.
Results
Stress had significant positive relationships with current ratings of craving for cocaine, heroin, and tobacco and with ratings of tiredness, boredom, and irritation, and had significant negative relationships with ratings of happiness and relaxation. Stress was significantly greater in entries in which participants also reported past-hour exposure to negative-mood triggers, most of the drug-exposure triggers, or any trigger involving thoughts about drugs (e.g., tempted out of the blue). The linear increase in stress during the 5-h preceding individual episodes of cocaine use was not significant (p = 0.12), though there was a trend for such an increase before the use episodes that participants attributed to stressful states when they occurred (p = 0.87).
Conclusions
The findings suggest a complex role of stress in addiction. Stress reported in real time in the natural environment showed strong cross-sectional momentary relationships with craving, mood, and exposure to drug-use trigger. However, the prospective association between stress ratings and cocaine-use episodes was, at best, weak.
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Notes
In this paper, we use the term mood synonymously with affect to refer to a transient feeling state (Watson 2000). Some authors distinguish mood from affect, but the distinction varies among authors.
Denominator degrees of freedom were expressed in rounded exponential form (“27E3”) in the SAS Proc Mixed output.
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Acknowledgments
This research was supported by 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.
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This research was supported by the NIDA Intramural Research Program and Genes and Environment Initiative Cooperative Agreement Z01-DA000499.
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Preston, K.L., Epstein, D.H. Stress in the daily lives of cocaine and heroin users: relationship to mood, craving, relapse triggers, and cocaine use. Psychopharmacology 218, 29–37 (2011). https://doi.org/10.1007/s00213-011-2183-x
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DOI: https://doi.org/10.1007/s00213-011-2183-x