Before and after: craving, mood, and background stress in the hours surrounding drug use and stressful events in patients with opioid-use disorder
Ecological momentary assessment (EMA) of specific events usually focuses more on antecedents and concomitants than on aftermaths.
To examine mental state both before and after discrete episodes of stress and drug use.
For up to 16 weeks, outpatients on opioid-agonist treatment carried smartphones on which they initiated entries for stressful events (SEs) or lapses to drug use (DUs), and thrice daily when randomly prompted (RPs). Participants rated their stress, opioid craving, cocaine craving, and moods. RP entries within 5 h of an event were analyzed and compared to other RPs.
Stress, negative mood, and craving were generally higher before and after DUs and SEs compared to background levels in participants with at least one DU (n = 149) or SE (n = 158). Before DUs, there were increases in negative mood, opioid craving, and cocaine craving, but not background stress. Before SEs, there were increases in background stress, opioid craving, and cocaine craving, but not negative mood. These changes were more variable after events than before. Neither DUs nor SEs were significantly related to positive mood.
Stress increased before stressful-event entries, but was less evident before drug use. Craving increased in the hours before drug use and stressful events—and remained elevated in the hours after either event. These results suggest a stronger link between drug use and craving than between drug use and stress. Lapses to drug use did not improve mood or reduce stress, at least not at our 1-h-bin time resolution, suggesting that if such benefits exist, they are brief.
KeywordsCocaine Opioid Ecological momentary assessment Stress Craving
This study was supported by the Intramural Research Program of the National Institute on Drug Abuse, National Institutes of Health.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- Campbell EM, Jia H, Shankar A, Hanson D, Luo W, Masciotra S, Owen SM, Oster AM, Galang RR, Spiller MW, Blosser SJ, Chapman E, Roseberry JC, Gentry J, Pontones P, Duwve J, Peyrani P, Kagan RM, Whitcomb JM, Peters PJ, Heneine W, Brooks JT, Switzer WM (2017) Detailed transmission network analysis of a large opiate-driven outbreak of HIV infection in the United States. J Infect Dis 216:1053–1062CrossRefGoogle Scholar
- Lin M, Mahmooth Z, Dedhia N, Frutchey R, Mercado CE, Epstein DH, Preston KL, Gibbons MC, Bowie JV, Labrique AB, Cheskin LJ (2015) Tailored, interactive text messages for enhancing weight loss among African American adults: the TRIMM randomized controlled trial. Am J Med 128:896–904CrossRefGoogle Scholar
- Robins LN, Cottler LB, Bucholz KK, Compton WM III (1995) The diagnostic interview schedule, Version IV. Washington University, St. LouisGoogle Scholar
- 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) 167–172Google Scholar
- Vahabzadeh M, Mezghanni M, Lin J-L (2012) Context aware mobile device software for substance abuse interventions and behavioral modification. Fed Regist 77:48997–48998Google Scholar