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Beyond abstinence and relapse II: momentary relationships between stress, craving, and lapse within clusters of patients with similar patterns of drug use

Psychopharmacology volume 238, pages 1513–1529 (2021)Cite this article

Abstract

Rationale

Given that many patients being treated for opioid-use disorder continue to use drugs, identifying clusters of patients who share similar patterns of use might provide insight into the disorder, the processes that affect it, and ways that treatment can be personalized.

Objectives and methods

We applied hierarchical clustering to identify patterns of opioid and cocaine use in 309 participants being treated with methadone or buprenorphine (in a buprenorphine–naloxone formulation) for up to 16 weeks. A smartphone app was used to assess stress and craving at three random times per day over the course of the study.

Results

Five basic patterns of use were identified: frequent opioid use, frequent cocaine use, frequent dual use (opioids and cocaine), sporadic use, and infrequent use. These patterns were differentially associated with medication (methadone vs. buprenorphine), race, age, drug-use history, drug-related problems prior to the study, stress-coping strategies, specific triggers of use events, and levels of cue exposure, craving, and negative mood. Craving tended to increase before use in all except those who used sporadically. Craving was sharply higher during the 90 min following moderate-to-severe stress in those with frequent use, but only moderately higher in those with infrequent or sporadic use.

Conclusions

People who share similar patterns of drug-use during treatment also tend to share similarities with respect to psychological processes that surround instances of use, such as stress-induced craving. Cluster analysis combined with smartphone-based experience sampling provides an effective strategy for studying how drug use is related to personal and environmental factors.

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Funding

This study was supported by the Intramural Research Program of NIH, NIDA. S.W.S. was supported by National Science Foundation grant DGE1255832. S.T.L. was supported by National Institute on Drug Abuse grant NIDA P50-DA039838. The authors report no conflicts of interest.

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Authors and Affiliations

  1. Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA

    Leigh V. Panlilio, Samuel W. Stull, Jeremiah W. Bertz, Albert J. Burgess-Hull, Brenda L. Curtis, Karran A. Phillips, David H. Epstein & Kenzie L. Preston

  2. Department of Biobehavioral Health, The Pennsylvania State University, State College, PA, USA

    Samuel W. Stull & Stephanie T. Lanza

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  1. Leigh V. Panlilio
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  2. Samuel W. Stull
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Correspondence to Leigh V. Panlilio.

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Panlilio, L.V., Stull, S.W., Bertz, J.W. et al. Beyond abstinence and relapse II: momentary relationships between stress, craving, and lapse within clusters of patients with similar patterns of drug use. Psychopharmacology 238, 1513–1529 (2021). https://doi.org/10.1007/s00213-021-05782-2

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Keywords

  • Ecological momentary assessment
  • Opioid use disorder
  • Time-varying effects modeling (TVEM)
  • Stress
  • Craving
  • Cocaine
  • Buprenorphine
  • Methadone