Real-time electronic diary reports of cue exposure and mood in the hours before cocaine and heroin craving and use

Abstract

Context: In ecological momentary assessment (EMA), participants electronically report their activities and moods in their daily environments in real time, enabling a truly prospective approach to the study of acute precipitants of behavioral events. Ecological momentary assessment has greatly enhanced the study of tobacco addiction, but its use has rarely been attempted in individuals with cocaine or heroin addiction.

Objective: To prospectively monitor the acute daily life precipitants of craving for and use of cocaine and heroin.

Design: Cohort study.

Participants: A volunteer sample of 114 cocaine- and heroin-abusing outpatients who were being treated with methadone provided EMA data on handheld electronic devices for 14 918 person-days (mean, 130.9; range, 6-189 days per participant). Of these outpatients, a total of 102 (63 men, 39 women) provided acute precraving and/or preuse data and were thus included in the present analyses.

Main outcome measures: Changes in reports of mood and exposure to 12 putative drug-use triggers at random intervals during the 5 hours preceding each self-reported episode of drug craving or use, analyzed via repeated-measures logistic regression (generalized linear mixed models).

Results: During the 5 hours preceding cocaine use or heroin craving, most of the 12 putative triggers showed linear increases. Cocaine use was most robustly associated with increases in participants reporting that they "saw [the] drug" (P < .001), were "tempted to use out of the blue" (P < .001), "wanted to see what would happen if I used" (P < .001), and were in a good mood (P < .001). Heroin craving was most robustly associated with increases in reports of feeling sad (P < .001) or angry (P = .01). Cocaine craving and heroin use showed few reliable associations with any of the putative triggers assessed.

Conclusions: These findings confirm that polydrug-abusing individuals can provide behavioral data in their daily environments using handheld electronic devices and that those data can reveal orderly patterns, including prospectively detectable harbingers of craving and use, which may differ across drugs.

Figure 1

Real-time participant reports of putative triggers of cocaine use in the five hours of random-prompt entries preceding each episode of use. F and p values reflect linear trends in Hours Before Use from repeated-measures logistic regressions (SAS GLIMMIX macro); df’s are (1,124). The r values are effect sizes for the linear trends and can be compared across figures. The number of datapoints per bar ranges from 83 to 101.

Figure 2

Real-time participant reports of putative triggers of cocaine craving in the five hours of random-prompt entries preceding each episode of craving. Details are the same as those for figure 1, except that df’s are (1,114) and the number of datapoints per bar ranges from 55 to 97.

Figure 3

Real-time participant reports of putative triggers of heroin use in the five hours of random-prompt entries preceding each episode of use. (Episodes of use of heroin and cocaine together are also included.) Details are the same as those for figure 1, except that df’s are (1,64) and the number of datapoints per bar ranges from 33 to 49.

Figure 4

Real-time participant reports of putative triggers of heroin craving in the five hours of random-prompt entries preceding each episode of craving. (Episodes of use of heroin and cocaine together are also included.) Details are the same as those for figure 1, except that df’s are (1,135) and the number of datapoints per bar ranges from 68 to 103.