Epstein David H, Willner-Reid Jessica, Vahabzadeh Massoud, Mezghanni Mustapha, Lin Jia-Ling, Preston Kenzie L
National Institute on Drug Abuse Intramural Research Program, Treatment Section, Clinical Pharmacology and Therapeutics Branch, Baltimore, MD 21224, USA.
Arch Gen Psychiatry. 2009 Jan;66(1):88-94. doi: 10.1001/archgenpsychiatry.2008.509.
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.
To prospectively monitor the acute daily life precipitants of craving for and use of cocaine and heroin.
Cohort study.
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.
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).
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.
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.
在生态瞬时评估（EMA）中，参与者通过电子方式实时报告其在日常环境中的活动和情绪，从而为研究行为事件的急性诱发因素提供了一种真正前瞻性的方法。生态瞬时评估极大地促进了对烟草成瘾的研究，但在可卡因或海洛因成瘾个体中的应用却很少尝试。
前瞻性监测可卡因和海洛因渴望及使用的日常急性诱发因素。
队列研究。
114名接受美沙酮治疗的可卡因和海洛因滥用门诊患者的志愿者样本，他们通过手持电子设备提供了14918人日的EMA数据（平均每人130.9天；范围为每人6 - 189天）。在这些门诊患者中，共有102人（63名男性，39名女性）提供了急性渴望前和/或使用前的数据，因此被纳入本分析。
在每次自我报告的药物渴望或使用事件前5小时内，随机间隔报告的情绪变化以及接触12种假定的药物使用触发因素的情况，通过重复测量逻辑回归（广义线性混合模型）进行分析。
在使用可卡因或渴望海洛因前的5小时内，12种假定触发因素中的大多数呈线性增加。可卡因使用与报告“看到毒品”（P < 0.001）、“突然想使用”（P < 0.001）、“想看看如果我使用会发生什么”（P < 0.001）以及心情良好（P < 0.001）的参与者增加最为密切相关。海洛因渴望与感到悲伤（P < 0.001）或愤怒（P = 0.01）的报告增加最为密切相关。可卡因渴望和海洛因使用与所评估的任何假定触发因素之间几乎没有可靠的关联。
这些发现证实，多药滥用个体可以使用手持电子设备在其日常环境中提供行为数据，并且这些数据可以揭示有序的模式，包括可前瞻性检测到的渴望和使用预兆，这些预兆可能因药物而异。
