Clinical Pharmacology and Therapeutics Research Branch, Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA.
Biomedical Informatics Section, Administrative Management Branch, Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd., Suite 200, Baltimore, MD, 21224, USA.
Psychopharmacology (Berl). 2017 Sep;234(17):2631-2642. doi: 10.1007/s00213-017-4663-0. Epub 2017 Jun 8.
Knowing how stress manifests in the lives of people with substance-use disorders could help inform mobile "just in time" treatment.
The purpose of this paper is to examine discrete episodes of stress, as distinct from the fluctuations in background stress assessed in most EMA studies.
For up to 16 weeks, outpatients on opioid-agonist treatment carried smartphones on which they initiated an entry whenever they experienced a stressful event (SE) and when randomly prompted (RP) three times daily. Participants reported the severity of stress and craving and the context of the report (location, activities, companions). Decomposition of covariance was used to separate within-person from between-person effects; r sizes below are within-person.
Participants (158 of 182; 87%) made 1787 stress-event entries. Craving for opioids increased with stress severity (r = 0.50). Stress events tended to occur in social company (with acquaintances, 0.63, friends, 0.17, or on the phone, 0.41) rather than with family (spouse, -0.14; child, -0.18), and in places with more overall activity (bars, 0.32; outside, 0.28; walking, 0.28) and more likelihood of unexpected experiences (with strangers, 0.17). Being on the internet was slightly protective (-0.22). Our prior finding that being at the workplace protects against background stress in our participants was partly supported in these stressful-event data.
The contexts of specific stressful events differ from those we have seen in prior studies of ongoing background stress. However, both are associated with drug craving.
了解物质使用障碍患者生活中的压力表现方式可能有助于提供移动“即时”治疗。
本文旨在检查离散的应激事件，与大多数 EMA 研究中评估的背景应激波动不同。
在 16 周内，接受阿片类激动剂治疗的门诊患者携带智能手机，每当他们经历应激事件 (SE) 时以及每天随机提示 (RP) 三次时，他们就会启动条目输入。参与者报告压力和渴望的严重程度以及报告的背景（位置、活动、同伴）。协方差分解用于分离个体内和个体间的效应；r 大小低于个体内。
参与者（182 人中的 158 人，87%）共记录了 1787 次应激事件。对阿片类药物的渴望随着压力严重程度的增加而增加（r = 0.50）。应激事件往往发生在社交场合（与熟人在一起，0.63；与朋友在一起，0.17；或通过电话，0.41），而不是与家人（配偶，-0.14；孩子，-0.18），并且发生在活动更多的地方（酒吧，0.32；户外，0.28；步行，0.28）和更有可能出现意外体验（与陌生人在一起，0.17）。上网稍微有保护作用（-0.22）。我们之前的发现是，在我们的参与者中，工作场所可以预防背景压力，在这些应激事件数据中得到了部分支持。
特定应激事件的背景与我们之前在持续背景应激研究中看到的不同。然而，两者都与药物渴望有关。
