Burgess-Hull Albert, Epstein David H
Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD USA.
Curr Addict Rep. 2021;8(1):122-135. doi: 10.1007/s40429-020-00351-7. Epub 2021 Jan 2.
Addiction scientists have begun using ambulatory assessment methods-including ecological momentary assessment (EMA), experience sampling, and daily diaries-to collect real-time or near-real-time reports of participants' internal states in their natural environments. The goal of this short review is to synthesize EMA findings from our research group, which has studied several hundred outpatients during treatment for opioid-use disorder (OUD). (We cite pertinent findings from other groups, but have not tried to be comprehensive.) One of our main goals in using EMA is to examine momentary changes in internal states that proximally predict, or concurrently mark, events such as lapses to opioid use.
We summarize findings evaluating several classes of momentary markers or predictors (craving, stress, negative and positive moods, and physical pain/discomfort) of lapses and other states/behaviors. Craving and some negatively valenced mood states are concurrently and prospectively associated with lapses to opioid use during treatment. Craving is also concurrently and prospectively associated with momentary changes in stress and mood. Convincing evidence has not yet emerged for stress as a robust redictor of lapse to opioid use; it appears to be contributory, but neither necessary nor sufficient.
Ambulatory assessment can capture changes in internal states and drug-related behaviors in situ and at high temporal resolution. We recommend research strategies that may increase the clinical and prognostic utility of ambulatory assessment, including denser sampling (i.e., more assessments per day) and more attention to heterogeneity across people and across populations.
成瘾科学家已开始使用动态评估方法，包括生态瞬时评估（EMA）、经验抽样法和日常日记，以收集参与者在自然环境中的内部状态的实时或近实时报告。本简短综述的目的是综合我们研究小组的EMA研究结果，该小组在阿片类药物使用障碍（OUD）治疗期间对数百名门诊患者进行了研究。（我们引用了其他小组的相关研究结果，但并未试图做到全面。）我们使用EMA的主要目标之一是检查内部状态的瞬时变化，这些变化可近端预测或同时标记诸如复吸阿片类药物使用等事件。
我们总结了评估复吸及其他状态/行为的几类瞬时标记物或预测因素（渴望、压力、消极和积极情绪以及身体疼痛/不适）的研究结果。在治疗期间，渴望和一些负性情绪状态与阿片类药物使用的复吸同时存在且具有前瞻性关联。渴望还与压力和情绪的瞬时变化同时存在且具有前瞻性关联。尚未出现令人信服的证据表明压力是阿片类药物使用复吸的有力预测因素；它似乎有一定作用，但既非必要条件也非充分条件。
动态评估能够在现场以高时间分辨率捕捉内部状态和与药物相关行为的变化。我们推荐可能提高动态评估临床和预后效用的研究策略，包括更密集的抽样（即每天进行更多评估）以及更多关注个体和人群间的异质性。
