Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, United States.
Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, United States; Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, United States.
J Subst Use Addict Treat. 2023 Mar;146:208931. doi: 10.1016/j.josat.2022.208931. Epub 2023 Jan 6.
Negative affect (NA) and craving are often independently examined as precipitators of relapse among individuals with substance use disorders, including opioid use disorder (OUD). Recent ecological momentary assessment (EMA) research has revealed that NA and craving frequently co-occur within individuals. Yet we know little about the general patterns of, and variability in, within-person associations between NA and craving, as well as whether the nature and degree of within-person NA-craving coupling predicts post-treatment time-to-relapse.
Seventy-three patients (77 % male, M = 30.10, Range = 19-61) in residential treatment for OUD took part in a 12-day, 4× daily smartphone-based EMA study. Linear mixed-effects models tested within-person, day-level associations between self-reported NA and craving during treatment. The study used Person-specific slopes (i.e., average within-person NA-craving coupling for each participant) estimated from the mixed-effects model in survival analyses with Cox proportional hazards regression models to determine if between-person differences in the within-person coupling predicted post-treatment time-to-relapse (operationalized as the return to problematic use of any substance except tobacco), and whether this prediction was similar across patients' average levels of NA and craving intensity. The study monitored relapse through a combination of hair samples and reports from patients or alternative contacts via a voice response system twice a month for up to 120 days or more following discharge.
Among the 61 participants with time-to-relapse data, those with stronger positive within-person NA-craving coupling on average during residential OUD treatment had a lower hazard of relapsing (slower time to relapse) post-treatment than participants with weaker NA-craving slopes. The significant association held after controlling for interindividual differences in age, sex, and average levels of NA and craving intensity. Average NA and craving intensity did not moderate the association between NA-craving coupling and time-to-relapse.
Interindividual differences in average within-person, day-level NA-craving coupling during residential treatment predict OUD patients' post-treatment time-to-relapse.
在患有物质使用障碍（包括阿片类药物使用障碍）的个体中，负性情绪（NA）和渴求通常被独立地视为复发的诱因。最近的生态瞬时评估（EMA）研究表明，NA 和渴求在个体内部经常同时发生。然而，我们对个体内部 NA 和渴求之间的关联的一般模式和可变性知之甚少，也不知道个体内部 NA-渴求耦合的性质和程度是否预测治疗后复发时间。
73 名（77%为男性，M=30.10，范围为 19-61）接受阿片类药物使用障碍住院治疗的患者参与了一项为期 12 天、每天 4 次的智能手机 EMA 研究。线性混合效应模型测试了治疗期间自我报告的 NA 和渴求之间的个体内、每日关联。该研究使用混合效应模型估计的个体特异性斜率（即每个参与者的平均个体内 NA-渴求耦合），并在 Cox 比例风险回归模型的生存分析中使用，以确定个体内耦合的个体间差异是否预测治疗后复发时间（操作化为除烟草以外的任何物质的问题使用的恢复），以及这种预测在患者的平均 NA 和渴求强度水平是否相似。该研究通过每月两次通过头发样本和患者或替代联系人通过语音应答系统的报告相结合来监测复发，最长可达 120 天或更长时间。
在有复发时间数据的 61 名参与者中，与住院治疗期间 OUD 治疗中平均具有更强的正个体内 NA-渴求耦合的参与者相比，治疗后复发的风险（复发时间更慢）较低。在控制年龄、性别以及平均水平的个体间差异后，这种关联仍然存在 NA 和渴求强度。平均 NA 和渴求强度并未调节 NA-渴求耦合与复发时间之间的关联。
住院治疗期间个体内部、每日 NA-渴求耦合的个体间差异预测了 OUD 患者治疗后的复发时间。
