Preston KL, Kowalczyk WJ, Philips KA, et al. (2018). Before and after: Craving, mood, and background stress in the hours surrounding drug use and stressful events in patients with opioid-use disorder. Psychopharmacology. doi: 10.1007/s00213-018-4966-9
As a part of a larger study, 182 people seeking treatment for opioid use disorder were recruited from a research clinic to complete ecological momentary assessments (EMAs) concerning substance use, mood, and stress for 16 weeks. Researchers compared substance use and stressful events to mood, stress, and cravings in the 5 hours surrounding each event. EMAs randomly prompted participants to answer questions about their opioid and cocaine cravings, stress, and mood. Participants were asked to initiate an assessment every time they experienced a stressful event or an instance of substance use to report the nature of the stressful event or the drug used. Participants completed urine tests for substance use 3 times weekly that were used to verify self-reported substance use. Stress significantly increased before cocaine and opioid use, but did not show any systematic change before substance use. Reported stress showed a quadratic (U-shaped) pattern of change after substance use. Negative mood and opioid and cocaine cravings increased linearly prior to substance use. Opioid and cocaine cravings were significantly higher than base levels (not within 5 hours of an event) following substance use, though cocaine craving decreased linearly after substance use. Opioid and cocaine cravings increased linearly prior to a stress event. Opioid and cocaine cravings did not systematically change after a stress event. Negative mood was elevated before and after stress events, though did not show systematic changes surrounding a stress event. Researchers conclude that substance use and cravings are more strongly related than stress and substance use.