1. Stress, craving and mood as predictors of early dropout from opioid agonist therapy.
- Author
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Panlilio LV, Stull SW, Kowalczyk WJ, Phillips KA, Schroeder JR, Bertz JW, Vahabzadeh M, Lin JL, Mezghanni M, Nunes EV, Epstein DH, and Preston KL
- Subjects
- Adult, Analgesics, Opioid therapeutic use, Buprenorphine, Naloxone Drug Combination therapeutic use, Ecological Momentary Assessment, Female, Humans, Male, Methadone therapeutic use, Middle Aged, Opioid-Related Disorders drug therapy, Withholding Treatment, Affect drug effects, Craving drug effects, Opiate Substitution Treatment adverse effects, Opioid-Related Disorders psychology, Patient Dropouts psychology, Stress, Psychological chemically induced
- Abstract
Background: Treatment with opioid agonists is effective for opioid use disorder, but early discontinuation of treatment is a major obstacle to success. Intensive longitudinal methods - which take many repeated measurements over time, usually in the field- have provided unique insight into the effects of stress, mood and craving on drug use while people are being treated; these methods might also be useful for studying the processes that lead people to drop out of treatment., Methods: Ecological momentary assessment (EMA) was conducted for up to 17 weeks by obtaining multiple electronic diary entries per day from 238 participants being treated with methadone or buprenorphine-naloxone. Survival analysis was used to study two outcomes: dropping out of treatment and noncompliance with EMA self-report requirements. Self-reports of stress, craving, and mood were used as time-varying predictors. Demographic and psychosocial variables measured with the Addiction Severity Index at the start of treatment were used as time-invariant predictors., Results: Dropping out of treatment was more likely in participants with more reported hassles (a measure of stress), higher levels of cocaine craving, lower levels of positive mood, a recent history of emotional abuse, a recent history of being bothered frequently by psychological problems, and with buprenorphine rather than methadone as their medication. In contrast, study noncompliance was not significantly associated with any of the variables analyzed., Conclusions: Assessment of stress, craving and mood during treatment might identify people who are at greater risk of dropping out, and therapeutic interventions targeting these processes might increase retention., (Published by Elsevier B.V.)
- Published
- 2019
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