Back to Search
Start Over
Exacerbated Craving in the Presence of Stress and Drug Cues in Drug-Dependent Patients.
- Source :
-
Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology [Neuropsychopharmacology] 2018 Mar; Vol. 43 (4), pp. 859-867. Date of Electronic Publication: 2017 Nov 06. - Publication Year :
- 2018
-
Abstract
- In addiction, risk factors for craving and use include stress and drug-related cues. Stress and cues have additive or more-than-additive effects on drug seeking in laboratory animals, but, surprisingly, seem to compete with one another (ie, exert less-than-additive effects) in human laboratory studies of craving. We sought heretofore elusive evidence that human drug users could show additive (or more-than-additive) effects of stress and cues on craving, using ecological momentary assessment (EMA). Outpatients (N=182) maintained on daily buprenorphine or methadone provided self-reports of stress, craving, mood, and behavior on electronic diaries for up to 16 weeks. In three randomly prompted entries (RPs) per day, participants reported the severity of stress and craving and whether they had seen or been offered opioids, cocaine, cannabis, methamphetamine, alcohol, or tobacco. In random-effects models controlling for between-person differences, we tested effects of momentary drug-cue exposure and stress (and their interaction) on momentary ratings of cocaine and heroin craving. For cocaine craving, the Stress × Cue interaction term had a positive mean effect across participants (M=0.019; CL95 0.001-0.036), denoting a more-than-additive effect. For heroin, the mean was not significantly greater than 0, but the confidence interval was predominantly positive (M=0.019; CL95 -0.007-0.044), suggesting at least an additive effect. Heterogeneity was substantial; qualitatively, the Stress × Cue effect appeared additive for most participants, more than additive for a sizeable minority, and competitive in very few. In the field, unlike in human laboratory studies to date, craving for cocaine and heroin is greater with the combination of drug cues and stress than with either alone. For a substantial minority of users, the combined effect may be more than additive.
- Subjects :
- Adult
Female
Humans
Male
Middle Aged
Opioid-Related Disorders diagnosis
Opioid-Related Disorders epidemiology
Random Allocation
Self Report
Stress, Psychological diagnosis
Stress, Psychological epidemiology
Substance-Related Disorders diagnosis
Substance-Related Disorders epidemiology
Substance-Related Disorders psychology
Craving physiology
Cues
Opioid-Related Disorders psychology
Stress, Psychological psychology
Subjects
Details
- Language :
- English
- ISSN :
- 1740-634X
- Volume :
- 43
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology
- Publication Type :
- Academic Journal
- Accession number :
- 29105663
- Full Text :
- https://doi.org/10.1038/npp.2017.275