The Treatment Section continues its long-term projects to improve treatment for substance dependence through behavioral, pharmacologic, and combined behavioral and pharmacologic interventions. In addition to the innovatively designed randomized clinical trial of clonidine that we completed in the past year, we are continuing to study individual differences that might be important for personalized treatment and for patient-treatment matching. We have made a point of addressing sex differences, because men and women with drug-use disorders differ in course, outcome, and possible biomarkers such as cue-induced activation of putative brain control network areas. In our ecological momentary assessment (EMA) study, in which participants report their mood, behavior, and drug use on electronic diaries as they go about their daily lives, we evaluated differences related to drug use in the 72 men and 42 women. We used stringent correction for multiple comparisons, but still found a large number of sex differences. In random-prompt entries, women and men reported significantly different patterns of drug-cue exposure, with women more likely to report having seen cocaine or been tempted to use in the past hour. Women also had higher craving after past-hour exposure to drug cues. In reports of drug use, women, compared to men, were more likely to report that they had used more cocaine than they had meant to, tended to feel guilty more often after drug use, and to have used despite trying not to use. These findings provide real-time behavioral evidence that women respond differently than men to drug cues and to drug use, consistent with laboratory and brain-imaging findings. This information may be useful for development of sex-specific treatment strategies. We also found evidence that our taxonomy of lapse triggers did not include items that were salient for women, suggesting that the classic, still-influential formative research on which it was based needs to be updated. We are currently replicating these analyses in participants in a larger study. In that study, participants initiate EMA reports for each stressful event they experience, as well each time they use drugs. We plan to investigate whether men and women experience stressful events differently and show different relationships between stressful events and drug use;this information will be incorporated into the mobile intervention we are starting to develop. Another factor we are examining for incorporation into treatment, independent of sex differences, is actual patterns of drug craving and drug use. We analyzed ecological momentary assessment (EMA) data on the timing of cocaine craving and use in the context of their relationship with a societal construct of daily temporal organization: 9-to-5 Monday-to-Friday business hours. Few of our participants report full-time work and fewer still report a 9-to-5 job. One possibility is that underemployed polydrug misusers largely disregard such conventions, but another possibility is that, in some ways, they implicitly abide by them. At baseline, 34% of participants reported full-time employment in the preceding 3 years, and most participants'current work status fluctuated throughout the study. In a generalized linear mixed model using current work status as a time-varying predictor, cocaine craving was significantly more frequent during business hours, while actual use was significantly more frequent after business hoursregardless of current work status. This finding suggests that the societal conventions reflected in business hours influence drug-use patterns even in individuals whose daily schedules are not dictated by employment during those hours. This may reflect an internalization of the social sanctions that help keep drug use under some degree of control. Finally we continue to develop Geographical Momentary Assessment (GMA), a descriptive approach to better measure and understand the relationships among mood, drug use, and environmental exposure to psychosocial stressors. We remain committed to transforming description into intervention. For example, we have shown that electronic-diary studies can provide amazing insight into the daily lives of substance abusers during treatment and data that are sensitive to behavioral changes during even brief periods of abstinence. The technologies that enable us to collect data on drug use, craving, and stress in the field may also be used for delivery of treatment in the field, perhaps in response to the patients own self-reported behaviors or previously identified triggers.
Showing the most recent 10 out of 34 publications
