Longitudinal patterns of momentary stress during outpatient opioid agonist treatment: A growth-mixture-model approach to classifying patients

• Published in: Drug and alcohol dependence Vol. 226; p. 108884
• Main Authors: Burgess-Hull, Albert J., Smith, Kirsten E., Schriefer, Destiny, Panlilio, Leigh V., Epstein, David H., Preston, Kenzie L.
• Format: Journal Article
• Language: English
• Published: Lausanne Elsevier B.V 01.09.2021; Elsevier Science Ltd
• Subjects: Agonists; Alcohol use; Cluster analysis; Craving; Differentiation; Drug abuse; Drug addiction; Drug use; Drug withdrawal; Ecological momentary assessment; Growth mixture models; Individual differences; Narcotics; Opioid use disorder; Opioids; Outpatient care facilities; Outpatient treatment; Outpatients; Patients; Stress; Substance abuse treatment; Substance use disorder; Cluster analysis; Ecological momentary assessment; Opioid use disorder; Stress; Individual differences; Growth mixture models
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2021.108884

•People in treatment for opioid-use disorder differ in patterns of momentary stress.•Unique patterns of momentary stress are differentially associated with drug use and craving during treatment.•These differences may help explain why stress and lapse aren’t always associated. We previously showed, in people starting treatment for opioid use disorder (OUD), that stress is neither necessary nor sufficient for lapses to drug use to occur, despite an association between the two. Both theoretical clarity and case-by-case prediction accuracy may require initial differentiation among patients. To examine: (a) evidence for distinct overall trajectories of momentary stress during OUD treatment, (b) relationships between stress trajectory and treatment response, and (c) relationships between stress trajectory and momentary changes in stress and craving prior to lapses. We used ecological momentary assessment (EMA) to collect ratings of stress and craving 3x/day for up to 16 weeks in 211 outpatients during agonist treatment for OUD. With growth mixture models, we identified trajectories of stress. We used mixed effect models to examine trajectory-group differences in the dynamics of stress and craving just before lapses to any drug use. We identified four trajectories of stress: Increasing (13.7 %); Moderate and Stable (23.7 %); Declining and Increasing (18 %); and Low (44.6 %). Overall drug use and opioid craving were lowest in the Low Stress group. Overall drug use was highest in the Moderate and Stable group. Alcohol use and opioid craving were highest in the Increasing Stress group. Opioid craving increased before lapse for most groups, but stress increased before lapses for only the Moderate and Stable group. There are natural groupings of participants with distinct patterns of stress severity during OUD treatment. Momentary stress/craving/lapse associations may be better characterized when these groupings are considered first.