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Exacerbated Craving in the Presence of Stress and Drug Cues in Drug-Dependent Patients

Neuropsychopharmacology (New York, N.Y.), 2018-03, Vol.43 (4), p.859-867 [Peer Reviewed Journal]

Copyright Nature Publishing Group Mar 2018 ;Copyright © 2018 American College of Neuropsychopharmacology 2018 American College of Neuropsychopharmacology ;ISSN: 0893-133X ;EISSN: 1740-634X ;DOI: 10.1038/npp.2017.275 ;PMID: 29105663

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  • Title:
    Exacerbated Craving in the Presence of Stress and Drug Cues in Drug-Dependent Patients
  • Author: Preston, Kenzie L ; Kowalczyk, William J ; Phillips, Karran A ; Jobes, Michelle L ; Vahabzadeh, Massoud ; Lin, Jia-Ling ; Mezghanni, Mustapha ; Epstein, David H
  • Subjects: Addiction ; Alcoholic beverages ; Buprenorphine ; Cannabis ; Cocaine ; Cues ; Drug abuse ; Drug addiction ; Drug dependence ; Ecological monitoring ; Heroin ; Laboratory animals ; Laboratory tests ; Methadone ; Methamphetamine ; Mood ; Narcotics ; Opioids ; Original ; Risk factors ; Stress ; Tobacco
  • Is Part Of: Neuropsychopharmacology (New York, N.Y.), 2018-03, Vol.43 (4), p.859-867
  • Description: 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.
  • Publisher: England: Nature Publishing Group
  • Language: English
  • Identifier: ISSN: 0893-133X
    EISSN: 1740-634X
    DOI: 10.1038/npp.2017.275
    PMID: 29105663
  • Source: ProQuest One Psychology
    Geneva Foundation Free Medical Journals at publisher websites
    AUTh Library subscriptions: ProQuest Central
    PubMed Central
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