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Intra-individual variability and stability of affect and craving among individuals receiving medication treatment for opioid use disorder

A Correction to this article was published on 05 July 2022

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Abstract

Affect and craving are dynamic processes that are clinically relevant in opioid use disorder (OUD) treatment, and can be quantified in terms of intra-individual variability and stability. The purpose of the present analysis was to explore associations between opioid use and variability and stability of affect and craving among individuals receiving medication treatment for OUD (MOUD). Adults (N = 224) with OUD in outpatient methadone or buprenorphine treatment completed ecological momentary assessment (EMA) prompts assessing positive affect, negative affect, opioid craving, and opioid use. Dynamic structural equation modeling (DSEM) was used to quantify person-level indices of magnitude and stability of change. Beta regression was used to examine associations between intra-individual variability and stability and proportion of opioid-use days, when controlling for overall intensity of affect and craving. Results suggested that greater magnitude of craving variability was associated with opioid use on a greater proportion of days, particularly among individuals with lower average craving. Low average positive affect was also associated with higher proportion of days of use. Individuals who experience substantial craving variability in the context of lower average craving may be particularly vulnerable to opioid use during treatment. Ongoing assessment of craving may be useful in identifying treatment needs. Examining correlates of intra-individual variability and stability in MOUD treatment remains a relevant direction for future work.

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Fig. 1: Slope of the craving log(iSD2) at different mean levels of craving.

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References

  1. Scott L, Victor S, Kaufman E, Beeney J, Byrd A, Vine V, et al. Affective dynamics across internalizing and externalizing dimensions of psychopathology. Clin Psychol Sci. 2020;8:412–27.

    Article  Google Scholar 

  2. Bei B, Wiley J, Trinder J, Manber R. Beyond the mean: a systematic review on the correlates of daily intraindividual variability of sleep/wake patterns. Sleep Med Rev. 2016;28:108–24.

    Article  Google Scholar 

  3. Mun C, Suk H, Davis M, Karoly P, Finan P, Tennen H, et al. Investigating intraindividual pain variability: methods, applications, issues, and directions. Pain. 2019;160:2415–29.

    Article  Google Scholar 

  4. Gottfredson N, Hussong A. Drinking to dampen affect variability: findings from a college student sample. J Stud Alcohol Drugs. 2013;74:576–83.

    Article  Google Scholar 

  5. Jahng S, Solhan M, Tomko R, Wood P, Piasecki T, Trull T. Affect and alcohol use: an ecological momentary assessment study of outpatients with borderline personality disorder. J Abnorm Psychol. 2011;120:572–84.

    Article  Google Scholar 

  6. Dvorak R, Stevenson B, Kilwein T, Sargent E, Dunn M, Leary A, et al. Tension reduction and affect regulation: an examination of mood indices on drinking and non-drinking days among university student drinkers. Exp Clin Psychopharmacol. 2018;26:377–90.

    Article  Google Scholar 

  7. Weinstein S, Mermelstein R, Shiffman S. Mood variability and cigarette smoking escalation among adolescents. Psychol Addict Behav. 2008;22:504–13.

    Article  Google Scholar 

  8. McKee K, Russell M, Mennis J, Mason M, Neale M. Emotion regulation dynamics predict substance use in high-risk adolescents. Addict Behav. 2020;106:106374.

    Article  Google Scholar 

  9. Cleveland H, Knapp K, Brick T, Russell M, Gajos J, Bunce S. Effectiveness and utility of mobile device assessment of subjective craving during residential opioid dependence treatment. Subst Use Misuse. 2021;56:1284–94.

    Article  Google Scholar 

  10. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. United States: American Psychiatric Association.; 2013.

  11. Tsui J, Anderson B, Strong D, Stein M. Craving predicts opioid use in opioid-dependent patients initiating buprenorphine treatment: a longitudinal study. Am J Drug Alcohol Abus. 2014;40:163–9.

    Article  Google Scholar 

  12. Burgess-Hull A, Smith K, Schriefer D, Palilio L, Epstein D, Preston K. Longitudinal patterns of momentary stress during outpatient opioid agonist treatment: A growth-mixture-model approach to classifying patients. Drug Alcohol Depend. 2021;226:108884.

    CAS  Article  Google Scholar 

  13. Panlilio L, Stull S, Bertz J, Burgess-Hull A, Lanza S, Curtis B, et al. Beyond abstinence and relapse II: momentary relationships between stress, craving, and lapse within clusters of patients with similar patterns of drug use. Psychopharmacology. 2021;238:1513–29.

    CAS  Article  Google Scholar 

  14. Preston K, Kowalczyk W, Phillips K, Jobes M, Vahabzadeh M, Lin L, et al. Before and after: craving, mood, and background stress in the hours surrounding drug use and stressful events in patients with opioid-use disorder. Psychopharmacology. 2018;235:2713–23.

    CAS  Article  Google Scholar 

  15. Preston K, Kowalczyk W, Phillips K, Jobes M, Vahabzadeh M, Lin J, et al. Exacerbated craving in the presence of stress and drug cues in drug-dependent patients. Neuropsychopharmacology. 2018;43:859–67.

    CAS  Article  Google Scholar 

  16. Kowalczyk W, Moran L, Bertz J, Phillips K, Ghitza U, Vahabzadeh M, et al. Using ecological momentary assessment to examine the relationship between craving and affect with opioid use in a clinical trial of clonidine as an adjunct medication to buprenorphine treatment. Am J Drug Alcohol Abus. 2018;44:502–11.

    Article  Google Scholar 

  17. Mun C, Finan P, Epstein D, Kowalczyk W, Agage D, Letzen J, et al. Craving mediates the association between momentary pain and illicit opioid use during treatment for opioid-use disorder: An ecological momentary assessment study. Addiction. 2021;116:1794–804.

    Article  Google Scholar 

  18. Kakko J, Alho H, Baldacchino A, Molina R, Nava F, Shaya G. Craving in opioid use disorder: from neurobiology to clinical practice. Front Psychiatry. 2019;10:592.

    Article  Google Scholar 

  19. Muthén LK, Muthén BO. Mplus user’s guide. Eighth Edition. Los Angeles, CA: Muthén & Muthén (1998–2017).

  20. Wang L, Hamaker E, Bergeman C. Investigating inter-individual differences in short-term intra-individual variability. Psychol Methods. 2012;17:567–81.

    Article  Google Scholar 

  21. Hamaker E, Asparouhov T, Brose A, Schmiedek F, Muthén B. At the frontiers of modeling intensive longitudinal data: dynamic structural equation models for the affective measurements from the COGITO study. Multivar Behav Res. 2018;3171:1–22.

    Google Scholar 

  22. Cribari-Neto F, Zeileis A. Beta regression in R. J Stat Softw. 2010;32:1–24.

    Google Scholar 

  23. Bayer F, Cribari-Neto F. Model selection criteria in beta regression with varying dispersion. Commun Stat-Simul Comput. 2017;46:729–46.

    Article  Google Scholar 

  24. Smithson M, Verkuilen J. A better lemon squeezer? Maximum-likelihood regression with beta-distributed dependent variables. Psychol Methods. 2006;11:54–71.

    Article  Google Scholar 

  25. Hunger M, Baumert J, Holle R. Analysis of SF-6D index data: is beta regression appropriate? Value Health. 2011;14:759–67.

    Article  Google Scholar 

  26. Zeileis A, Caribari-Neto F, Gruen B, Kosmidis I, Simas A, Rocha A, et al. Package ‘betareg’. 2016.

  27. Thissen D, Steinberg L, Kuang D. Quick and easy implementation of the Benjamini-Hochberg procedure for controlling the false positive rate in multiple comparisons. J Educ Behav Stat. 2002;27:77–83.

    Article  Google Scholar 

  28. Tiffany S, Wray J. The clinical significance of drug craving. Ann NY Acad Sci. 2012;1248:1–17.

    CAS  Article  Google Scholar 

  29. Serre F, Fatseas M, Swendsen J, Auriacombe M. Ecological momentary assessment in the investigation of craving and substance use in daily life: a systematic review. Drug Alcohol Depend. 2015;148:1–20.

    Article  Google Scholar 

  30. Preston K, Epstein D. Stress in the daily lives of cocaine and heroin users: relationship to mood, craving, relapse triggers, and cocaine use. Psychopharmacology. 2011;218:29–37.

    CAS  Article  Google Scholar 

  31. Garland E, Bryan C, Nakamura Y, Foreliger B, Howard M. Deficits in autonomic indices of emotion regulation and reward processing associated with prescription opioid use and misuse. Psychopharmacology. 2017;234:621–9.

    CAS  Article  Google Scholar 

  32. Bergeria C, Strickland J, Huhn A, Strain E, Dunn K. A preliminary examination of the multiple dimensions of opioid craving. Drug Alcohol Depend. 2021;219:108473.

    CAS  Article  Google Scholar 

  33. Kiluk B, Yip S, DeVito E, Carroll K, Sofuoglu M. Anhedonia as a key clinical feature in the maintenance and treatment of opioid use disorder. Clin Psychol Sci. 2019;7:1190–206.

    Article  Google Scholar 

  34. McHugh R, Hearon B, Otto M. Cognitive-behavioral therapy for substance use disorders. Psychiatr Clin. 2010;33:511–25.

    Google Scholar 

  35. Linehan M. DBT skills training manual. Guilford Publications; 2014.

  36. Miller WR, Meyers RJ, Hiller-Sturmhöfel S. The community-reinforcement approach. Alcohol Research & Health. 1999;23:116–21.

    CAS  Google Scholar 

  37. Ghabrash M, Bahremand A, Veileuz M, Blais-Normandin G, Chicoine G, Sutra-Cole C, et al. Depression and outcomes of methadone and buprenorphine treatment among people with opioid use disorders: a literature review. J Dual Diagn. 2020;16:191–207.

    Article  Google Scholar 

  38. Ellis J, Rabinowitz J, Wells J, Liu F, Finan P, Stein M, et al. Latent trajectories of anxiety and depressive symptoms among adults in early treatment for nonmedical opioid use. J Affect Disord. 2022;299:223–32.

    Article  Google Scholar 

  39. Zhu Y, Mooney L, Yoo C, Evans E, Kelleghan A, Saxon A, et al. Psychiatric comorbidity and treatment outcomes in patients with opioid use disorder: results from a multisite trial of buprenorphine-naloxone and methadone. Drug Alcohol Depend. 2021;228:108996.

    Article  Google Scholar 

  40. Petitjean S, Stohler R, Déglon J, Livoti S, Waldvogel D, Uehlinger C, et al. Double-blind randomized trial of buprenorphine and methadone in opiate dependence. Drug Alcohol Depend. 2001;62:97–104.

    CAS  Article  Google Scholar 

  41. Marlatt G, George W. Relapse prevention: introduction and overview of the model. Br J Addict. 1984;79:261–73.

    CAS  Article  Google Scholar 

  42. De Leon A, Dvorak R, Kramer M, Peterson R, Pinto D, Leary A, et al. Daily patterns of emotional functioning on drinking and nondrinking days. Alcohol Clin Exp Res. 2020;44:2598–610.

    Article  Google Scholar 

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Funding

This study was supported by the Intramural Research Program of the National Institute on Drug Abuse, National Institutes of Health and the National Institute on Drug Abuse T32 DA007209 (Strain, Bigelow, Weerts) and F32 DA04939302 (Mun).

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JDE: Conceptualization, formal analysis, visualization, writing—original draft.; CJM: Conceptualization, formal analysis, visualization, writing—original draft; DHE: Methodology, data curation, writing—review & editing, project administration; KAP: Writing—review & editing, project administration; PAF: Conceptualization, supervision, writing—review & editing; KLP: Investigation, resources, writing—review & editing, project administration, funding acquisition.

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Correspondence to Patrick H. Finan or Kenzie L. Preston.

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PHF is on the scientific advisory board for Ninnion. The other authors report no conflicts of interest.

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The original online version of this article was revised to correct typos in the abstract and results section.

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Ellis, J.D., Mun, C.J., Epstein, D.H. et al. Intra-individual variability and stability of affect and craving among individuals receiving medication treatment for opioid use disorder. Neuropsychopharmacol. 47, 1836–1843 (2022). https://doi.org/10.1038/s41386-022-01352-y

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