Beyond abstinence and relapse II: momentary relationships between stress, craving, and lapse within clusters of patients with similar patterns of drug use

Panlilio, Leigh V.; Stull, Samuel W.; Bertz, Jeremiah W.; Burgess-Hull, Albert J.; Lanza, Stephanie T.; Curtis, Brenda; Phillips, Karran A.; Epstein, David H.; Preston, Kenzie L.

doi:10.1007/s00213-021-05782-2

Cited by 23 publications

(13 citation statements)

References 80 publications

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“…Measures of cumulative lifetime stress positively correlate with CUD severity [3]. Life stress often precedes cocaine use [4-6] and can predict relapse [7; 8] and poor treatment outcomes [9]. Further, relapse susceptibility is greater in those with lower distress tolerance [10].…”

Section: Introductionmentioning

confidence: 99%

Role of mesolimbic cannabinoid receptor 1 in stress-driven increases in cocaine self-administration in male rats

McReynolds

Wolf

Starck

et al. 2022

Preprint

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Stress is prevalent in the lives of those with substance use disorders (SUDs) and influences SUD outcomes. Understanding the neurobiological mechanisms through which stress promotes drug use is important for the development of effective SUD interventions. We have developed a model wherein exposure to a stressor, uncontrollable electric footshock, daily at the time of cocaine self-administration (SA) escalates intake in male rats. Here we test the hypothesis that stress-induced escalation of cocaine SA is the result of persistent recruitment of endocannabinoid signaling. Male Sprague-Dawley rats self-administered cocaine (0.5 mg/kg/inf, i.v.) during 2-h sessions comprised of four 30-min SA components separated by 5-min shock sequences or 5-min shock-free periods for 14 days. Footshock produced an escalation of cocaine SA that persisted following shock removal. Systemic administration of the cannabinoid receptor type 1 (CB1R) antagonist, AM251, attenuated cocaine intake only in rats with a history of stress. This effect was localized to the mesolimbic system, as intra-nucleus accumbens (NAc) shell and intra-ventral tegmental area (VTA) micro-infusions of AM251 also attenuated cocaine intake only in stress-escalated rats. Cocaine SA, regardless of stress history, increases CB1R binding site density in the VTA, but not NAc shell. Following extinction, cocaine-primed reinstatement (10 mg/kg, ip) was increased in rats with prior footshock during SA. AM251 attenuated reinstatement only in rats with a stress history. Altogether, these data suggest that repeated stress at the time of cocaine use recruits endocannabinoid signaling in mesolimbic regions to escalate intake and heighten relapse susceptibility.

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Section: Introductionmentioning

confidence: 99%

Role of mesolimbic cannabinoid receptor 1 in stress-driven increases in cocaine self-administration in male rats

McReynolds

Wolf

Starck

et al. 2022

Preprint

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“…There were possibly times when participants experienced craving and did not use the app, as well as days when craving triggers were not encountered. Recent computational modeling approaches using in-the-field autonomic signals, GPS indicators of trigger-heavy environments, and ecological momentary assessment (EMA) of subjective stress successfully predicted substance craving with a high degree of accuracy ( 16 , 17 , 81 ). Development of a neurocardiac intervention that is able to “ping” an individual to launch the resonance breathing app based on EMA and continuous physiological and location data may improve upon the self-administration model.…”

Section: Discussionmentioning

confidence: 99%

Use and perceived usefulness of a just-in-time resonance breathing intervention adjunct for substance use disorder: Contextual and physiological predictors

et al. 2022

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Craving for alcohol and other drugs is often described as a momentary hyperarousal state that interferes with one's ability to use top-down strategies. As such, it may be best interrupted ‘in the moment' through bottom-up modulation. We recently reported that episodic resonance paced breathing (eRPB) delivered via mobile phone app as an add-on to outpatient treatment for substance use disorder (SUD) was effective at dampening craving over the course of an 8-week intervention (NCT#02579317). However, not all participants engaged with the eRPB app and there was high intra- and inter-individual variability in weekly ratings of usefulness. Here we examined baseline demographic, physiological, and psychiatric measures as well as time-varying exposure to positive, negative, and temptation craving triggers as predictors of frequency of eRPB app use and ratings of usefulness. Seventy-seven outpatient women were randomized to an eRPB (0.1 Hz) or a faster paced breathing sham (0.23 Hz) condition. Baseline measures were assessed within the first 3 weeks of treatment entry prior to randomization. App use frequency, ratings of usefulness, and trigger exposure were measured weekly throughout the intervention. Variables were entered into marginal means models with forward stepwise model selection and examined as predictors of use and usefulness. Frequent app use was associated with a lifetime alcohol use disorder (AUD) diagnosis (p = 0.026), higher ratings of usefulness (p < 0.001), and fewer exposures to positive triggers (e.g., celebration, socialization; p < 0.001). There was a trend-level association between frequency of app use and greater cardiovascular capacity at baseline (p = 0.088). Higher ratings of usefulness were associated with greater exposure to negative triggers (e.g,. loneliness, frustration; p < 0.001) and parasympathetic dysregulation at baseline (p = 0.05). A positive relationship between app use frequency and ratings of usefulness was present only in the eRPB group (p = 0.045). Matching ideal candidates and moments to an arousal modulation anti-craving intervention can help streamline screening and implementation of eRPB in the treatment of SUD.Clinical Trial Registrationhttps://clinicaltrials.gov/ct2/show/NCT02579317, identifier NCT02579317.

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“…The average age was 48 years (standard deviation [ SD ] = 10.0). Greater detail regarding the participant clinical and demographic characteristics can be found elsewhere (Panlilio et al, 2021). Eligibility criteria were: age 18–75 years; physical dependence on opioids; and residence in or near Baltimore, Maryland.…”

Section: Methodsmentioning

confidence: 99%

Variability in intensively assessed mood: Systematic sources and factor structure in outpatients with opioid use disorder.

Stull¹,

Mogle²,

Bertz³

et al. 2022

Psychological Assessment

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In intensive longitudinal studies using ecological momentary assessment, mood is typically assessed by repeatedly obtaining ratings for a large set of adjectives. Summarizing and analyzing these mood data can be problematic because the reliability and factor structure of such measures have rarely been evaluated in this context, which—unlike cross-sectional studies—captures between- and within-person processes. Our study examined how mood ratings (obtained thrice daily for 8 weeks; n = 306, person moments = 39,321) systematically vary and covary in outpatients receiving medication for opioid use disorder (MOUD). We used generalizability theory to quantify several aspects of reliability, and multilevel confirmatory factor analysis (MCFA) to detect factor structures within and across people. Generalizability analyses showed that the largest proportion of systematic variance across mood items was at the person level, followed by the person-by-day interaction and the (comparatively small) person-by-moment interaction for items reflecting low arousal. The best-fitting MCFA model had a three-factor structure both at the between- and within-person levels: positive mood, negative mood, and low-arousal states (with low arousal considered as either a separate factor or a subfactor of negative mood). We conclude that (a) mood varied more between days than between moments and (b) low arousal may be worth scoring and reporting separately from positive and negative mood states, at least in a MOUD population. Our three-factor structure differs from prior analyses of mood; more work is needed to understand the extent to which it generalizes to other populations.

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Beyond abstinence and relapse II: momentary relationships between stress, craving, and lapse within clusters of patients with similar patterns of drug use

Cited by 23 publications

References 80 publications

Role of mesolimbic cannabinoid receptor 1 in stress-driven increases in cocaine self-administration in male rats

Role of mesolimbic cannabinoid receptor 1 in stress-driven increases in cocaine self-administration in male rats

Use and perceived usefulness of a just-in-time resonance breathing intervention adjunct for substance use disorder: Contextual and physiological predictors

Variability in intensively assessed mood: Systematic sources and factor structure in outpatients with opioid use disorder.

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