Context In Ecological Momentary Assessment (EMA), participants electronically report their activities and moods in their daily environments in real time, enabling a truly prospective approach to the study of acute precipitants of behavioral events. EMA has greatly enhanced the study of tobacco addiction, but has rarely been attempted in individuals with cocaine or heroin addiction. Objective To prospectively monitor the acute daily-life precipitants of craving for, and use of, cocaine and heroin. Design Cohort study. Participants A volunteer sample of 114 cocaine- and heroin-abusing outpatients who were being treated with methadone provided EMA data on handheld computers for 14,918 person-days (mean 130.9 days per participant, range 6–189). Of those 114, a total of 102 (63 men, 39 women) provided acute pre-craving or pre-use data and were thus included in the present analyses. Main outcome measures Changes in reports of mood and exposure to 12 putative drug-use triggers at random intervals during the five hours preceding each self-reported episode of drug craving or use, analyzed via repeated-measures logistic regression (SAS GLIMMIX macro). Results During the five hours preceding cocaine use or heroin craving, most of the 12 putative triggers showed linear increases. Cocaine use was most robustly associated with increases in reports of “Saw Drug” (p<.0001), “Tempted to use out of the blue” (p<.0001), “Wanted to see what would happen if I used” (p<.0001), and “Good mood” (p<.0001). Heroin craving was most robustly associated with increases in reports of “Sad” (p=.0002) and “Angry” (p<.011). Cocaine craving and heroin use showed few reliable associations with any of the putative triggers assessed. Conclusions These findings confirm that polydrug-abusing individuals can provide behavioral data in their daily environments using handheld computers, and that those data can reveal orderly patterns, including prospectively detectable harbingers of craving and use, which may differ across drugs.

We examined the impact of methadone maintenance treatment (MMT) on risk behaviors for transmission of bloodborne diseases in polydrug users who had tested positive or negative for hepatitis C (HCV). At intake, HCV-positive participants (n = 362) engaged in more HIV risk behaviors (as measured by the HIV Risk-Taking Behaviour Scale; HRBS) than HCV-negative participants (n = 297) (p<.001). This difference was specific to injection-related behaviors and decreased significantly within the first few weeks of MMT (p<.0001). Where needles continued to be used, HCV-positive participants became more likely over time to engage in safer injecting practices. Furthermore HCV-positive participants became more likely to use condoms than HCVnegative participants. These findings demonstrate that both drug-and sex-related risk behaviors decrease during MMT, and emphasize the benefits of methadone programs for public health and HIV/HCV prevention.

Objectives: The purpose of this study was to evaluate the effects of homework-task difficulty and electronic-diary reminders on written homework completion during cognitive-behavioral therapy (CBT) for addiction. Completion of homework is an important element in CBT that may affect outcome. Design: All participants received all combinations of our two interventions in a factorial 2×2 counterbalanced Latin-square design. Methods: Methadone-maintained cocaine and heroin users were given homework between each of 12 weekly CBT sessions and carried electronic diaries that collected ecological momentary assessment (EMA) data on craving and exposure to drug-use triggers in four 3-week blocks assessing two levels of homework difficulty and prompted and unprompted homework. Results: Neither simplified (picture-based) homework nor electronic reminders increased homework completion. In EMA reports, standard but not simplified homework seemed to buffer the craving that followed environmental exposure to drug cues. EMA recordings before and after the CBT intervention confirmed a decrease over time in craving for cocaine and heroin. Conclusions: These findings demonstrate the utility of EMA to assess treatment effects. However, the hypothesis that simplified homework would increase compliance was not supported.

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