Rationale-Craving is often assumed to cause ongoing drug use and relapse and is a major focus of addiction research. However, its relationship to drug use has not been adequately documented.Objectives-The aim of this study was to investigate the relationship between craving and drug use in real time and in the daily living environments of drug users. Methods-In a prospective, longitudinal, cohort design (Ecological Momentary Assessment), 112cocaine-abusing individuals in methadone maintenance treatment rated their craving and mood at random times (two to five times daily, prompted by electronic diaries) as they went about their everyday activities. They also initiated an electronic-diary entry each time they used cocaine. Drug use was monitored by thrice-weekly urine testing.Results-During periods of urine-verified cocaine use, ratings of cocaine craving increased across the day and were higher than during periods of urine-verified abstinence. During the five hours prior to cocaine use, ratings of craving significantly increased. These patterns were not seen in ratings of heroin craving or mood (e.g., feeling happy or bored).Conclusions-Cocaine craving is tightly coupled to cocaine use in users' normal environments. Our findings provide previously unavailable support for a relationship that has been seriously questioned in some theoretical accounts. We discuss what steps will be needed to determine whether craving causes use. Keywordscraving; Ecological Momentary Assessment; cocaine; mood; addiction; psychological theory Craving-a conscious, reportable urge-is a frequently discussed aspect of drug addiction (Lowman et al. 2000;Pickens and Johanson 1992), but its exact role in addiction, particularly its relationship with drug use and relapse, has been disputed from both theoretical and clinical perspectives. Across the spectrum of addiction theories, craving is given varying degrees of importance as a driver of drug use (Drummond 2001). NIH Public AccessAuthor Manuscript Psychopharmacology (Berl). Author manuscript; available in PMC 2010 September 20. Published in final edited form as:Psychopharmacology (Berl Clinical studies of the relationship between craving and drug use have had mixed results. Some studies have shown that craving before or during treatment predicts post-treatment cocaine use (Baer et al. 1989;Hartz et al. 2001;Paliwal et al. 2008;Rohsenow et al. 2007;Weiss et al. 2003), while others have shown no relationship (Kranzler et al. 1999;Walton et al. 2003;Weiss et al. 1995). In laboratory studies, the amount of cocaine craving induced by stressors in experimental sessions predicts time to resumption of cocaine use in daily life ; similar findings have been reported for tobacco smokers, with either stress-induced (al'Absi et al. 2005) or cue-induced craving . However, during an experimental session, reductions in craving do not necessarily lead to reductions in drug selfadministration (Haney and Spealman 2008;Leyton et al. 2005;Sofuoglu et al. 2009).In spite of the mixed clinical data, muc...

Background Maladaptive behaviors may be more fully understood and efficiently prevented by ambulatory tools that assess people’s ongoing experience in the context of their environment. Methods To demonstrate new field-deployable methods for assessing mood and behavior as a function of neighborhood surroundings (Geographical Momentary Assessment; GMA), we collected time-stamped GPS data and Ecological Momentary Assessment (EMA) ratings of mood, stress, and drug craving over 16 weeks at randomly prompted times during the waking hours of opioid-dependent polydrug users receiving methadone maintenance. Locations of EMA entries and participants’ travel tracks were calculated for the 12 hours before each EMA entry were mapped. Associations between subjective ratings and objective environmental ratings were evaluated at the whole neighborhood and 12-hour track levels. Results Participants (N=27) were compliant with GMA data collection; 3,711 randomly prompted EMA entries were matched to specific locations. At the neighborhood level, physical disorder was negatively correlated with negative mood, stress, and heroin and cocaine craving (ps <.0001 to .0335); drug activity was negatively correlated with stress, heroin and cocaine craving (ps .0009 to .0134). Similar relationships were found for the environments around respondents’ tracks in the 12 hours preceding EMA entries. Conclusions The results support the feasibility of GMA. The relationships between neighborhood characteristics and participants’ reports were counterintuitive and counter-hypothesized, and challenge some assumptions about how ostensibly stressful environments are associated with lived experience and how such environments ultimately impair health. GMA methodology may have applications for development of individual- or neighborhood-level interventions.

Rationale Knowing how stress manifests in the lives of people with substance-use disorders could help inform mobile “just in time” treatment. Objectives To examine discrete episodes of stress, as distinct from the fluctuations in background stress assessed in most EMA studies. Methods For up to 16 weeks, outpatients on opioid-agonist treatment carried smartphones on which they initiated an entry whenever they experienced a stressful event (SE) and when randomly prompted (RP) three times daily. Participants reported the severity of stress and craving and the context of the report (location, activities, companions). Decomposition of covariance was used to separate within-person from between-person effects; reffect sizes below are within-person. Results Participants (158 of 182; 87%) made 1,787 stress-event entries. Craving for opioids increased with stress severity (reffect = 0.50). Stress events tended to occur in social company (with acquaintances, 0.63, friends, 0.17, or on the phone, 0.41) rather than with family (spouse, −0.14; child, −0.18), and in places with more overall activity (bars, 0.32; outside, 0.28; walking, 0.28) and more likelihood of unexpected experiences (with strangers, 0.17). Being on the internet was slightly protective (−0.22). Our prior finding that being at the workplace protects against background stress in our participants was partly supported in these stressful-event data. Conclusions The contexts of specific stressful events differ from those we have seen in prior studies of ongoing background stress. However, both are associated with drug craving.

EMA did not support the idea that stress is a necessary or sufficient trigger for cocaine or heroin use after accounting for the base rates of stress and use. But EMA did show that stressful events can increase in severity in the days preceding cocaine use.