Being at work improves stress, craving, and mood for people with opioid use disorder: Ecological momentary assessment during a randomized trial of experimental employment in a contingency-management-based therapeutic workplace

Bertz, Jeremiah W.; Panlilio, Leigh V.; Stull, Samuel W.; Smith, Kirsten E.; Reamer, David; Holtyn, August F.; Toegel, Forrest; Kowalczyk, William J.; Phillips, Karran A.; Epstein, David H.; Silverman, Kenneth; Preston, Kenzie L.

doi:10.1016/j.brat.2022.104071

Cited by 8 publications

(7 citation statements)

References 76 publications

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“…Another consideration is that, compared to samples in other EMA studies of illicit substance use, many in our sample had relatively higher socioeconomic status (SES) and may have had more free/flexible time to participate in such a study, though certainly not all participants were higher SES. High rates of compliance to EMA can be achieved even among lower SES groups using primarily illicit drugs (Bertz et al, 2022; Panlilio et al, 2019; Preston et al, 2017, 2018), though we are unsure whether such rates for a study like ours could be achieved remotely without extensive staffing. However, other studies using remote EMA have achieved high compliance rates without an in-person component (Carr et al, 2020).…”

Section: Discussionmentioning

confidence: 79%

Novel methods for the remote investigation of emerging substances: Application to kratom.

Smith¹,

Feldman²,

Dunn³

et al. 2024

Experimental and Clinical Psychopharmacology

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The botanical product commonly called "kratom" is still relatively novel to the United States. Like other natural products marketed as supplements, kratom is highly variable, both in terms of the alkaloids naturally occurring in kratom leaves and in terms of processing and formulation. Kratom products sold in the United States are not well-characterized, nor are daily use patterns among regular users. Surveys and case reports have comprised most of the literature on kratom use among humans. To advance our understanding of real-world kratom use, we developed a protocol for the remote study of regular kratom-using adults in the United States. Our study had three aspects implemented in one pool of participants nationwide: an in-depth online survey, 15 days of ecological momentary assessment (EMA) via smartphone app, and the collection and assay of the kratom products used by participants during EMA. Here, we describe these methods, which can be used to investigate myriad drugs or supplements. Recruiting, screening, and data collection occurred between July 20, 2022 and October 18, 2022. During this time, we demonstrated that these methods, while challenging from a logistical and staffing standpoint, are feasible and can produce high-quality data. The study achieved high rates of enrollment, compliance, and completion. Substances that are emerging or novel, but still largely legal, can be productively studied via nationwide EMA combined with assays of shipped product samples from participants. We discuss challenges and lessons learned so other investigators can adapt these methods. Public Health SignificanceFor this nationwide study investigating the real-world use of kratom products, we utilized a three-phase fully remote design that included an in-depth survey, ecological momentary assessment, and collection of hundreds of participants' product samples. The methods required no in-person participant interaction. These methods permitted collection of subjective self-report data that can be compared to objective chemical characterization of the products used. While labor intensive, these novel methods can be applied to studying a wide range of emerging drugs or legal supplements.

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Section: Discussionmentioning

confidence: 79%

Novel methods for the remote investigation of emerging substances: Application to kratom.

Smith¹,

Feldman²,

Dunn³

et al. 2024

Experimental and Clinical Psychopharmacology

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“…This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. have been shown to have protective (greater PA) and deleterious impacts on mood (greater NA; Bertz et al, 2022;Epstein & Preston, 2012). This may be one, among potentially many, explanations for how the person-by-day variability in mood is unique for people with addiction.…”

Section: Discussionmentioning

confidence: 97%

“…This pattern was especially pronounced for negative mood items, suggesting that variance in negative mood for certain people may be particularly dependent on the type of day (e.g., weekdays vs. weekends). For people with addictions, days with structured versus unstructured time (e.g., work vs. nonwork days) have been shown to have protective (greater PA) and deleterious impacts on mood (greater NA; Bertz et al, 2022; Epstein & Preston, 2012). This may be one, among potentially many, explanations for how the person-by-day variability in mood is unique for people with addiction.…”

Section: Discussionmentioning

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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“…Furthermore, they have extended abstinence reinforcement procedures in the context of employment, including long‐term wage supplements for evidence of drug abstinence, resulting in a greater likelihood of sustained employment and movement out of poverty (Holtyn et al, 2020; Novak et al, 2022). They note that such methods could also mitigate a broad range of poverty‐related health conditions (Bertz et al, 2022; Silverman et al, 2018; Silverman et al, 2019). The present results suggest that behavior‐analytic methods to reduce poverty could also prevent or mitigate problematic discounting patterns.…”

Section: Discussionmentioning

confidence: 99%

Effects of economic context and reward amount on delay and probability discounting

Anderson

Cox

Dallery

2023

J Exper Analysis Behavior

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Steep delay and shallow probability discounting are associated with myriad problem behaviors; thus, it is important to understand factors that influence the degree of discounting. The present study evaluated the effects of economic context and reward amount on delay and probability discounting. Two hundred thirteen undergraduate psychology students completed four delay‐ or probability‐discounting tasks. Participants were exposed to hypothetical narratives involving four bank amounts ($750, $12,000, $125,000, and $2,000,000). The delayed/probabilistic amount was $3,000 for the two smaller bank amounts and $500,000 for the two larger bank amounts. The discounting tasks included five delays to, or probabilities of, receipt of the larger amount. The area under the empirical discounting function was calculated for each participant. Participants discounted delayed and uncertain outcomes more when the bank amount was smaller than the outcome (i.e., the economic context was low). Participants discounted the delayed larger amounts less than delayed smaller amounts, even when the relative economic context was the same. In contrast, probability discounting did not differ across magnitudes, which suggests that economic context may attenuate the magnitude effect in probability discounting. The results further highlight the importance of considering the economic context in delay and probability discounting.

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Being at work improves stress, craving, and mood for people with opioid use disorder: Ecological momentary assessment during a randomized trial of experimental employment in a contingency-management-based therapeutic workplace

Cited by 8 publications

References 76 publications

Novel methods for the remote investigation of emerging substances: Application to kratom.

Novel methods for the remote investigation of emerging substances: Application to kratom.

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

Effects of economic context and reward amount on delay and probability discounting

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