Stress Allostasis in Substance Use Disorders: Promise, Progress, and Emerging Priorities in Clinical Research

Fronk, Gaylen; Sant'Ana, Sarah June Kittleson; Kaye, Jesse T.; Curtin, John J.

doi:10.1146/annurev-clinpsy-102419-125016

Cited by 25 publications

(38 citation statements)

References 151 publications

(194 reference statements)

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“…Additionally, evaluating intensity represents a key component of the stressor appraisal process, which has also been shown to affect responding (Lazarus, 1999). These stressor characteristics have been haphazardly considered in studies of the stressor-drug use relationship, and we have advocated recently for their more consistent inclusion (Fronk et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Stressor-elicited smoking and craving during a smoking cessation attempt.

Schultz¹,

Fronk²,

Jaume³

et al. 2022

Journal of Psychopathology and Clinical Science

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Stressors can undermine smokers' attempts to quit smoking. Although contemporary theories and animal models support this idea, human research has struggled to demonstrate definitively the relationship between stressors and smoking. Researchers have employed more ecologically valid methods like ecological momentary assessment to address this question, but studies focusing explicitly on stressors remain sparse and findings inconsistent. The purpose of this study was to examine the effect of stressful event intensity on smoking and craving among cigarette smokers during a quit attempt. We conducted preregistered, complementary concurrent and prospective (i.e., 8-hour lag window between stressful event and outcomes) analyses to maximize statistical power and provide temporal ordering, respectively. We also conducted follow-up moderation (Lag 3 Stressful Event Intensity) analyses. We hypothesized that smokers would be more likely to report both smoking and craving as the intensity of stressful events increased. Cigarette smokers (N = 125; 77 male) were randomly assigned to take nicotine replacement therapy (NRT) or placebo and provided 4x daily self-reports during the first 2 weeks of a quit attempt. Stressful events increased craving and the probability of smoking in concurrent analyses, and lag moderated the effect of stressful event intensity in follow-up prospective lagged analyses. NRT reduced the probability of smoking but not craving and did not moderate the effect of stressful events on smoking or craving. This study supports a prospective relationship between stressful events and smoking/ craving in situ and demonstrates that NRT does not reduce the impact of stressors on smoking or craving. General Scientific SummaryStress has been hypothesized but not confirmed to cause drug use in humans. This study provides evidence that experiencing stressful events increases the probability of smoking and increases craving among cigarette smokers trying to quit.

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Section: Discussionmentioning

confidence: 99%

Stressor-elicited smoking and craving during a smoking cessation attempt.

Schultz¹,

Fronk²,

Jaume³

et al. 2022

Journal of Psychopathology and Clinical Science

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“…This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. 3 Exploring general startle reactivity as a moderator prompted us to conduct posthoc analyses examining whether biological sex (male vs. female) moderated deprivation or heavy use, given its frequent yet inconsistent inclusion in stress-drug use research (Fronk et al, 2020). We did not find sex × deprivation interactions (probability task: p = .971; timing task: p = .381) or sex × deprivation × stressor predictability interactions (probability task: p = .362; timing task: p = .076).…”

Section: Deprivation × General Startle Reactivitymentioning

confidence: 99%

Central stress response among deprived and continuing marijuana users and nonusers.

Fronk¹,

Hefner²,

Gloria³

et al. 2022

Psychology of Addictive Behaviors

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Objective: We examined central nervous system [CNS] stress responses among deprived and continuing heavy marijuana users and nonusers. Method: Participants (N = 210; 46.7% female; M age = 21.99; 91.4% White, 94.3% Non-Hispanic) were heavy marijuana users (N = 134) and nonusers (N = 76). Heavy users were randomly assigned to a 3-day marijuana deprivation condition (N = 68) or to continue using regularly (N = 66). Participants completed two threat-of-shock stressor tasks that manipulated stressor predictability by varying shock probability or timing. We measured central stress responses via startle potentiation (stressor conditions minus matched no-stressor condition). We examined two group contrasts (heavy use: all heavy users vs. nonusers; deprivation: deprived vs. continuing heavy users) on startle potentiation overall and moderated by stressor predictability (unpredictable vs. predictable). Results: Deprivation did not affect startle potentiation overall (timing task: p = .184; probability task: p = .328) or differently by stressor predictability (timing task: p = .147; probability task: p = .678). Heavy use did not affect startle potentiation overall (timing task: p = .213; probability task: p = .843) or differently by stressor predictability (timing task: p = .655; probability task: p = .273). Posthoc analyses showed mixed evidence of general startle reactivity × deprivation interaction on startle potentiation overall (timing task: p = .019; probability task: p = .056) and differently by stressor predictability (probability task: p = .024; timing task: p = .364). Conclusions: A history of marijuana use or acute deprivation did not alter central stress responses despite prominent theoretical expectations. This study adds to growing research on central stress responses in individuals with a history of drug use and begins to parse moderating roles of individual differences and stressor characteristics. Public Health Significance StatementIndividuals with a history of drug use have been theorized to display atypical stress responses. This study does not find evidence of altered CNS stress responses when comparing heavy marijuana users to nonusers or when comparing continuing marijuana users to acutely deprived marijuana users. Expanding research to include naturalistic stressors, more stressor characteristics, and multisystemic responses may improve understanding of stress mechanisms in substance use disorders and offer paths forward for theory refinement and treatment.

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“…Most people lapse (ie, engage in a single episode of opioid use), and some people who lapse, relapse fully (ie, return to regular, harmful opioid use) [ 11 , 12 ]. Lapses can be triggered by mundane sources such as everyday hassles [ 13 ]. Lapses can also occur because maintaining recovery-supportive behaviors is difficult in the long term; over time, people may stop taking medications, engaging with therapy, and attending peer-support groups [ 14 - 16 ].…”

Section: Introductionmentioning

confidence: 99%

Prospective Prediction of Lapses in Opioid Use Disorder: Protocol for a Personal Sensing Study

Moshontz¹,

Colmenares²,

Fronk³

et al. 2021

JMIR Res Protoc

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Background Successful long-term recovery from opioid use disorder (OUD) requires continuous lapse risk monitoring and appropriate use and adaptation of recovery-supportive behaviors as lapse risk changes. Available treatments often fail to support long-term recovery by failing to account for the dynamic nature of long-term recovery. Objective The aim of this protocol paper is to describe research that aims to develop a highly contextualized lapse risk prediction model that forecasts the ongoing probability of lapse. Methods The participants will include 480 US adults in their first year of recovery from OUD. Participants will report lapses and provide data relevant to lapse risk for a year with a digital therapeutic smartphone app through both self-report and passive personal sensing methods (eg, cellular communications and geolocation). The lapse risk prediction model will be developed using contemporary rigorous machine learning methods that optimize prediction in new data. Results The National Institute of Drug Abuse funded this project (R01DA047315) on July 18, 2019 with a funding period from August 1, 2019 to June 30, 2024. The University of Wisconsin-Madison Health Sciences Institutional Review Board approved this project on July 9, 2019. Pilot enrollment began on April 16, 2021. Full enrollment began in September 2021. Conclusions The model that will be developed in this project could support long-term recovery from OUD—for example, by enabling just-in-time interventions within digital therapeutics. International Registered Report Identifier (IRRID) DERR1-10.2196/29563

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Stress Allostasis in Substance Use Disorders: Promise, Progress, and Emerging Priorities in Clinical Research

Cited by 25 publications

References 151 publications

Stressor-elicited smoking and craving during a smoking cessation attempt.

Stressor-elicited smoking and craving during a smoking cessation attempt.

Central stress response among deprived and continuing marijuana users and nonusers.

Prospective Prediction of Lapses in Opioid Use Disorder: Protocol for a Personal Sensing Study

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