Daily stressors as antecedents, correlates, and consequences of alcohol and drug use and cravings in community-based offenders

Traumatic Life Events and Stressors: Associations With Substance Use Problems of Men Under Community Supervision

This study aims to determine associations between sources of stress and substance use problems among men under community supervision programs. We used ordinary least squares regression models to test the hypotheses that the traumatic life events and stressors of men under community supervision and their partners, respectively, were associated with the substance use problems of men under community supervision. The sample included 230 men involved in community supervision programs in New York City and 230 women who were their intimate partners. We found that the traumatic events and the depression and anxiety of men under community supervision and partner's substance use problems were associated with the substance use problems of the men. These findings underscore the importance of addressing trauma in substance use treatment for men under community supervision. Future research can explore how stressful events impact substance use, sources of coping for couples, and the association between racism, traumatic events, stress, and substance use. Clinical Trial Registration: NCT01690494.

Examining Associations Between Negative Affect and Substance Use in Treatment-Seeking Samples: A Review of Studies Using Intensive Longitudinal Methods

Purpose of Review

Understanding dynamic relationships between negative affect and substance use disorder (SUD) outcomes, including craving, may help inform adaptive and personalized interventions. Recent studies using intensive longitudinal methods were reviewed to examine relationships between negative affect and the outcomes of either craving or substance use during and following SUD treatment.

Recent Findings

Results on associations between negative affect and craving/substance use were mixed and difficult to synthesize, given methodological differences across studies. The strength and direction of these relationships varied across outcomes, subgroups, contexts, and time course.

Summary

The current literature is mixed concerning negative affect and craving/substance use associations during and following SUD treatment. Researchers should increasingly recruit diverse individuals, for example, samples of varying racial and ethnic backgrounds and those reporting co-occurring disorders and polysubstance use. Experimental, qualitative, and person-specific methods will improve our understanding of relationships between negative affect and substance-related outcomes during SUD treatment.

Alcohol Use Cravings as a Mediator Between Associated Risk Factors on Increased Alcohol Use among Youth Adults in New York During the COVID-19 Pandemic

The sudden increase in alcohol use in the young adult population during the COVID-19 pandemic may be partially explained by social isolation and stress due to restricted stay-at-home orders. The goal of this study was to assess specific psychological factors (e.g., anxiety, depressive symptoms, sleep disturbances, and alcohol cravings) and COVID-19 diagnoses and their association with increased alcohol use and misuse during the COVID-19 pandemic among New York residents 18-35 years of age. Survey data were collected via Qualtrics between July 2020-October 2020. Path analyses tests were employed to test alcohol use cravings as a mediator. Among the total sample (N=575), mean age was 27.94±4.12; a majority were White non-Hispanic (66%), female (55%) and had completed a 4-year college or university degree (n = 249; 43.5%). Results revealed that alcohol use cravings was a significant mediator between sleep disturbances, having a COVID-19 diagnoses, and having mental health symptoms on increased alcohol use. Our findings underscore the importance of providing alcohol use prevention and treatment resources in this unprecedented COVID-19 era. Policymakers, public health professionals, and clinicians have a significant role in curbing the COVID-19-induced substance use epidemic.

Clinical Outcomes of Severe Forms of Early Social Stress

Early social stress, particularly severe but nevertheless frequent forms such as abuse and neglect, are among the major risk factors for the development of mental disorders. However, we only have very limited knowledge of the psychobiological disease mechanisms underlying the influence of early life stress and stress-related disorders during this vulnerable phase of life. Early stress can have long-lasting adverse effects on the brain and other somatic systems, e.g. through influences on brain development. In adulthood, the prior experience of abuse or neglect can result in complex clinical profiles. Besides conditions such as mood and anxiety disorders as well as posttraumatic stress disorder, substance use disorders (SUD) are among the most prevalent sequelae of early social stress. Current social stress further influences the development and maintenance of these disorders, e.g., by increasing the risk of relapses. In this chapter, we will first give an overview of currently used methods to assess the phenomenology and pathophysiology of stress-related disorders and then focus on the phenomenological and neurobiological background of the interaction between early social stress and SUD. We will give an overview of important insights from neuroimaging studies and will also highlight recent findings from studies using digital tools such as ecological momentary assessment or virtual reality to capture the influence of early social stress as well as current social stress in everyday life of persons with SUD.

Stress Among a Sample of Returning Citizens Living with HIV and Substance Use Disorder: A Mixed Methods Analysis

This mixed-methods study asks: among a sample of returning citizens living with HIV and substance use disorder, how is stress experienced; and what are the leading stressors and stress-coping strategies? Data is from a parent study that randomized 36 people to a yoga intervention and 36 people to treatment as usual. Qualitative analysis found that securing basic life needs was more acute in early reentry, and challenges with HIV acceptance were greater among those with a more recent HIV diagnosis. Social support was the most widely employed coping strategy but many lacked social networks. Post-program, multiple regression found older age(β = - 0.38, p < .05), greater income(β = - 0.002, p < .01), shorter incarceration(β = .03, p < .01) and randomization to yoga(β = 6.92, p < .01) predicted lower levels of stress. Results indicate that reentry needs for people living with HIV and substance use disorder include basic life needs, social supports, and stress-coping interventions that address physical and mental stress symptoms (such as yoga).

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

RATIONALE

Given that many patients being treated for opioid-use disorder continue to use drugs, identifying clusters of patients who share similar patterns of use might provide insight into the disorder, the processes that affect it, and ways that treatment can be personalized.

OBJECTIVES AND METHODS

We applied hierarchical clustering to identify patterns of opioid and cocaine use in 309 participants being treated with methadone or buprenorphine (in a buprenorphine-naloxone formulation) for up to 16 weeks. A smartphone app was used to assess stress and craving at three random times per day over the course of the study.

RESULTS

Five basic patterns of use were identified: frequent opioid use, frequent cocaine use, frequent dual use (opioids and cocaine), sporadic use, and infrequent use. These patterns were differentially associated with medication (methadone vs. buprenorphine), race, age, drug-use history, drug-related problems prior to the study, stress-coping strategies, specific triggers of use events, and levels of cue exposure, craving, and negative mood. Craving tended to increase before use in all except those who used sporadically. Craving was sharply higher during the 90 min following moderate-to-severe stress in those with frequent use, but only moderately higher in those with infrequent or sporadic use.

CONCLUSIONS

People who share similar patterns of drug-use during treatment also tend to share similarities with respect to psychological processes that surround instances of use, such as stress-induced craving. Cluster analysis combined with smartphone-based experience sampling provides an effective strategy for studying how drug use is related to personal and environmental factors.

The Psychosocial Predictors and Day-Level Correlates of Substance Use Among Participants Recruited via an Online Crowdsourcing Platform in the United States: Daily Diary Study

BACKGROUND

Alcohol consumption and stimulant use are major public health problems and contribute to morbidity and mortality in the United States. To inform interventions for substance use, there is a need to identify the day-level correlates of substance use by collecting repeated measures data in one's natural environment. There is also a need to use crowdsourcing platforms like Amazon Mechanical Turk (MTurk) to efficiently engage larger populations of people who use alcohol and stimulants in research.

OBJECTIVE

We aimed to (1) utilize daily diaries to examine the temporal relationship between day-level cravings for alcohol and stimulant/substance use (ie, heavy drinking or any drug use) in a given day over 14 days and (2) assess whether depression, negative affect, and self-esteem measured at baseline predict substance use in a given day over 14 days among people who use alcohol and/or stimulants in the United States.

METHODS

Individuals aged ≥18 years in the United States, who reported alcohol or stimulant (ie, cocaine, crack cocaine, and methamphetamine) use in the past year, were recruited using MTurk between March 26 and April 13, 2018. Eligible participants completed a baseline survey and 14 daily surveys online. The baseline survey assessed sociodemographics and psychosocial (ie, depression, affect, self-esteem, and stress) factors. Daily surveys assessed substance use and cravings for alcohol and stimulants. Four multivariable random-intercept logistic regression models were built to examine psychosocial constructs separately along with other significant predictors from bivariate analyses while controlling for age and education.

RESULTS

Among a total of 272 participants, 220 were White, 201 were male, and 134 were men who have sex with men (MSM). The mean age was 36.1 years (SD 10.5). At baseline, 173 participants engaged in any current or past hazardous alcohol consumption, 31 reported using cocaine, 19 reported using methamphetamine, 8 reported using crack cocaine, and 104 reported any noninjection or injection drug use in the past 6 months. Factors independently associated with substance use were depression (adjusted odds ratio [aOR] 1.11, 95% CI 1.02-1.21; P=.01), negative affect (aOR 1.08, 95% CI 1.01-1.16; P=.01), lower levels of self-esteem (aOR 0.90, 95% CI 0.82-0.98; P=.02), and cravings for alcohol (aOR 1.02, 95% CI 1.01-1.03; P<.001) and stimulants (aOR 1.03, 95% CI 1.01-1.04; P=.01). MSM had higher odds of engaging in substance use in all models (model 1: aOR 4.90, 95% CI 1.28-18.70; P=.02; model 2: aOR 5.47, 95% CI 1.43-20.87; P=.01; model 3: aOR 5.99, 95% CI 1.55-23.13; P=.009; and model 4: aOR 4.94, 95% CI 1.29-18.84; P=.01).

CONCLUSIONS

Interventions for substance use should utilize evidenced-based approaches to reduce depression, negative affect, and cravings; increase self-esteem; and engage MSM. Interventions may also consider leveraging technology-based approaches to reduce substance use among populations who use crowdsourcing platforms.

The complex nature of willpower and conceptual mapping of its normative significance in research on stress, addiction, and dementia

Willpower (as suppression, resolve, and habit) has ramifications for autonomy and mental time-travel. Autonomy presupposes mature powers of volition and the capacity to anticipate future events and consequences of one's actions. Ainslie's study is useful to clarify basic autonomy in addiction and dementia. Furthermore, we show how our study on coping with stress can be applied to suppression and resolve.

Exploring Factors Associated with Alcohol and/or Substance Use During the COVID-19 Pandemic

This study explored the relationship between alcohol and substance use in the general population during the early stages of COVID-19 as related to individual, family, and community stressors. A convenience sample of adults who resided in the USA and Canada was utilized. An online survey was conducted. Over one-third of the sample reported utilizing alcohol and substances as a means to cope during the pandemic. A linear regression revealed that use of social media as a source of information, being personally affected by COVID-19, experiencing child care challenges, and not being associated with a religious community were related to increased likeliness for alcohol and/or substance use. Future research should explore these concepts further within the general population.

Addictive behaviors and craving during the COVID-19 pandemic of people who have recovered from substance use disorder

Stressors caused by the coronavirus pandemic (COVID-19) contribute to increased addictive behaviors in the general population worldwide. Little is known, however, about addictive behaviors of people who have recovered a long time ago, even years, from substance use disorder (SUD). The goal of the present research was to examine the craving for drug use and addictive behaviors (tobacco and alcohol consumption, viewing of pornography, gambling, and shopping online) of people who recovered from SUD, before and after the outbreak of the COVID-19 pandemic.Methods: During one week of isolation imposed in Israel following the outbreak of COVID-19 in April, 2020, a self-report questionnaire was distributed to a convenience sample of 113 people who had recovered from SUD, aged 22-69, 78% men.Results Fifty-one percent of participants reported craving drugs during the isolation period and engaging in addictive behaviors. Significant differences were found in tobacco and alcohol consumption, gambling, and viewing of pornography online, before and after the outbreak of the pandemic, especially in participants who reported having engaged in these addictive behaviors to some extent before the outbreak. A hierarchical linear regression showed a significant explained variance (R²=44%, p<.001), with stronger feelings of loneliness and shorter length of time free from drug use being associated with stronger craving for drugs.Conclusions: The drug addiction treatment establishment should pay close attention and strengthen communication with people who recovered from SUD. It is necessary to develop real-time anti-craving and anti-replacement addiction interventions to prevent relapses.

Clinical and demographic characteristics of people who smoke versus inject crystalline methamphetamine in Australia: Findings from a pharmacotherapy trial

INTRODUCTION AND AIMS

There has been a rapid increase in smoking crystalline methamphetamine in Australia. We compare the clinical and demographic characteristics of those who smoke versus inject the drug in a cohort of people who use methamphetamine.

DESIGN AND METHODS

Participants (N = 151) were dependent on methamphetamine, aged 18-60 years, enrolled in a pharmacotherapy trial for methamphetamine dependence, and reported either injecting (n = 54) or smoking (n = 97) methamphetamine. Measures included the Timeline Followback, Severity of Dependence Scale, Amphetamine Withdrawal Questionnaire, Craving Experience Questionnaire and the Brief Psychiatric Rating Scale (symptoms of depression, hostility, psychosis and suicidality). Simultaneous regression was used to identify independent demographic correlates of smoking methamphetamine and to compare the clinical characteristics of participants who smoked versus injected.

RESULTS

Compared to participants who injected methamphetamine, those who smoked methamphetamine were younger and less likely to be unemployed, have a prison history or live alone. Participants who smoked methamphetamine used methamphetamine on more days in the past 4 weeks than participants who injected methamphetamine (26 vs. 19 days, P = 0.001); they did not differ significantly in their severity of methamphetamine dependence, withdrawal, craving or psychiatric symptoms (P > 0.05). After adjustment for demographic differences, participants who smoked had lower craving [b (SE) = -1.1 (0.5), P = 0.021] and were less likely to report psychotic symptoms [b (SE) = -1.8 (0.7), P = 0.013] or antidepressant use [b (SE) = -1.1 (0.5), P = 0.022].

DISCUSSION AND CONCLUSIONS

Smoking crystalline methamphetamine is associated with a younger less marginalised demographic profile than injecting methamphetamine, but a similarly severe clinical profile.

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

Clinicians and researchers alike have long believed that stressors play a pivotal etiologic role in risk, maintenance, and/or relapse of alcohol and other substance use disorders (SUDs). Numerous seminal and contemporary theories on SUD etiology posit that stressors may motivate drug use and that individuals who use drugs chronically may display altered responses to stressors. We use foundational basic stress biology research as a lens through which to evaluate critically the available evidence to support these key stress-SUD theses in humans. Additionally, we examine the field's success to date in targeting stressors and stress allostasis in treatments for SUDs. We conclude with our recommendations for how best to advance our understanding of the relationship between stressors and drug use, and we discuss clinical implications for treatment development.