Real Time Assessment of Drug Craving, Use, and Abstinence During Outpatient: A Development and Feasibility Study

Background. We have already completed the original, major arm of this protocol (a natural-history study of craving and lapse). Still open for enrollment is the second minor arm (a within-subject trial of PDA-based treatment-task reminders). In the third arm there will be enhanced assessment of mood, stress, and geographical location to further study craving and lapse. All arms of the study have developed from either or both of two aspects of the original arm: (1) Our growing appreciation of the technical possibilities of electronic data collection in participants daily environments, and (2) our growing interest in having participants provide descriptive data about the day-to-day experience of addiction and recovery.

The major completed arm of the protocol has provided a wealth of descriptive data on drug craving and lapse via Ecological Momentary Assessment (EMA), in which participants carry handheld data-collection devices (electronic diaries, EDs) on which they report, in real time, their activities and moods. Beyond data monitoring, EDs can be used to complement behavioral interventions. The data-collection devices can be additionally programmed to prompt completion of therapist-assigned homework exercises; by extending support outside the therapy session, clinical outcome may be improved. Furthermore, there is an evidenced association between completion of homework exercises and therapeutic outcome. Adapting existing homework assignments to make them more engaging may increase homework completion and, in turn, general compliance with therapy (Arm 2). The rationale for the third arm of the study is to broaden the perspective of the examination of the natural history of drug cravings and lapses by refining our assessments of geographical location and the stressors associated with it. In doing so, we intend to investigate determinants of addiction that are not reducible to individual-level traits but are instead reflective of broader socioeconomic problems manifested in differences among neighborhoods.

Scientific goals. Arm 1) To investigate the relationships between putative triggers and drug craving and lapse; Arm 2) To investigate interactive effects of electronic-diary reminders, and simplified therapy-assigned homework tasks, on homework completion and therapeutic outcome; Arm 3) Using refinements in our assessment methods, to investigate the role of stress associated with geographical location in drug craving and use.

Participant population. Arm 2: 35 cocaine-abusing opioid-dependent outpatients. Arm 3: 50 cocaine-abusing opioid-dependent outpatients (separate from those in Arm 2). Target enrollment for both arms will include 40% women and 60% minorities (mostly African-American).

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