title: Craving and self-efficacy in the first five weeks of methadone maintenance therapy: a daily process study.
abstract: OBJECTIVE
  Among individuals initiating methadone maintenance therapy for heroin addiction, low craving and high self-efficacy are thought to predict treatment response; however, in the case of craving, findings have been inconsistent. This study will test two hypotheses: (1) craving and self-efficacy both predict treatment response and (2) withdrawal symptoms and sleep quality predict greater craving and greater self-efficacy, respectively.
  
  
  METHODS
  An exploratory study using electronic diary data and multilevel models examined these hypotheses. A sample of 21 heroin users was recruited during the first 1-2 days of methadone maintenance therapy to take part in a 5-week diary study. Comparisons were made between days before participants reached a 70 mg or greater dose and subsequent days. This is in keeping with research showing that this dosage corresponds to optimal opioid receptor blockade.
  
  
  RESULTS
  Analysis of 449 diary records nested within 21 participants showed a marked decline in heroin use on days subsequent to the 70 mg methadone dosage plateau. Controlling for methadone dosage plateau, the likelihood of heroin use was lower on days in which participants reported both high self-efficacy and low craving, as compared with other days. Support was found for hypothesized direct associations between craving and withdrawal symptoms and between self-efficacy and sleep quality.
  
  
  CONCLUSIONS
  Consistent with a previously published theory, the effect of low craving on positive response to methadone maintenance therapy is evident on days distinguished by high self-efficacy. Also, improving patients' sleep quality may enhance the benefits of methadone maintenance therapy.
authors.affiliation: Center for Health, Intervention, and Prevention, University of Connecticut, Storrs, 06269, USA. billbarta@yahoo.com
authors.forename: William D
authors.initials: WD
authors.lastname: Barta
authors.forename: Megan E
authors.initials: ME
authors.lastname: Kurth
authors.forename: Michael D
authors.initials: MD
authors.lastname: Stein
authors.forename: Howard
authors.initials: H
authors.lastname: Tennen
authors.forename: Susan M
authors.initials: SM
authors.lastname: Kiene
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D016739:Behavior, Addictive / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006556:Heroin Dependence / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D008297:Male; D008499:Medical Records; D008691:Methadone / Q000008:administration & dosage*; D011446:Prospective Studies; D020377:Self Efficacy; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008691:Methadone