Daily life hour by hour, with and without cocaine: an ecological momentary assessment study.
BACKGROUND
Effects of an intervention cannot be understood without precise knowledge of the baseline behavior on which the intervention is superimposed. For misusers of illicit drugs, patterns of daily activities and moods have not been studied in a way that is amenable to statistical aggregation.


OBJECTIVE
The aim of the study was to compare hour-by-hour daily activities in cocaine-dependent outpatients during urine-verified periods of use and abstinence.


METHODS
In a cohort design, a volunteer sample of 112 methadone-maintained cocaine- and heroin-abusing outpatients provided ecological momentary assessment (EMA) data on handheld computers for 10,781 person-days. EMA responses to questions about current location, activities, companions, moods, and recent exposure to putative drug-use triggers were compared across periods of use and abstinence using SAS Proc Glimmix (for binary outcomes) and Proc Mixed (for continuous outcomes).


RESULTS
Periods of cocaine use were associated with idle, solitary, affectively negative afternoons but, unexpectedly, were also associated with a greater likelihood of early-morning or late-evening work. The whole-day concomitants of cocaine use were often distinct from the acute predecessors of use seen in prior analyses from the same sample. Several measures of negative mood increased during abstinence.


CONCLUSIONS
Weeks of cocaine use and abstinence in outpatients are associated with distinct patterns of mood and behavior; the detailed hourly data reported here should help inform treatment interventions aimed at changing daily activities. The findings also argue against the contention that cocaine abstinence symptoms decrease monotonically from the day of cessation.
Treatment Section, Clinical Pharmacology and Therapeutics Research Branch, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Department of Health & Human Services, Room 01B-606, 251 Bayview Blvd., Suite 200, Baltimore, MD 21224, USA. depstein@intra.nida.nih.gov
David H
DH
Epstein
Kenzie L
KL
Preston
D000328:Adult; D000339:Affect; D003042:Cocaine; D019970:Cocaine-Related Disorders / Q000523:psychology* / Q000534:rehabilitation; D015331:Cohort Studies; D034201:Computers, Handheld; D005260:Female; D006556:Heroin Dependence / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use; D012008:Recurrence; D013375:Substance Withdrawal Syndrome / Q000523:psychology*; D013997:Time Factors; D055815:Young Adult
D009294:Narcotics; D003042:Cocaine; D008691:Methadone