title: Stress in the daily lives of cocaine and heroin users: relationship to mood, craving, relapse triggers, and cocaine use.
abstract: BACKGROUND
  Quantitative real-time data on the stress experienced by drug misusers in their daily lives may provide additional insight into stress's role in drug use.
  
  
  OBJECTIVE
  The purpose of this study is to evaluate stress in relation to craving, mood, relapse-trigger exposure, and cocaine use in cocaine-dependent outpatients.
  
  
  METHODS
  Methadone-maintained cocaine- and heroin-abusing outpatients (N = 114) provided ecological momentary assessment data on handheld computers. Ratings of stress were compared to those of craving and mood and past-hour exposure to putative drug-use triggers in randomly prompted entries and in the 5 h prior to participant-initiated cocaine use reports.
  
  
  RESULTS
  Stress had significant positive relationships with current ratings of craving for cocaine, heroin, and tobacco and with ratings of tiredness, boredom, and irritation, and had significant negative relationships with ratings of happiness and relaxation. Stress was significantly greater in entries in which participants also reported past-hour exposure to negative-mood triggers, most of the drug-exposure triggers, or any trigger involving thoughts about drugs (e.g., tempted out of the blue). The linear increase in stress during the 5-h preceding individual episodes of cocaine use was not significant (p = 0.12), though there was a trend for such an increase before the use episodes that participants attributed to stressful states when they occurred (p = 0.87).
  
  
  CONCLUSIONS
  The findings suggest a complex role of stress in addiction. Stress reported in real time in the natural environment showed strong cross-sectional momentary relationships with craving, mood, and exposure to drug-use trigger. However, the prospective association between stress ratings and cocaine-use episodes was, at best, weak.
authors.affiliation: Treatment Section, Clinical Pharmacology and Therapeutics Branch, NIDA Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, Room 01B-602, 251 Bayview Blvd., Suite 200, Baltimore, MD 21224, USA. kpreston@intra.nida.nih.gov
authors.forename: Kenzie L
authors.initials: KL
authors.lastname: Preston
authors.forename: David H
authors.initials: DH
authors.lastname: Epstein
mesh_terms: D000328:Adult; D000339:Affect; D019970:Cocaine-Related Disorders / Q000523:psychology* / Q000534:rehabilitation; D034201:Computers, Handheld; D005260:Female; D006556:Heroin Dependence / Q000523:psychology* / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000379:methods; D011446:Prospective Studies; D013315:Stress, Psychological / Q000150:complications*; D055815:Young Adult
chemical_list: D008691:Methadone