title: Persistence on a stress-challenge task before initiating buprenorphine treatment was associated with successful transition from opioid use to early abstinence.
abstract: OBJECTIVE
  Lapse to opiate use after initiation of buprenorphine treatment is common and is a strong predictor of poor treatment retention and increased risk of long-term opiate use. Drug cues and situations or events associated with distress are known to provoke craving and increase risk for lapse. This study evaluated the predictive validity of a behavioral index of persistence during a stress challenge among opiate users identified as affectively vulnerable to lapse risk due to elevated depressive symptoms.
  
  
  METHODS
  Patients from an ongoing clinical trial (n = 48) completed a stress-challenge task before receiving their first dose of buprenorphine.
  
  
  RESULTS
  After controlling for levels of craving on their induction day, persistence on the stress-challenge task before initiating buprenorphine treatment was associated with successful transition to early abstinence, and lower rates of opiate use during the initial 3 months of buprenorphine treatment across antidepressant and placebo groups.
  
  
  CONCLUSIONS
  Results from this preliminary study suggest the promise of laboratory-based behavioral paradigms in facilitating an understanding of important mechanisms of early lapse. Identifying individual behavioral responses to drug and stress cues before attempts at abstinence may facilitate delivery of adjunctive behavioral treatments to prevent early lapse.
authors.affiliation: Department of Family and Preventive Medicine, University of California, San Diego, 9500 Gilman Dr. #0813, La Jolla, CA 92093, USA. dstrong@ucsd.edu
authors.forename: David R
authors.initials: DR
authors.lastname: Strong
authors.forename: Richard A
authors.initials: RA
authors.lastname: Brown
authors.forename: Meredith
authors.initials: M
authors.lastname: Sims
authors.forename: Debra S
authors.initials: DS
authors.lastname: Herman
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Anderson
authors.forename: Michael D
authors.initials: MD
authors.lastname: Stein
mesh_terms: D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000627:therapeutic use; D002047:Buprenorphine / Q000009:adverse effects / Q000627:therapeutic use*; D015283:Citalopram / Q000009:adverse effects / Q000627:therapeutic use; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D009042:Motivation; D009294:Narcotics / Q000009:adverse effects / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000523:psychology* / Q000534:rehabilitation*; D010352:Patient Dropouts / Q000523:psychology*; D011336:Probability; D018570:Risk Assessment; D013315:Stress, Psychological / Q000150:complications*; D015813:Substance Abuse Detection / Q000706:statistics & numerical data; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis* / Q000523:psychology*
chemical_list: D018687:Antidepressive Agents, Second-Generation; D009294:Narcotics; D015283:Citalopram; D002047:Buprenorphine