title: Perceived stress and substance use in methadone-maintained smokers.
abstract: BACKGROUND
  In methadone maintenance treatment programs (MMTPs), 80-90% of participants smoke cigarettes. Patients in MMTPs are at particular risk for life stress, and nicotine, as well as other substances like alcohol, benzodiazepines, cocaine, marijuana, and opiates have been shown to reduce the effects of stress. Use of these addictive substances to cope with stress may precipitate illicit opiate relapse in MMTP patients. In the current study, we examined the relationship between perceived stress and substance abuse.
  
  
  METHODS
  Participants were 315 cigarette smokers recruited from nine MMTPs for a smoking cessation study. Logistic regression was used to evaluate the adjusted association of perceived stress with dichotomous indicators of hazardous alcohol use and recent substance use at baseline.
  
  
  RESULTS
  After controlling for demographic and smoking-related variables, perceived stress was associated positively and significantly with the likelihood of screening positive for hazardous drinking or alcohol-related problems (OR=1.13, 95%CI 1.02; 1.25), with the likelihood of recent cocaine use (OR=1.18, 95%CI 1.02; 1.37), and with the likelihood of recent benzodiazepine use (OR=1.24, 95%CI 1.07).
  
  
  CONCLUSIONS
  Perceived stress may be a marker of patients' risk for illicit substance use, a known risk factor for illicit opiate relapse. These findings indicate that cigarette use might not be sufficient in managing stress and methadone-maintained persons turn to other substances for relief.
authors.affiliation: Warren Alpert Medical School of Brown University, Providence, RI 02912, United States. Electronic address: ethan_moitra@brown.edu.
authors.forename: Ethan
authors.initials: E
authors.lastname: Moitra
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Anderson
authors.forename: Michael D
authors.initials: MD
authors.lastname: Stein
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications / Q000523:psychology; D004522:Educational Status; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000523:psychology*; D012907:Smoking / Q000523:psychology*; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000523:psychology*; D019966:Substance-Related Disorders / Q000523:psychology*; D014029:Tobacco Use Disorder / Q000150:complications / Q000523:psychology
chemical_list: D009294:Narcotics; D008691:Methadone
keywords: Methadone; Nicotine; Perceived stress; Substance abuse