title: Some of the people, some of the time: field evidence for associations and dissociations between stress and drug use.
abstract: BACKGROUND
  Stress's role in drug use is supported by retrospective interview and laboratory studies, but prospective data confirming the association in daily life are sparse.
  
  
  OBJECTIVE
  This study aims to assess the relationship between drug use and stress in real time with ambulatory monitoring.
  
  
  METHODS
  For up to 16 weeks, 133 outpatients on opiate agonist treatment used smartphones to report each time they used drugs or felt more stressed than usual. They rated stress-event severity on a 10-point scale and as a hassle, day spoiler, or more than a day spoiler. For analysis, stress reports made within 72 h before a reported use of cocaine or opioid were binned into 24-h periods.
  
  
  RESULTS
  Of 52 participants who reported stress events in the 72-h timeframe, 41 reported stress before cocaine use and 26 before opioid use. For cocaine use, the severity of stressors, rated numerically (r effect = 0.42, CL95 0.17-0.62, p = 0.00061) and percent rated as "more than a day spoiler" (r effect = 0.34, CL95 0.07-0.56, p = 0.0292)], increased linearly across the three days preceding use. The number of stressors did not predict cocaine use, and no measure of stress predicted opioid use. In ecological momentary assessment (EMA) from the whole sample of 133, stress and drug use occurred independently and there was no overall relationship.
  
  
  CONCLUSIONS
  EMA did not support the idea that stress is a necessary or sufficient trigger for cocaine or heroin use after accounting for the base rates of stress and use. But EMA did show that stressful events can increase in severity in the days preceding cocaine use.
authors.affiliation: Clinical Pharmacology and Therapeutics Research Branch, Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA.
authors.forename: Melody
authors.initials: M
authors.lastname: Furnari
authors.forename: David H
authors.initials: DH
authors.lastname: Epstein
authors.forename: Karran A
authors.initials: KA
authors.lastname: Phillips
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Jobes
authors.forename: William J
authors.initials: WJ
authors.lastname: Kowalczyk
authors.forename: Massoud
authors.initials: M
authors.lastname: Vahabzadeh
authors.forename: Jia-Ling
authors.initials: JL
authors.lastname: Lin
authors.forename: Kenzie L
authors.initials: KL
authors.lastname: Preston
mesh_terms: D000328:Adult; D019970:Cocaine-Related Disorders / Q000175:diagnosis / Q000523:psychology*; D004644:Emotions; D005260:Female; D006556:Heroin Dependence / Q000175:diagnosis / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000523:psychology*; D011446:Prospective Studies; D012189:Retrospective Studies; D000068997:Smartphone; D013315:Stress, Psychological / Q000175:diagnosis / Q000523:psychology*; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000523:psychology; D013997:Time Factors