Effects of anxiety and mood disorders on craving and substance use among patients with substance use disorder: An ecological momentary assessment study
Effects of anxiety and mood disorders on craving and substance use among patients with substance use disorder: An ecological momentary assessment study
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DOI：
10.1016/j.drugalcdep.2018.03.008
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发表时间：
2018-06-01
影响因子：
4.2
通讯作者：
Auriacombe, Marc
中科院分区：
文献类型：
--
作者：
Fatseas, Melina;Serre, Fuschia;Auriacombe, Marc
背景：尽管人们认识到精神疾病共病对成瘾障碍的负面影响，但这种联系背后的机制仍然知之甚少。本研究应用移动技术，在日常生活的自然条件下，考察了共病情绪或焦虑障碍对渴求强度和物质使用的影响。方法：从法国一家门诊成瘾诊所招募159名参与者，使用生态瞬间评估(EMA)对日常生活体验进行为期两周的计算机动态监测。患者实时描述他们的情绪状态、渴望强度和物质使用情况。根据DSM-IV标准诊断当前情绪和/或焦虑症。主要依赖物质为酒精(n=48)、烟草(n=43)、大麻(n=35)或鸦片类物质(n=33)。结果：在有(OR=1.13，p=.009，n=95)和没有(OR=1.20，p=.002，n=)当前并存精神障碍的两组中，渴求强度强烈地预测了一天中随后几个小时的药物使用。目前共存的情绪和/或焦虑症与较高的渴望强度(Gamma Coef=0.632，SE=0.254，p=.014)相关，因此更频繁地使用药物(Gamma Coef=0.162，SE=0.052，p=.003)。与当前情绪和/或焦虑障碍相关的物质使用增加的一部分与渴望强度的增加无关。结论：对渴望管理的关注对患有物质使用障碍和情绪和/或焦虑障碍的患者特别重要，但也需要额外的干预措施，以解决这些障碍通过其他机制导致物质使用频率增加的独立于渴望的机制。
Background: Despite recognition of the negative impact of psychiatric comorbidity on addictive disorders, the mechanisms underlying this association remain poorly understood. The present investigation applied mobile technologies to examine the effect of comorbid mood or anxiety disorders on craving intensity and substance use within the natural conditions of daily life.Methods: A total of 159 participants were recruited from a French outpatient addiction clinic and completed two weeks of computerized ambulatory monitoring of daily life experiences using Ecological Momentary Assessment (EMA). Patients described in real-time their emotional states, craving intensity, and substance use. Current mood and/or anxiety disorders were diagnosed according to DSM-IV criteria. The main substances of dependence were alcohol (n = 48), tobacco (n = 43), cannabis (n = 35), or opiates (n = 33).Results: Craving intensity strongly predicted substance use reported over subsequent hours of the day both in groups with (OR = 1.13, p = .009, n = 95) and without (OR = 1.20, p = .002, n = 64) current comorbid psychiatric disorders. Current comorbid mood and/or anxiety disorders were associated with higher craving intensity (gamma coef = 0.632, SE = 0.254, p = .014) and consequently more frequent substance use (gamma coef = 0.162, SE = 0.052, p = .003). A portion of increased substance use associated with current mood and/or anxiety disorders was independent of increases in craving intensity.Conclusions: Attention to craving management is particularly important for patients with substance use disorders and comorbid mood and/or anxiety disorders, but additional interventions are also needed that address other mechanisms through which these disorders lead to an increase in substance use frequency, independently from craving.