Quantifying Exposure to Illicit Drugs & Psychosocial Stress in Real Time

由于吸毒和心理社会压力往往是短暂的，难以准确回忆，因此对吸毒和心理社会压力的评估十分复杂。由于因果关系的复杂性和环境的难以捉摸，评估它们之间的因果关系及其遗传和环境决定因素变得复杂。在这个项目中，我们通过生态瞬时评估（EMA）近实时地评估药物使用和心理社会压力，参与者使用手持电子日记记录事件，并报告最近或正在发生的事件，以响应全天随机定时的提示。我们还通过让参与者携带全球定位系统（GPS）设备，以几米的空间分辨率跟踪他们的行踪，实时记录所报告的事件发生的地点。我们将这些数据集中使用在一种我们称之为地理瞬时评估（GMA）的方法中，下面将进一步描述。 我们的多药使用者在治疗中的EMA数据分析表明，负面影响（压力），庆祝状态和药物线索与随后的可卡因使用。接触烟草等法律的毒品也与可卡因的使用和对可卡因的渴望密切相关。在特定时刻吸烟的可能性随着当前可卡因渴望（或对海洛因和可卡因的双重渴望）的严重程度而线性增加。在使用可卡因（或可卡因和海洛因）期间吸烟的可能性更大。在我们控制了人口统计学变量、地点和情绪后，这种关联仍然很显著。这些发现对暴露于压力和非法药物有影响，并将被纳入我们的风险暴露评估算法。 我们还调查了尿液验证的可卡因使用和戒断期的伴随因素。在一项队列设计中，112名美沙酮维持可卡因和海洛因滥用门诊患者的志愿者样本在手持计算机上提供了10，781人日的EMA数据。EMA对当前位置、活动、同伴、情绪和最近暴露于假定的药物使用触发因素的问题的回答在使用和戒断期间进行了比较。可卡因的使用期与空闲、孤独、情绪消极的下午有关，但出乎意料的是，也与清晨或深夜工作的可能性更大有关。可卡因使用的全天伴随物通常与先前对同一样本进行的分析中观察到的急性使用前体不同。在禁欲期间，一些负面情绪的测量结果增加了。门诊患者数周的可卡因使用和戒断与不同的情绪和行为模式相关;这里报告的详细的每小时数据应该有助于为旨在改变日常活动的治疗干预提供信息。 本研究的数据也被用来调查渴求和吸毒者在真实的时间和日常生活环境中的药物使用之间的关系。渴望通常被认为会导致持续的药物使用和复发，并且是成瘾研究的主要焦点。然而，其与药物使用的关系尚未得到充分的记录。参与者在进行日常活动时随机评价他们的渴望和情绪（每天两到五次，由电子日记提示）。他们还在每次使用可卡因时启动电子日记条目。通过每周三次的尿检监测药物使用情况。在尿液验证的可卡因使用期间，可卡因渴望的评级在一天中增加，并且高于尿液验证的禁欲期间。在使用可卡因之前的五个小时内，渴望的等级显着增加。这些模式在海洛因渴望或情绪的评级中没有看到（例如，感到快乐或无聊）。可卡因渴望与正常环境中的可卡因使用密切相关。我们的研究结果提供了以前无法支持的关系，已受到严重质疑，在一些理论帐户。 扩大环境因素的定义，我们正在使用GMA，它结合了连续的地理位置跟踪，以评估邻里水平的影响，这些影响是根据专门开发的指数来衡量的，例如邻里心理社会危害指数（NPH），该指数基于从公共来源获得的客观统计数据，独立于自我报告，加上NIfETy，基于受过训练的观察员的客观环境评级。为了进行比较，我们还通过回顾性访谈和生物样本（尿液）评估药物暴露，并通过生理测量（非稳态负荷）评估压力。其结果预计将是一套现场部署，国家的最先进的工具不可或缺的基因环境相互作用影响药物使用和压力的未来研究。 迄今为止，我们的实时采样出版物都使用了我们第一次完成的该类型研究的数据，这是一项不包含GPS的EMA研究。 我们将继续分析该研究的数据，但我们的重点是完成一项后续研究，该研究将GPS与额外的EMA压力测量沿着。我们正在分析实时位置数据，并将其与EMA数据和尿液药物筛查结果相结合;我们还一直在根据公开数据库和NIfETy数据开发环境风险测量，作为风险暴露算法开发的一部分。 这项研究虽然仍在进行中，但在地方、国家和国际新闻出版物和广播中得到了非常有利的关注，并在印刷品、广播和电视上进行了报道。 其他研究人员和当地治疗提供者的反应也非常热烈。

Assessment of exposure to drug use and psychosocial stress is complicated by the fact that each is often transient and difficult to recall accurately. Assessment of their causal connections with one another, and of their genetic and environmental determinants, is complicated by the complexity of the causal connections and by the elusive nature of what constitutes the environment. In this project, we are assessing drug use and psychosocial stress in near-real time through Ecological Momentary Assessment (EMA), in which participants use handheld electronic diaries to record events as they occur and to report recent or ongoing events in response to randomly timed prompts throughout the day. We are also maintaining real-time records of where the reported events occurred by having participants carry Global Positioning System (GPS) devices to track their whereabouts with a spatial resolution of several meters. We use these data collectively in a method we are calling Geographical Momentary Assessment (GMA), described further below. Analyses of EMA data in our population of polydrug users in treatment have shown that negative affect (stress), celebratory states, and drug cues are associated with subsequent cocaine use. Exposure to legal drugs, such as tobacco, is also strongly linked to cocaine use as well as cocaine craving. The likelihood of smoking tobacco at a given moment increased linearly with the current severity of cocaine craving (or dual craving for heroin and cocaine). The likelihood of tobacco smoking during episodes of use of cocaine (or cocaine and heroin), was greater still. This association remained significant after we controlled for demographic variables, location, and mood. These findings have implications for exposure to stress and illicit drugs and will be incorporated into our algorithms for risk-exposure assessment. We have also investigated the concomitants of urine-verified periods of cocaine use and abstinence. In a cohort design, a volunteer sample of 112 methadone-maintained cocaine- and heroin-abusing outpatients provided EMA data on handheld computers for 10,781 person-days. EMA responses to questions about current location, activities, companions, moods, and recent exposure to putative drug-use triggers were compared across periods of use and abstinence. Periods of cocaine use were associated with idle, solitary, affectively negative afternoons, but, unexpectedly, were also associated with a greater likelihood of early-morning or late-evening work. The whole-day concomitants of cocaine use were often distinct from the acute predecessors of use seen in prior analyses from the same sample. Several measures of negative mood increased during abstinence. Weeks of cocaine use and abstinence in outpatients are associated with distinct patterns of mood and behavior; the detailed hourly data reported here should help inform treatment interventions aimed at changing daily activities. Data from this study were also used to investigate the relationship between craving and drug use in real time and in the daily living environments of drug users. Craving is often assumed to cause ongoing drug use and relapse and is a major focus of addiction research. However, its relationship to drug use has not been adequately documented. Participants rated their craving and mood at random times (two to five times daily, prompted by electronic diaries) as they went about their everyday activities. They also initiated an electronic-diary entry each time they used cocaine. Drug use was monitored by thrice-weekly urine testing. During periods of urine-verified cocaine use, ratings of cocaine craving increased across the day and were higher than during periods of urine-verified abstinence. During the five hours prior to cocaine use, ratings of craving significantly increased. These patterns were not seen in ratings of heroin craving or mood (e.g., feeling happy or bored). Cocaine craving is tightly coupled to cocaine use in users normal environments. Our findings provide previously unavailable support for a relationship that has been seriously questioned in some theoretical accounts. Broadening the definition of environmental factors, we are using GMA, which incorporates continuous geolocation tracking, to evaluate neighborhood-level effects measured in terms of specially developed indices, such as the Neighborhood Psychosocial Hazards index (NPH), based on objective statistical data available from public sources and independent of self-report, plus the NIfETy, based on objective environmental ratings by trained observers. For comparison, we are also assessing drug exposure through retrospective interviews and from biological specimens (urine), and assessing stress through physiological measures (allostatic load). The result is expected to be a set of field-deployable, state-of-the-art tools indispensable to future studies of gene-environment interactions affecting drug use and stress. Our real-time sampling publications to date have all used data from our first completed study of that type, an EMA study that did not incorporate GPS. We continue to analyze data from that study, but our focus is on completing a follow-up study that does incorporate GPS, along with additional EMA measures of stress We are analyzing the real-time location data and combining it with EMA data and urine drug screen results; we have also been developing measures of environmental risk based on publicly available databases and NIfETy data as part of risk- exposure algorithm development. This study, though still in progress, has received very favorable attention in local, national, and international news publications and broadcasts, with coverage in print, on radio, and on television. Responses from other investigators and from local treatment providers have also been highly enthusiastic.