Quantifying Exposure to Illicit Drugs & Psychosocial Stress in Real Time

对吸毒和心理社会压力事件的评估很复杂，因为每一事件往往是短暂的，难以准确回忆。 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。 我们的团队率先使用生态瞬时评估（EMA）对药物相关行为进行实时现场评估。 我们在新冠疫情前的方法需要参与者频繁进行实地考察，因此于二零二零年至二零二一年不得不暂停。我们利用这段时间改变了我们的方法，以便我们可以在全国范围内远程实施EMA。 在本报告所述期间，为了继续开展该项目，我们使用EMA研究了全国范围内使用药物kratom的人群样本。 为了补充EMA数据，我们进行了一项现场子研究，其中一些参与者在我们的观察下接受了他们的kratom，进行了前后行为和生理评估，并在驾驶模拟器中进行了测试，提供了与评估药物作用的项目目标直接相关的信息，因为它们会在日常生活中表现出来。 kratom项目在快速实施和科学生产力方面都非常成功。全国范围内的EMA研究以前所未有的速度招募了参与者，行为数据具有深刻的信息性，部分原因是我们让参与者运送他们购买的kratom项目样品进行实验室分析，以便我们可以检查特定生物碱含量与真实的报告效果之间的关系。 我们正在分析和撰写结果，并将其提交出版。 我们还发表了几篇相关的系统综述、一篇方法论文和一篇总结了对参与者的叙述性访谈的论文;访谈为我们对现场（EMA）数据和人类实验室数据的解释提供了信息和澄清。 我们为kratom项目开发和实施的方法将成为我们未来实时评估的模型。

Assessment of episodes of 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. Our group pioneered the use of ecological momentary assessment (EMA) for real-time field assessment of drug-related behaviors. Our method prior to the Covid pandemic required frequent on-site visits from participants and therefore had to be paused in 2020-2021. We used that time to change our methodology so that we could implement EMA remotely and nationwide. In a continuation of this project during the current reporting period, we used EMA to study a nationwide sample of people who use the drug kratom. To complement the EMA data, we ran an on-site substudy in which some participants took their kratom under our observation for pre-post behavioral and physiological assessment and a test in a driving simulator, providing information that was directly relevant to the project goal of assessing drug effects as they would manifest in daily life. The kratom project has been exceedingly successful, both in terms of its rapid implementation and its scientific productivity. The nationwide EMA study enrolled participants at a pace that was unprecedented for us, and the behavioral data have been deeply informative, in part because we had participants ship samples of their purchased kratom project for laboratory analysis so we could examine relationships between specific alkaloid content and effects reported in real time. We are analyzing and writing up the results and submitting them for publication. We have also published several related systematic reviews, a methods paper, and a paper summarizing narrative interviews with participants; the interviews informed and clarified our interpretations of both the field (EMA) data and the human-laboratory data. The methods we developed and implemented for the kratom project will be our model for real-time assessment going forward.