Day and within-Day Trends of Drug Cravings: Ecological Momentary Assessment Among a Sample of Patients with Prescription Opiate Dependence

Introduction: Cravings have been shown to be related to drug relapse and recovery outcomes, but this association is poorly understood due to limitations surrounding the timing and methods of measuring cravings (Serre et al., 2015). Experiences with cravings, nonetheless, are often assessed with retrospective reports—thereby increasing the potential for recall bias, reducing ecological validity, and limiting the understanding of within-person processes. Ecological momentary assessment (EMA) can inform the understanding of the dynamic relationship between everyday experiences and drug cravings among opioid addicts during the early recovery process. The purpose of this study is to highlight the utility of EMA to assess changes in drug cravings among a sample of individuals with prescription opiate dependence in a clinical residential setting.

Methods: Participants (n = 73) were recruited from the Caron Treatment Center, a residential drug and alcohol treatment facility located in Wernersville, Pennsylvania. Participants ranged in age from 19 to 61 (M = 30) and were 24% female. EMA via mobile phone surveys were administered to participants following medically assisted withdrawal from prescription opiates. Mobile phone surveys inquired about drug craving frequency and intensity four times daily for approximately fourteen consecutive days at fixed times throughout the day (i.e., beginning in the early morning, late morning, mid-afternoon, and evening). Random linear growth models estimated average daily craving trends, average within-day craving trends, and within-day craving trends across assessment days.

Results: Average daily assessments of drug cravings steadily declined across study days (predicted mean at Day 1 = 13.74 versus Day 14 M = 9.42), whereas average within-day assessments of drug cravings increased from morning assessments to evening assessments (mean cravings = 9.89 and 15.23, respectively). Analysis of within-day drug cravings across assessment days revealed mid-afternoon cravings to steeply decline, whereas early morning assessments of craving levels stayed consistent across days.

Conclusions: The results provide evidence for the potential utility of EMA to assess cravings in a treatment setting. Validity of the assessments is supported by mean levels of craving dropping as expected from the first through 14^th days of the study, which approximately correspond to days 14 to 28 in treatment. Differences in level across time of assessments, as well as different changes across the 14 days of data in craving for these time-of-day levels, suggest the EMA assessments are sensitive to within-day variation in craving. Accurate assessment of craving in treatment may inform post-treatment decisions. This study highlights that the assessment protocol of EMA is sufficiently sensitive to capture important between- and within-person differences for relapse risk, offering a useful tool for treatment professionals.