, Volume 235, Issue 9, pp 2713–2723 | Cite as

Before and after: craving, mood, and background stress in the hours surrounding drug use and stressful events in patients with opioid-use disorder

  • Kenzie L. PrestonEmail author
  • William J. Kowalczyk
  • Karran A. Phillips
  • Michelle L. Jobes
  • Massoud Vahabzadeh
  • Jia-Ling Lin
  • Mustapha Mezghanni
  • David H. Epstein
Original Investigation



Ecological momentary assessment (EMA) of specific events usually focuses more on antecedents and concomitants than on aftermaths.


To examine mental state both before and after discrete episodes of stress and drug use.


For up to 16 weeks, outpatients on opioid-agonist treatment carried smartphones on which they initiated entries for stressful events (SEs) or lapses to drug use (DUs), and thrice daily when randomly prompted (RPs). Participants rated their stress, opioid craving, cocaine craving, and moods. RP entries within 5 h of an event were analyzed and compared to other RPs.


Stress, negative mood, and craving were generally higher before and after DUs and SEs compared to background levels in participants with at least one DU (n = 149) or SE (n = 158). Before DUs, there were increases in negative mood, opioid craving, and cocaine craving, but not background stress. Before SEs, there were increases in background stress, opioid craving, and cocaine craving, but not negative mood. These changes were more variable after events than before. Neither DUs nor SEs were significantly related to positive mood.


Stress increased before stressful-event entries, but was less evident before drug use. Craving increased in the hours before drug use and stressful events—and remained elevated in the hours after either event. These results suggest a stronger link between drug use and craving than between drug use and stress. Lapses to drug use did not improve mood or reduce stress, at least not at our 1-h-bin time resolution, suggesting that if such benefits exist, they are brief.


Cocaine Opioid Ecological momentary assessment Stress Craving 



This study was supported by the Intramural Research Program of the National Institute on Drug Abuse, National Institutes of Health.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

213_2018_4966_MOESM1_ESM.docx (1 mb)
ESM 1 (DOCX 1074 kb)


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Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2018

Authors and Affiliations

  • Kenzie L. Preston
    • 1
    Email author
  • William J. Kowalczyk
    • 1
  • Karran A. Phillips
    • 1
  • Michelle L. Jobes
    • 1
  • Massoud Vahabzadeh
    • 1
  • Jia-Ling Lin
    • 1
  • Mustapha Mezghanni
    • 1
  • David H. Epstein
    • 1
  1. 1.Intramural Research ProgramNational Institute on Drug AbuseBaltimoreUSA

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