Ecological momentary assessment of relapse to substance use following treatment

University Of Tennessee Knoxville, Knoxville TN

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Abstract

DESCRIPTION (provided by applicant): Although advances in the treatment of alcohol and drug dependence have led to major reductions in substance use, relapse remains a prevalent national problem. While researchers have linked a number of important distal and proximal factors with risk for lapse and relapse, most studies typically assessed proximal variables using retrospective reports which cannot provide direct evidence of the variables present in the hours preceding a lapse or relapse. However, recent advances in ecological momentary assessment technology now allow researchers to assess real-time reports of affect and behavior that can be used to establish a temporal connection between proximal variables and lapses/relapse with great precision. To the extent that such factors precede and predict lapses and relapse, they may be appropriate targets for relapse prevention. This technology is in its infancy in the alcohol and drug relapse field, and thus, examining feasibility for assessing risk for lapses/relapse using ecological momentary assessments is grossly understudied. Therefore, we propose to conduct a prospective, longitudinal pilot study of the feasibility of using ecological momentary assessments to assess the proximal variables surrounding lapses and relapse using a sample of 40 patients entering intensive outpatient treatment for alcohol and/or drug dependence. Men and women will complete a baseline assessment to gather demographic and other distal information, including psychopathology, substance use patterns, copying styles, relationship functioning, etc. Patients will use handheld computers for 6 months to respond to random and scheduled prompts asking them to chronicle experiences with substance-related cues, cravings, negative affect, interpersonal experiences, lapses and relapse. All participants will participate in a 6-month follow-up session to complete additional questionnaires. The overall objectives of this study are to (a) establish feasibility to conduct a larger trial examining risk factors for relapse by demonstrating high recruitment, retention, and ecological momentary assessment compliance rates among patients involved in substance abuse treatment, and (b) examine the extent to which distal and proximal factors vary over time within and between participants and interact to increase risk for lapses and relapse. The long-term objective of this study is to identify methods to best examine the interactive influence of distal and proximal variables on lapse and relapse to substance use in order to enhance relapse prevention efforts. This study holds the promise of identifying risk factors involved the temporal sequence of events that may lead to a lapse or relapse, which could significantly inform relapse prevention efforts. PUBLIC HEALTH RELEVANCE: Although advances in the treatment of alcohol and drug dependence have led to major reductions in substance use, relapse remains a prevalent national problem;as many as 50% of patients completing treatment relapse. In attempting to use ecological momentary assessment technology to establish feasibility for assessing relapse among substance abusers completing treatment, this research has the long-term potential to help produce more effective relapse prevention strategies.