Effects of anxiety and mood disorders on craving and substance use among patients with substance use disorder: An ecological momentary assessment study

• Published in: Drug and alcohol dependence 2018-06, Vol.187, p.242-248
• Main Authors: Fatseas, Melina, Serre, Fuschia, Swendsen, Joel, Auriacombe, Marc
• Format: Article
• Language: English
• Subjects: Activities of daily living; Addiction; Addictions; Alcohols; Ambulatory health care; Anxiety; Anxiety disorders; Behavioral psychology; Cannabis; Comorbidity; Computerization; Craving; Dependence; Disorders; Drug abuse; Ecological Momentary Assessment; Ecological monitoring; Emotional disorders; Emotional states; Life experiences; Life Sciences; Marijuana; Mental disorders; Monitoring; Mood; Mood disorders; Narcotics; Opiates; Opioids; Patients; Psychiatry; Substance use; Substance use disorder; Tobacco
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2018.03.008

•Comorbidity between psychiatric and addictive disorders is frequent.•In comorbid mood/anxiety disorders craving remains a mediator of substance use.•Mood/anxiety comorbid disorders are associated with higher craving intensity.•Mood/anxiety comorbid disorders are associated with more frequent substance use.•Mood/anxiety comorbidity increased substance use is partly independent of craving. Despite recognition of the negative impact of psychiatric comorbidity on addictive disorders, the mechanisms underlying this association remain poorly understood. The present investigation applied mobile technologies to examine the effect of comorbid mood or anxiety disorders on craving intensity and substance use within the natural conditions of daily life. A total of 159 participants were recruited from a French outpatient addiction clinic and completed two weeks of computerized ambulatory monitoring of daily life experiences using Ecological Momentary Assessment (EMA). Patients described in real-time their emotional states, craving intensity, and substance use. Current mood and/or anxiety disorders were diagnosed according to DSM-IV criteria. The main substances of dependence were alcohol (n = 48), tobacco (n = 43), cannabis (n = 35), or opiates (n = 33). Craving intensity strongly predicted substance use reported over subsequent hours of the day both in groups with (OR = 1.13, p = .009, n = 95) and without (OR = 1.20, p = .002, n = 64) current comorbid psychiatric disorders. Current comorbid mood and/or anxiety disorders were associated with higher craving intensity (γ coef = 0.632, SE = 0.254, p = .014) and consequently more frequent substance use (γ coef = 0.162, SE = 0.052, p = .003). A portion of increased substance use associated with current mood and/or anxiety disorders was independent of increases in craving intensity. Attention to craving management is particularly important for patients with substance use disorders and comorbid mood and/or anxiety disorders, but additional interventions are also needed that address other mechanisms through which these disorders lead to an increase in substance use frequency, independently from craving.