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Capturing illicit drug use where and when it happens: an ecological momentary assessment of the social, physical and activity environment of using versus craving illicit drugs
Author(s) -
Linas Beth S.,
Latkin Carl,
Westergaard Ryan P.,
Chang Larry W.,
Bollinger Robert C.,
Genz Andrew,
Kirk Gregory D.
Publication year - 2015
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.12768
Subject(s) - craving , heroin , confidence interval , odds ratio , mood , odds , medicine , drug , generalized estimating equation , logistic regression , psychology , psychiatry , addiction , clinical psychology , statistics , mathematics
Aims To understand the environmental and contextual influences of illicit cocaine and heroin use and craving using mobile health (m H ealth) methods. Design Interactive m H ealth methods of ecological momentary assessment ( EMA ) were utilized in the E xposure A ssessment in C urrent T ime ( EXACT ) study to assess drug use and craving among urban drug users in real time. Participants were provided with mobile devices and asked to self‐report every time they either craved (without using) or used heroin or cocaine for 30 days from N ovember 2008 through M ay 2013. Setting B altimore, MD , USA . Participants A total of 109 participants from the AIDS L inked to the I ntra V enous E xperience ( ALIVE ) study. Measurements For each drug use or craving event, participants answered questions concerning their drug use, current mood and their social, physical and activity environments. Odds ratios (OR) of drug use versus craving were obtained from logistic regression models with generalized estimating equations of all reported events. Findings Participants were a median of 48.5 years old, 90% A frican A merican, 52% male and 59% HIV ‐infected. Participants were significantly more likely to report use rather than craving drugs if they were with someone who was using drugs [adjusted odds ratio (a OR) = 1.45, 95% confidence interval ( CI ) = 1.13, 1.86), in an abandoned space (a OR = 6.65, 95% CI = 1.78, 24.84) or walking/wandering (a OR = 1.68, 95% CI = 1.11, 2.54). Craving drugs was associated with being with a child (a OR = 0.26, 95% CI = 0.12, 0.59), eating (a OR = 0.54, 95% CI = 0.34, 0.85) or being at the doctor's office (a OR = 0.31, 95% CI = 0.12, 0.80). Conclusions There are distinct drug using and craving environments among urban drug users, which may provide a framework for developing real‐time context‐sensitive interventions.