Contact
Biomedical Research Center251 Bayview Boulevard
Suite 200
Baltimore, MD 21224
Email: kpreston@intra.nida.nih.gov
Education
Post Doctoral Fellowship - Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD
Ph.D. - Pharmacology, University of Chicago, Chicago, IL
B.S. with Honors - Pharmacy, University of Illinois, Chicago, IL
Research Interests
The goals of our research are to develop and test the efficacy and safety of new treatments for drug abuse and to understand the individual and environmental factors that affect drug taking and relapse. Our primary focus is on evaluating treatments for cocaine and opioid abuse, including both pharmacologic and non-pharmacologic (psychosocial and behavioral) treatments. Related projects are evaluating the effects of specifically targeted counseling programs for reducing high-risk HIV-transmission behaviors, developing new screening and assessment tools (questionnaires, drug-screening methods) for testing potential treatment medications, and assessing the effects of patient characteristics (e.g., co-morbidity, family history, drug metabolism) on compliance, treatment outcome, and other clinical variables. Another major focus of our research is developing field tools to measure the effect of psychosocial stress as it actually occurs in daily life. With these tools, individuals with substance use disorders provide behavioral and physiological data in real time in their usual environments. Behavioral and physiological data are linked with a geographical location that can be codified in terms of objective ratings of neighborhood disarray, enabling us to relate indices of community-level risk to intensive field measurements of individual attempts at behavior change. The field measurements are supplemented with laboratory data from the same pool of participants, enabling assessment of dysregulation of biological responses to stress and its association with time spent in particular environments. The field tools will also enable a more sophisticated, integrative approach to the study of interactions between genes and environment in determining health outcomes.
Publications
Selected Publications
2015
Kowalczyk, William J; Phillips, Karran A; Jobes, Michelle L; Kennedy, Ashley P; Ghitza, Udi E; Agage, Daniel A; Schmittner, John P; Epstein, David H; Preston, Kenzie L
In: Am J Psychiatry, vol. 172, no. 8, pp. 760–767, 2015, ISSN: 1535-7228 (Electronic); 0002-953X (Linking).
@article{Kowalczyk2015,
title = {Clonidine Maintenance Prolongs Opioid Abstinence and Decouples Stress From Craving in Daily Life: A Randomized Controlled Trial With Ecological Momentary Assessment.},
author = {Kowalczyk, William J and Phillips, Karran A and Jobes, Michelle L and Kennedy, Ashley P and Ghitza, Udi E and Agage, Daniel A and Schmittner, John P and Epstein, David H and Preston, Kenzie L},
url = {https://www.ncbi.nlm.nih.gov/pubmed/25783757},
doi = {10.1176/appi.ajp.2014.14081014},
issn = {1535-7228 (Electronic); 0002-953X (Linking)},
year = {2015},
date = {2015-08-01},
journal = {Am J Psychiatry},
volume = {172},
number = {8},
pages = {760--767},
abstract = {OBJECTIVE: The authors tested whether clonidine blocks stress-induced seeking of heroin and cocaine. The study was also intended to confirm translational findings from a rat model of drug relapse by using ecological momentary assessment of patients' stress to test hypotheses about clonidine's behavioral mechanism of action. METHOD: The authors conducted a randomized double-blind placebo-controlled clinical trial with 208 opioid-dependent patients at an outpatient buprenorphine clinic. The 118 participants (57%) who maintained abstinence during weeks 5-6 were continued on buprenorphine and randomly assigned to receive clonidine (N=61) or placebo (N=57) for 14 weeks. Urine was tested thrice weekly. Lapse was defined as any opioid-positive or missed urine test, and relapse as two or more consecutive lapses. Time to lapse and relapse were examined with Cox regressions; longest period of abstinence was examined with a t test, and ecological momentary assessment data were examined with generalized linear mixed models. RESULTS: In an intent-to-treat analysis, clonidine produced the longest duration (in consecutive days) of abstinence from opioids during the intervention phase (34.8 days [SD=3.7] compared with 25.5 days [SD=2.7]; Cohen's d=0.38). There was no group difference in time to relapse, but the clonidine group took longer to lapse (hazard ratio=0.67, 95% CI=0.45-1.00). Ecological momentary assessment showed that daily-life stress was partly decoupled from opioid craving in the clonidine group, supporting the authors' hypothesized mechanism for clonidine's benefits. CONCLUSIONS: Clonidine, a readily available medication, is useful in opioid dependence not just for reduction of withdrawal signs, but also as an adjunctive maintenance treatment that increases duration of abstinence. Even in the absence of physical withdrawal, it decouples stress from craving in everyday life.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: The authors tested whether clonidine blocks stress-induced seeking of heroin and cocaine. The study was also intended to confirm translational findings from a rat model of drug relapse by using ecological momentary assessment of patients' stress to test hypotheses about clonidine's behavioral mechanism of action. METHOD: The authors conducted a randomized double-blind placebo-controlled clinical trial with 208 opioid-dependent patients at an outpatient buprenorphine clinic. The 118 participants (57%) who maintained abstinence during weeks 5-6 were continued on buprenorphine and randomly assigned to receive clonidine (N=61) or placebo (N=57) for 14 weeks. Urine was tested thrice weekly. Lapse was defined as any opioid-positive or missed urine test, and relapse as two or more consecutive lapses. Time to lapse and relapse were examined with Cox regressions; longest period of abstinence was examined with a t test, and ecological momentary assessment data were examined with generalized linear mixed models. RESULTS: In an intent-to-treat analysis, clonidine produced the longest duration (in consecutive days) of abstinence from opioids during the intervention phase (34.8 days [SD=3.7] compared with 25.5 days [SD=2.7]; Cohen's d=0.38). There was no group difference in time to relapse, but the clonidine group took longer to lapse (hazard ratio=0.67, 95% CI=0.45-1.00). Ecological momentary assessment showed that daily-life stress was partly decoupled from opioid craving in the clonidine group, supporting the authors' hypothesized mechanism for clonidine's benefits. CONCLUSIONS: Clonidine, a readily available medication, is useful in opioid dependence not just for reduction of withdrawal signs, but also as an adjunctive maintenance treatment that increases duration of abstinence. Even in the absence of physical withdrawal, it decouples stress from craving in everyday life.
Kennedy, Ashley P; Epstein, David H; Jobes, Michelle L; Agage, Daniel; Tyburski, Matthew; Phillips, Karran A; Ali, Amin Ahsan; Bari, Rummana; Hossain, Syed Monowar; Hovsepian, Karen; Rahman, Md Mahbubur; Ertin, Emre; Kumar, Santosh; Preston, Kenzie L
Continuous in-the-field measurement of heart rate: Correlates of drug use, craving, stress, and mood in polydrug users. Journal Article
In: Drug Alcohol Depend, vol. 151, pp. 159–166, 2015, ISSN: 1879-0046 (Electronic); 0376-8716 (Linking).
@article{Kennedy2015,
title = {Continuous in-the-field measurement of heart rate: Correlates of drug use, craving, stress, and mood in polydrug users.},
author = {Ashley P Kennedy and David H Epstein and Michelle L Jobes and Daniel Agage and Matthew Tyburski and Karran A Phillips and Amin Ahsan Ali and Rummana Bari and Syed Monowar Hossain and Karen Hovsepian and Md Mahbubur Rahman and Emre Ertin and Santosh Kumar and Kenzie L Preston},
url = {https://www.ncbi.nlm.nih.gov/pubmed/25920802},
doi = {10.1016/j.drugalcdep.2015.03.024},
issn = {1879-0046 (Electronic); 0376-8716 (Linking)},
year = {2015},
date = {2015-06-01},
journal = {Drug Alcohol Depend},
volume = {151},
pages = {159--166},
address = {Clinical Pharmacology and Therapeutics Research Branch, Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, United States.},
abstract = {BACKGROUND: Ambulatory physiological monitoring could clarify antecedents and consequences of drug use and could contribute to a sensor-triggered mobile intervention that automatically detects behaviorally risky situations. Our goal was to show that such monitoring is feasible and can produce meaningful data. METHODS: We assessed heart rate (HR) with AutoSense, a suite of biosensors that wirelessly transmits data to a smartphone, for up to 4 weeks in 40 polydrug users in opioid-agonist maintenance as they went about their daily lives. Participants also self-reported drug use, mood, and activities on electronic diaries. We compared HR with self-report using multilevel modeling (SAS Proc Mixed). RESULTS: Compliance with AutoSense was good; the data yield from the wireless electrocardiographs was 85.7%. HR was higher when participants reported cocaine use than when they reported heroin use (F(2,9)=250.3, p<.0001) and was also higher as a function of the dose of cocaine reported (F(1,8)=207.7, p<.0001). HR was higher when participants reported craving heroin (F(1,16)=230.9, p<.0001) or cocaine (F(1,14)=157.2, p<.0001) than when they reported of not craving. HR was lower (p<.05) in randomly prompted entries in which participants reported feeling relaxed, feeling happy, or watching TV, and was higher when they reported feeling stressed, being hassled, or walking. CONCLUSIONS: High-yield, high-quality heart-rate data can be obtained from drug users in their natural environment as they go about their daily lives, and the resultant data robustly reflect episodes of cocaine and heroin use and other mental and behavioral events of interest.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Ambulatory physiological monitoring could clarify antecedents and consequences of drug use and could contribute to a sensor-triggered mobile intervention that automatically detects behaviorally risky situations. Our goal was to show that such monitoring is feasible and can produce meaningful data. METHODS: We assessed heart rate (HR) with AutoSense, a suite of biosensors that wirelessly transmits data to a smartphone, for up to 4 weeks in 40 polydrug users in opioid-agonist maintenance as they went about their daily lives. Participants also self-reported drug use, mood, and activities on electronic diaries. We compared HR with self-report using multilevel modeling (SAS Proc Mixed). RESULTS: Compliance with AutoSense was good; the data yield from the wireless electrocardiographs was 85.7%. HR was higher when participants reported cocaine use than when they reported heroin use (F(2,9)=250.3, p<.0001) and was also higher as a function of the dose of cocaine reported (F(1,8)=207.7, p<.0001). HR was higher when participants reported craving heroin (F(1,16)=230.9, p<.0001) or cocaine (F(1,14)=157.2, p<.0001) than when they reported of not craving. HR was lower (p<.05) in randomly prompted entries in which participants reported feeling relaxed, feeling happy, or watching TV, and was higher when they reported feeling stressed, being hassled, or walking. CONCLUSIONS: High-yield, high-quality heart-rate data can be obtained from drug users in their natural environment as they go about their daily lives, and the resultant data robustly reflect episodes of cocaine and heroin use and other mental and behavioral events of interest.
2013
Epstein, David H; Tyburski, Matthew; Craig, Ian M; Phillips, Karran A; Jobes, Michelle L; Vahabzadeh, Massoud; Mezghanni, Mustapha; Lin, Jia-Ling; Furr-Holden, Debra C M; Preston, Kenzie L
In: Drug Alcohol Depend, vol. 134, pp. 22–29, 2013, ISSN: 1879-0046 (Electronic); 0376-8716 (Linking).
@article{Epstein2013,
title = {Real-time tracking of neighborhood surroundings and mood in urban drug misusers: application of a new method to study behavior in its geographical context.},
author = {David H Epstein and Matthew Tyburski and Ian M Craig and Karran A Phillips and Michelle L Jobes and Massoud Vahabzadeh and Mustapha Mezghanni and Jia-Ling Lin and Debra C M Furr-Holden and Kenzie L Preston},
url = {https://www.ncbi.nlm.nih.gov/pubmed/24332365},
doi = {10.1016/j.drugalcdep.2013.09.007},
issn = {1879-0046 (Electronic); 0376-8716 (Linking)},
year = {2013},
date = {2013-09-14},
urldate = {2013-09-14},
journal = {Drug Alcohol Depend},
volume = {134},
pages = {22--29},
address = {Treatment Section, Clinical Pharmacology and Therapeutics Research Branch, Intramural Research Program, 251 Bayview Blvd., Suite 200, National Institute on Drug Abuse, Baltimore, MD 21224, United States.},
abstract = {BACKGROUND: Maladaptive behaviors may be more fully understood and efficiently prevented by ambulatory tools that assess people's ongoing experience in the context of their environment. METHODS: To demonstrate new field-deployable methods for assessing mood and behavior as a function of neighborhood surroundings (geographical momentary assessment; GMA), we collected time-stamped GPS data and ecological momentary assessment (EMA) ratings of mood, stress, and drug craving over 16 weeks at randomly prompted times during the waking hours of opioid-dependent polydrug users receiving methadone maintenance. Locations of EMA entries and participants' travel tracks calculated for the 12 before each EMA entry were mapped. Associations between subjective ratings and objective environmental ratings were evaluated at the whole neighborhood and 12-h track levels. RESULTS: Participants (N=27) were compliant with GMA data collection; 3711 randomly prompted EMA entries were matched to specific locations. At the neighborhood level, physical disorder was negatively correlated with negative mood, stress, and heroin and cocaine craving (ps<.0001-.0335); drug activity was negatively correlated with stress, heroin and cocaine craving (ps .0009-.0134). Similar relationships were found for the environments around respondents' tracks in the 12h preceding EMA entries. CONCLUSIONS: The results support the feasibility of GMA. The relationships between neighborhood characteristics and participants' reports were counterintuitive and counter-hypothesized, and challenge some assumptions about how ostensibly stressful environments are associated with lived experience and how such environments ultimately impair health. GMA methodology may have applications for development of individual- or neighborhood-level interventions.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Maladaptive behaviors may be more fully understood and efficiently prevented by ambulatory tools that assess people's ongoing experience in the context of their environment. METHODS: To demonstrate new field-deployable methods for assessing mood and behavior as a function of neighborhood surroundings (geographical momentary assessment; GMA), we collected time-stamped GPS data and ecological momentary assessment (EMA) ratings of mood, stress, and drug craving over 16 weeks at randomly prompted times during the waking hours of opioid-dependent polydrug users receiving methadone maintenance. Locations of EMA entries and participants' travel tracks calculated for the 12 before each EMA entry were mapped. Associations between subjective ratings and objective environmental ratings were evaluated at the whole neighborhood and 12-h track levels. RESULTS: Participants (N=27) were compliant with GMA data collection; 3711 randomly prompted EMA entries were matched to specific locations. At the neighborhood level, physical disorder was negatively correlated with negative mood, stress, and heroin and cocaine craving (ps<.0001-.0335); drug activity was negatively correlated with stress, heroin and cocaine craving (ps .0009-.0134). Similar relationships were found for the environments around respondents' tracks in the 12h preceding EMA entries. CONCLUSIONS: The results support the feasibility of GMA. The relationships between neighborhood characteristics and participants' reports were counterintuitive and counter-hypothesized, and challenge some assumptions about how ostensibly stressful environments are associated with lived experience and how such environments ultimately impair health. GMA methodology may have applications for development of individual- or neighborhood-level interventions.
2010
Epstein, David H; Marrone, Gina F; Heishman, Stephen J; Schmittner, John; Preston, Kenzie L
Tobacco, cocaine, and heroin: Craving and use during daily life. Journal Article
In: Addict Behav, vol. 35, no. 4, pp. 318–324, 2010, ISSN: 1873-6327 (Electronic); 0306-4603 (Linking).
@article{Epstein2010,
title = {Tobacco, cocaine, and heroin: Craving and use during daily life.},
author = {David H Epstein and Gina F Marrone and Stephen J Heishman and John Schmittner and Kenzie L Preston},
url = {https://www.ncbi.nlm.nih.gov/pubmed/19939575},
doi = {10.1016/j.addbeh.2009.11.003},
issn = {1873-6327 (Electronic); 0306-4603 (Linking)},
year = {2010},
date = {2010-04-01},
journal = {Addict Behav},
volume = {35},
number = {4},
pages = {318--324},
address = {Clinical Pharmacology and Therapeutics Research Branch, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD 21224, USA. depstein@intra.nida.nih.gov},
abstract = {BACKGROUND: Relationships among tobacco smoking, tobacco craving, and other drug use and craving may have treatment implications in polydrug-dependent individuals. METHODS: We conducted the first ecological momentary assessment (EMA) study to investigate how smoking is related to other drug use and craving during daily life. For up to 20 weeks, 106 methadone-maintained outpatients carried PalmPilots (PDAs). They reported their craving, mood, behaviors, environment, and cigarette-smoking status in 2 to 5 random-prompt entries/day and initiated PDA entries when they used cocaine or heroin or had a discrete episode of craving for cocaine or heroin. RESULTS: Smoking frequency increased linearly with random-prompt ratings of tobacco craving, cocaine craving, and craving for both cocaine and heroin. Smoking frequency was greater during discrete episodes of cocaine use and craving than during random-prompt reports of low craving for cocaine. This pattern was also significant for dual cocaine and heroin use and craving. Smoking and tobacco craving were each considerably reduced during periods of urine-verified abstinence from cocaine, and there was a (nonsignificant) tendency for morning smoking to be especially reduced during those periods. CONCLUSIONS: This EMA study confirms that smoking and tobacco craving are strongly associated with the use of and craving for cocaine and heroin. Together with prior findings, our data suggest that tobacco and cocaine may each increase craving for (and likelihood of continued use of) themselves and each other. Treatment for tobacco dependence should probably be offered concurrently with (rather than only after) initiation of treatment for other substance-use disorders.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Relationships among tobacco smoking, tobacco craving, and other drug use and craving may have treatment implications in polydrug-dependent individuals. METHODS: We conducted the first ecological momentary assessment (EMA) study to investigate how smoking is related to other drug use and craving during daily life. For up to 20 weeks, 106 methadone-maintained outpatients carried PalmPilots (PDAs). They reported their craving, mood, behaviors, environment, and cigarette-smoking status in 2 to 5 random-prompt entries/day and initiated PDA entries when they used cocaine or heroin or had a discrete episode of craving for cocaine or heroin. RESULTS: Smoking frequency increased linearly with random-prompt ratings of tobacco craving, cocaine craving, and craving for both cocaine and heroin. Smoking frequency was greater during discrete episodes of cocaine use and craving than during random-prompt reports of low craving for cocaine. This pattern was also significant for dual cocaine and heroin use and craving. Smoking and tobacco craving were each considerably reduced during periods of urine-verified abstinence from cocaine, and there was a (nonsignificant) tendency for morning smoking to be especially reduced during those periods. CONCLUSIONS: This EMA study confirms that smoking and tobacco craving are strongly associated with the use of and craving for cocaine and heroin. Together with prior findings, our data suggest that tobacco and cocaine may each increase craving for (and likelihood of continued use of) themselves and each other. Treatment for tobacco dependence should probably be offered concurrently with (rather than only after) initiation of treatment for other substance-use disorders.
2009
Preston, Kenzie L; Vahabzadeh, Massoud; Schmittner, John; Lin, Jia-Ling; Gorelick, David A; Epstein, David H
Cocaine craving and use during daily life. Journal Article
In: Psychopharmacology (Berl), vol. 207, no. 2, pp. 291–301, 2009, ISSN: 1432-2072 (Electronic); 0033-3158 (Linking).
@article{Preston2009,
title = {Cocaine craving and use during daily life.},
author = {Kenzie L Preston and Massoud Vahabzadeh and John Schmittner and Jia-Ling Lin and David A Gorelick and David H Epstein},
url = {https://www.ncbi.nlm.nih.gov/pubmed/19777216},
doi = {10.1007/s00213-009-1655-8},
issn = {1432-2072 (Electronic); 0033-3158 (Linking)},
year = {2009},
date = {2009-12-01},
journal = {Psychopharmacology (Berl)},
volume = {207},
number = {2},
pages = {291--301},
address = {Treatment Section, Clinical Pharmacology and Therapeutics Research Branch, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD 21224, USA. kpreston@intra.nida.nih.gov},
abstract = {RATIONALE: Craving is often assumed to cause ongoing drug use and relapse and is a major focus of addiction research. However, its relationship to drug use has not been adequately documented. OBJECTIVES: The aim of this study was to investigate the relationship between craving and drug use in real time and in the daily living environments of drug users. METHODS: In a prospective, longitudinal, cohort design (ecological momentary assessment), 112 cocaine-abusing individuals in methadone maintenance treatment rated their craving and mood at random times (two to five times daily, prompted by electronic diaries) as they went about their everyday activities. They also initiated an electronic diary entry each time they used cocaine. Drug use was monitored by thrice-weekly urine testing. RESULTS: During periods of urine-verified cocaine use, ratings of cocaine craving increased across the day and were higher than during periods of urine-verified abstinence. During the 5 h prior to cocaine use, ratings of craving significantly increased. These patterns were not seen in ratings of heroin craving or mood (e.g., feeling happy or bored). CONCLUSIONS: Cocaine craving is tightly coupled to cocaine use in users' normal environments. Our findings provide previously unavailable support for a relationship that has been seriously questioned in some theoretical accounts. We discuss what steps will be needed to determine whether craving causes use.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
RATIONALE: Craving is often assumed to cause ongoing drug use and relapse and is a major focus of addiction research. However, its relationship to drug use has not been adequately documented. OBJECTIVES: The aim of this study was to investigate the relationship between craving and drug use in real time and in the daily living environments of drug users. METHODS: In a prospective, longitudinal, cohort design (ecological momentary assessment), 112 cocaine-abusing individuals in methadone maintenance treatment rated their craving and mood at random times (two to five times daily, prompted by electronic diaries) as they went about their everyday activities. They also initiated an electronic diary entry each time they used cocaine. Drug use was monitored by thrice-weekly urine testing. RESULTS: During periods of urine-verified cocaine use, ratings of cocaine craving increased across the day and were higher than during periods of urine-verified abstinence. During the 5 h prior to cocaine use, ratings of craving significantly increased. These patterns were not seen in ratings of heroin craving or mood (e.g., feeling happy or bored). CONCLUSIONS: Cocaine craving is tightly coupled to cocaine use in users' normal environments. Our findings provide previously unavailable support for a relationship that has been seriously questioned in some theoretical accounts. We discuss what steps will be needed to determine whether craving causes use.
Epstein, David H; Willner-Reid, Jessica; Vahabzadeh, Massoud; Mezghanni, Mustapha; Lin, Jia-Ling; Preston, Kenzie L
Real-time electronic diary reports of cue exposure and mood in the hours before cocaine and heroin craving and use. Journal Article
In: Arch Gen Psychiatry, vol. 66, no. 1, pp. 88–94, 2009, ISSN: 1538-3636 (Electronic); 0003-990X (Linking).
@article{Epstein2009,
title = {Real-time electronic diary reports of cue exposure and mood in the hours before cocaine and heroin craving and use.},
author = {David H Epstein and Jessica Willner-Reid and Massoud Vahabzadeh and Mustapha Mezghanni and Jia-Ling Lin and Kenzie L Preston},
url = {https://www.ncbi.nlm.nih.gov/pubmed/19124692},
doi = {10.1001/archgenpsychiatry.2008.509},
issn = {1538-3636 (Electronic); 0003-990X (Linking)},
year = {2009},
date = {2009-01-01},
journal = {Arch Gen Psychiatry},
volume = {66},
number = {1},
pages = {88--94},
address = {National Institute on Drug Abuse Intramural Research Program, Treatment Section, Clinical Pharmacology and Therapeutics Branch, Baltimore, MD 21224, USA. depstein@intra.nida.nih.gov},
abstract = {CONTEXT: In ecological momentary assessment (EMA), participants electronically report their activities and moods in their daily environments in real time, enabling a truly prospective approach to the study of acute precipitants of behavioral events. Ecological momentary assessment has greatly enhanced the study of tobacco addiction, but its use has rarely been attempted in individuals with cocaine or heroin addiction. OBJECTIVE: To prospectively monitor the acute daily life precipitants of craving for and use of cocaine and heroin. DESIGN: Cohort study. PARTICIPANTS: A volunteer sample of 114 cocaine- and heroin-abusing outpatients who were being treated with methadone provided EMA data on handheld electronic devices for 14 918 person-days (mean, 130.9; range, 6-189 days per participant). Of these outpatients, a total of 102 (63 men, 39 women) provided acute precraving and/or preuse data and were thus included in the present analyses. MAIN OUTCOME MEASURES: Changes in reports of mood and exposure to 12 putative drug-use triggers at random intervals during the 5 hours preceding each self-reported episode of drug craving or use, analyzed via repeated-measures logistic regression (generalized linear mixed models). RESULTS: During the 5 hours preceding cocaine use or heroin craving, most of the 12 putative triggers showed linear increases. Cocaine use was most robustly associated with increases in participants reporting that they "saw [the] drug" (P < .001), were "tempted to use out of the blue" (P < .001), "wanted to see what would happen if I used" (P < .001), and were in a good mood (P < .001). Heroin craving was most robustly associated with increases in reports of feeling sad (P < .001) or angry (P = .01). Cocaine craving and heroin use showed few reliable associations with any of the putative triggers assessed. CONCLUSIONS: These findings confirm that polydrug-abusing individuals can provide behavioral data in their daily environments using handheld electronic devices and that those data can reveal orderly patterns, including prospectively detectable harbingers of craving and use, which may differ across drugs.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
CONTEXT: In ecological momentary assessment (EMA), participants electronically report their activities and moods in their daily environments in real time, enabling a truly prospective approach to the study of acute precipitants of behavioral events. Ecological momentary assessment has greatly enhanced the study of tobacco addiction, but its use has rarely been attempted in individuals with cocaine or heroin addiction. OBJECTIVE: To prospectively monitor the acute daily life precipitants of craving for and use of cocaine and heroin. DESIGN: Cohort study. PARTICIPANTS: A volunteer sample of 114 cocaine- and heroin-abusing outpatients who were being treated with methadone provided EMA data on handheld electronic devices for 14 918 person-days (mean, 130.9; range, 6-189 days per participant). Of these outpatients, a total of 102 (63 men, 39 women) provided acute precraving and/or preuse data and were thus included in the present analyses. MAIN OUTCOME MEASURES: Changes in reports of mood and exposure to 12 putative drug-use triggers at random intervals during the 5 hours preceding each self-reported episode of drug craving or use, analyzed via repeated-measures logistic regression (generalized linear mixed models). RESULTS: During the 5 hours preceding cocaine use or heroin craving, most of the 12 putative triggers showed linear increases. Cocaine use was most robustly associated with increases in participants reporting that they "saw [the] drug" (P < .001), were "tempted to use out of the blue" (P < .001), "wanted to see what would happen if I used" (P < .001), and were in a good mood (P < .001). Heroin craving was most robustly associated with increases in reports of feeling sad (P < .001) or angry (P = .01). Cocaine craving and heroin use showed few reliable associations with any of the putative triggers assessed. CONCLUSIONS: These findings confirm that polydrug-abusing individuals can provide behavioral data in their daily environments using handheld electronic devices and that those data can reveal orderly patterns, including prospectively detectable harbingers of craving and use, which may differ across drugs.
2006
Epstein, David H; Preston, Kenzie L; Stewart, Jane; Shaham, Yavin
Toward a model of drug relapse: an assessment of the validity of the reinstatement procedure. Journal Article
In: Psychopharmacology (Berl), vol. 189, no. 1, pp. 1–16, 2006, ISSN: 0033-3158 (Print); 0033-3158 (Linking).
@article{Epstein2006,
title = {Toward a model of drug relapse: an assessment of the validity of the reinstatement procedure.},
author = {David H Epstein and Kenzie L Preston and Jane Stewart and Yavin Shaham},
url = {https://www.ncbi.nlm.nih.gov/pubmed/17019567},
doi = {10.1007/s00213-006-0529-6},
issn = {0033-3158 (Print); 0033-3158 (Linking)},
year = {2006},
date = {2006-11-01},
journal = {Psychopharmacology (Berl)},
volume = {189},
number = {1},
pages = {1--16},
address = {Clinical Pharmacology and Therapeutics Research Branch, IRP/NIDA/NIH/DHHS, Baltimore, MD 21224, USA. depstein@intra.nida.nih.gov},
abstract = {BACKGROUND AND RATIONALE: The reinstatement model is widely used to study relapse to drug addiction. However, the model's validity is open to question. OBJECTIVE: We assess the reinstatement model in terms of criterion and construct validity. RESEARCH HIGHLIGHTS AND CONCLUSIONS: We find that the reinstatement model has adequate criterion validity in the broad sense of the term, as evidenced by the fact that reinstatement in laboratory animals is induced by conditions reported to provoke relapse in humans. The model's criterion validity in the narrower sense, as a medication screen, seems promising for relapse to heroin, nicotine, and alcohol. For relapse to cocaine, criterion validity has not yet been established primarily because clinical studies have examined medication's effects on reductions in cocaine intake rather than relapse during abstinence. The model's construct validity faces more substantial challenges and is yet to be established, but we argue that some of the criticisms of the model in this regard may have been overstated.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND AND RATIONALE: The reinstatement model is widely used to study relapse to drug addiction. However, the model's validity is open to question. OBJECTIVE: We assess the reinstatement model in terms of criterion and construct validity. RESEARCH HIGHLIGHTS AND CONCLUSIONS: We find that the reinstatement model has adequate criterion validity in the broad sense of the term, as evidenced by the fact that reinstatement in laboratory animals is induced by conditions reported to provoke relapse in humans. The model's criterion validity in the narrower sense, as a medication screen, seems promising for relapse to heroin, nicotine, and alcohol. For relapse to cocaine, criterion validity has not yet been established primarily because clinical studies have examined medication's effects on reductions in cocaine intake rather than relapse during abstinence. The model's construct validity faces more substantial challenges and is yet to be established, but we argue that some of the criticisms of the model in this regard may have been overstated.
2003
Epstein, David H; Hawkins, Wesley E; Covi, Lino; Umbricht, Annie; Preston, Kenzie L
Cognitive-behavioral therapy plus contingency management for cocaine use: findings during treatment and across 12-month follow-up. Journal Article
In: Psychol Addict Behav, vol. 17, no. 1, pp. 73–82, 2003, ISSN: 0893-164X (Print); 0893-164X (Linking).
@article{Epstein2003,
title = {Cognitive-behavioral therapy plus contingency management for cocaine use: findings during treatment and across 12-month follow-up.},
author = {David H Epstein and Wesley E Hawkins and Lino Covi and Annie Umbricht and Kenzie L Preston},
url = {https://www.ncbi.nlm.nih.gov/pubmed/12665084},
issn = {0893-164X (Print); 0893-164X (Linking)},
year = {2003},
date = {2003-03-01},
journal = {Psychol Addict Behav},
volume = {17},
number = {1},
pages = {73--82},
address = {Clinical Pharmacology and Therapeutics Branch, National Institute on Drug Abuse, Intramural Research Program Treatment Section, Baltimore, Maryland 21224, USA. depstein@intra.nida.nih.gov},
abstract = {Contingency management (CM) rapidly reduces cocaine use, but its effects subside after treatment. Cognitive-behavioral therapy (CBT) produces reductions months after treatment. Combined, the 2 might be complementary. One hundred ninety-three cocaine-using methadone-maintained outpatients were randomly assigned to 12 weeks of group therapy (CBT or a control condition) and voucher availability (CM contingent on cocaine-negative urine or noncontingent). Follow-ups occurred 3, 6, and 12 months posttreatment. Primary outcome was cocaine-negative urine (urinalysis 3 times/week during treatment and once at each follow-up). During treatment, initial effects of CM were dampened by CBT. Posttreatment, there were signs of additive benefits, significant in 3- versus 12-month contrasts. Former CBT participants were also more likely to acknowledge cocaine use and its effects and to report employment.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Contingency management (CM) rapidly reduces cocaine use, but its effects subside after treatment. Cognitive-behavioral therapy (CBT) produces reductions months after treatment. Combined, the 2 might be complementary. One hundred ninety-three cocaine-using methadone-maintained outpatients were randomly assigned to 12 weeks of group therapy (CBT or a control condition) and voucher availability (CM contingent on cocaine-negative urine or noncontingent). Follow-ups occurred 3, 6, and 12 months posttreatment. Primary outcome was cocaine-negative urine (urinalysis 3 times/week during treatment and once at each follow-up). During treatment, initial effects of CM were dampened by CBT. Posttreatment, there were signs of additive benefits, significant in 3- versus 12-month contrasts. Former CBT participants were also more likely to acknowledge cocaine use and its effects and to report employment.
2000
Preston, K L; Umbricht, A; Epstein, D H
Methadone dose increase and abstinence reinforcement for treatment of continued heroin use during methadone maintenance. Journal Article
In: Arch Gen Psychiatry, vol. 57, no. 4, pp. 395–404, 2000, ISSN: 0003-990X (Print); 0003-990X (Linking).
@article{Preston2000,
title = {Methadone dose increase and abstinence reinforcement for treatment of continued heroin use during methadone maintenance.},
author = {K L Preston and A Umbricht and D H Epstein},
url = {https://www.ncbi.nlm.nih.gov/pubmed/10768702},
issn = {0003-990X (Print); 0003-990X (Linking)},
year = {2000},
date = {2000-04-01},
journal = {Arch Gen Psychiatry},
volume = {57},
number = {4},
pages = {395--404},
address = {National Institute on Drug Abuse Intramural Research Program, Baltimore, MD 21224, USA.},
abstract = {BACKGROUND: Although methadone maintenance is an effective therapy for heroin dependence, some patients continue to use heroin and may benefit from therapeutic modifications. This study evaluated a behavioral intervention, a pharmacological intervention, and a combination of both interventions. METHODS: Throughout the study all patients received daily methadone hydrochloride maintenance (initially 50 mg/d orally) and weekly counseling. Following baseline treatment patients who continued to use heroin were randomly assigned to 1 of 4 interventions: (1) contingent vouchers for opiate-negative urine specimens (n = 29 patients); (2) methadone hydrochloride dose increase to 70 mg/d (n = 31 patients); (3) combined contingent vouchers and methadone dose increase (n = 32 patients); and (4) neither intervention (comparison standard; n = 28 patients). Methadone dose increases were double blind. Vouchers had monetary value and were exchangeable for goods and services. Groups not receiving contingent vouchers received matching vouchers independent of urine test results. Primary outcome measure was opiate-negative urine specimens (thrice weekly urinalysis). RESULTS: Contingent vouchers and a methadone dose increase each significantly increased the percentage of opiate-negative urine specimens during intervention. Contingent vouchers, with or without a methadone dose increase, increased the duration of sustained abstinence as assessed by urine screenings. Methadone dose increase, with or without contingent vouchers, reduced self-reported frequency of use and self-reported craving. CONCLUSIONS: In patients enrolled in a methadone-maintainence program who continued to use heroin, abstinence reinforcement and a methadone dose increase were each effective in reducing use. When combined, they did not dramatically enhance each other's effects on any 1 outcome measure, but they did seem to have complementary benefits.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Although methadone maintenance is an effective therapy for heroin dependence, some patients continue to use heroin and may benefit from therapeutic modifications. This study evaluated a behavioral intervention, a pharmacological intervention, and a combination of both interventions. METHODS: Throughout the study all patients received daily methadone hydrochloride maintenance (initially 50 mg/d orally) and weekly counseling. Following baseline treatment patients who continued to use heroin were randomly assigned to 1 of 4 interventions: (1) contingent vouchers for opiate-negative urine specimens (n = 29 patients); (2) methadone hydrochloride dose increase to 70 mg/d (n = 31 patients); (3) combined contingent vouchers and methadone dose increase (n = 32 patients); and (4) neither intervention (comparison standard; n = 28 patients). Methadone dose increases were double blind. Vouchers had monetary value and were exchangeable for goods and services. Groups not receiving contingent vouchers received matching vouchers independent of urine test results. Primary outcome measure was opiate-negative urine specimens (thrice weekly urinalysis). RESULTS: Contingent vouchers and a methadone dose increase each significantly increased the percentage of opiate-negative urine specimens during intervention. Contingent vouchers, with or without a methadone dose increase, increased the duration of sustained abstinence as assessed by urine screenings. Methadone dose increase, with or without contingent vouchers, reduced self-reported frequency of use and self-reported craving. CONCLUSIONS: In patients enrolled in a methadone-maintainence program who continued to use heroin, abstinence reinforcement and a methadone dose increase were each effective in reducing use. When combined, they did not dramatically enhance each other's effects on any 1 outcome measure, but they did seem to have complementary benefits.
1996
Silverman, K; Higgins, S T; Brooner, R K; Montoya, I D; Cone, E J; Schuster, C R; Preston, K L
Sustained cocaine abstinence in methadone maintenance patients through voucher-based reinforcement therapy. Journal Article
In: Arch Gen Psychiatry, vol. 53, no. 5, pp. 409–415, 1996, ISSN: 0003-990X (Print); 0003-990X (Linking).
@article{Silverman1996,
title = {Sustained cocaine abstinence in methadone maintenance patients through voucher-based reinforcement therapy.},
author = {K Silverman and S T Higgins and R K Brooner and I D Montoya and E J Cone and C R Schuster and K L Preston},
url = {https://www.ncbi.nlm.nih.gov/pubmed/8624184},
issn = {0003-990X (Print); 0003-990X (Linking)},
year = {1996},
date = {1996-05-01},
journal = {Arch Gen Psychiatry},
volume = {53},
number = {5},
pages = {409--415},
address = {Addiction Research Center, Intramural Research Program of the National Institute on Drug Abuse, Baltimore, Md, USA.},
abstract = {BACKGROUND: Chronic cocaine abuse remains a serious and costly public health problem. This study assessed the effectiveness of a voucher-based reinforcement contingency in producing sustained cocaine abstinence. METHODS: A randomized controlled trial compared voucher-based reinforcement of cocaine abstinence to noncontingent voucher presentation. Patients were selected from 52 consecutively admitted injecting heroin abusers in a methadone maintenance treatment program. Patients with heavy cocaine use during baseline period (N = 37) participated. Except where otherwise indicated, the term cocaine abuse is used in this article in a generic sense and not according to the DSM-III-R definition. Patients exposed to abstinence reinforcement received a voucher for each cocaine-free urine sample (ie, negative for benzoylecgonine) provided three times per week throughout a 12-week period; the vouchers had monetary values that increased as the number of consecutive cocaine-free urine samples increased. Control patients received noncontingent vouchers that were matched in pattern and amount to the vouchers received by patients in the abstinence reinforcement group. RESULTS: Patients receiving vouchers for cocaine-free urine samples achieved significantly more weeks of cocaine abstinence (P = .007) and significantly longer durations of sustained cocaine abstinence (P = .001) than controls. Nine patients (47%) receiving vouchers for cocaine-free urine samples achieved between 7 and 12 weeks of sustained cocaine abstinence; only one control patient (6%) achieved more than 2 weeks of sustained abstinence. Among patients receiving vouchers for cocaine-free urine samples, those who achieved sustained abstinence ( > or = 5 weeks) had significantly lower concentrations of benzoylecgonine in baseline urine samples than those who did not achieve sustained abstinence (P < or = .01). Patients receiving voucher reinforcement rated the overall treatment quality significantly higher than controls (P = .002). CONCLUSION: Voucher-based reinforcement contingencies can produce sustained cocaine abstinence in injecting polydrug abusers.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Chronic cocaine abuse remains a serious and costly public health problem. This study assessed the effectiveness of a voucher-based reinforcement contingency in producing sustained cocaine abstinence. METHODS: A randomized controlled trial compared voucher-based reinforcement of cocaine abstinence to noncontingent voucher presentation. Patients were selected from 52 consecutively admitted injecting heroin abusers in a methadone maintenance treatment program. Patients with heavy cocaine use during baseline period (N = 37) participated. Except where otherwise indicated, the term cocaine abuse is used in this article in a generic sense and not according to the DSM-III-R definition. Patients exposed to abstinence reinforcement received a voucher for each cocaine-free urine sample (ie, negative for benzoylecgonine) provided three times per week throughout a 12-week period; the vouchers had monetary values that increased as the number of consecutive cocaine-free urine samples increased. Control patients received noncontingent vouchers that were matched in pattern and amount to the vouchers received by patients in the abstinence reinforcement group. RESULTS: Patients receiving vouchers for cocaine-free urine samples achieved significantly more weeks of cocaine abstinence (P = .007) and significantly longer durations of sustained cocaine abstinence (P = .001) than controls. Nine patients (47%) receiving vouchers for cocaine-free urine samples achieved between 7 and 12 weeks of sustained cocaine abstinence; only one control patient (6%) achieved more than 2 weeks of sustained abstinence. Among patients receiving vouchers for cocaine-free urine samples, those who achieved sustained abstinence ( > or = 5 weeks) had significantly lower concentrations of benzoylecgonine in baseline urine samples than those who did not achieve sustained abstinence (P < or = .01). Patients receiving voucher reinforcement rated the overall treatment quality significantly higher than controls (P = .002). CONCLUSION: Voucher-based reinforcement contingencies can produce sustained cocaine abstinence in injecting polydrug abusers.
