The allostatic model of addiction suggests that negative affect, such as depressive symptoms, mediates the effect of stress on outcomes among individuals with substance use disorders. However, few longitudinal treatment studies have demonstrated this effect. We analyzed data from a 12-week randomized trial of galantamine and/or computerized cognitive-behavioral therapy (CBT4CBT) for individuals (N = 120) with cocaine use disorder in methadone treatment for opioid use disorder. We evaluated baseline perceived stress as a predictor of end-of-treatment (EOT) substance use outcomes, and EOT perceived stress as a predictor of month 6 posttreatment outcomes. We conducted mediation models with intervening depressive symptoms as a mediator. We also explored whether CBT4CBT moderated the effects of perceived stress. Baseline perceived stress did not predict EOT outcomes (i.e., total effect). However, in mediation models, we found indirect effects of baseline perceived stress on EOT cocaine and illicit opioid use, via midtreatment depressive symptoms. EOT perceived stress had significant total effects on month 6 cocaine and illicit opioid use, and an indirect effect on month 6 illicit opioid use (but not cocaine use), via month 3 depressive symptoms. Alternative models with depressive symptoms as the predictor and perceived stress as a mediator revealed no indirect effects. The addition of CBT4CBT to standard methadone treatment did not moderate total or indirect effects of perceived stress on substance use. Depressive symptoms may play a mediating role in the prospective indirect effect of perceived stress on substance use outcomes, particularly illicit opioid use. Further research is needed on therapies targeting stress. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

中文翻译：

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评估感知压力、抑郁症状和物质使用治疗结果的纵向中介模型。

成瘾的分配模型表明，负面影响，如抑郁症状，介导了压力对物质使用障碍个体结果的影响。然而，很少有纵向治疗研究证明了这种效果。我们分析了一项为期 12 周的加兰他敏和/或计算机化认知行为疗法 (CBT4CBT) 随机试验的数据，该试验针对可卡因使用障碍个体（N = 120）在美沙酮治疗阿片类药物使用障碍中进行。我们评估了基线感知压力作为治疗结束 (EOT) 物质使用结果的预测指标，以及 EOT 感知压力作为治疗后第 6 个月结果的预测指标。我们以干预性抑郁症状作为中介进行了中介模型。我们还探讨了 CBT4CBT 是否减轻了感知压力的影响。基线感知压力不能预测 EOT 结果（即总效应）。然而，在中介模型中，我们发现基线感知压力通过治疗中期抑郁症状对 EOT 可卡因和非法阿片类药物使用产生间接影响。EOT 感知压力对第 6 个月的可卡因和非法阿片类药物使用有显着的总体影响，并通过第 3 个月的抑郁症状对第 6 个月的非法阿片类药物使用（但不是可卡因使用）产生间接影响。以抑郁症状作为预测因素和感知压力作为中介的替代模型显示没有间接影响。在标准美沙酮治疗中加入 CBT4CBT 并不能减轻感知压力对物质使用的总体或间接影响。抑郁症状可能在感知压力对物质使用结果的预期间接影响中起中介作用，特别是非法使用阿片类药物。需要进一步研究针对压力的疗法。（PsycInfo 数据库记录 (c) 2020 APA，保留所有权利）。