Rationale

Given that many patients being treated for opioid-use disorder continue to use drugs, identifying clusters of patients who share similar patterns of use might provide insight into the disorder, the processes that affect it, and ways that treatment can be personalized.

Objectives and methods

We applied hierarchical clustering to identify patterns of opioid and cocaine use in 309 participants being treated with methadone or buprenorphine (in a buprenorphine–naloxone formulation) for up to 16 weeks. A smartphone app was used to assess stress and craving at three random times per day over the course of the study.

Results

Five basic patterns of use were identified: frequent opioid use, frequent cocaine use, frequent dual use (opioids and cocaine), sporadic use, and infrequent use. These patterns were differentially associated with medication (methadone vs. buprenorphine), race, age, drug-use history, drug-related problems prior to the study, stress-coping strategies, specific triggers of use events, and levels of cue exposure, craving, and negative mood. Craving tended to increase before use in all except those who used sporadically. Craving was sharply higher during the 90 min following moderate-to-severe stress in those with frequent use, but only moderately higher in those with infrequent or sporadic use.

Conclusions

People who share similar patterns of drug-use during treatment also tend to share similarities with respect to psychological processes that surround instances of use, such as stress-induced craving. Cluster analysis combined with smartphone-based experience sampling provides an effective strategy for studying how drug use is related to personal and environmental factors.

中文翻译：

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超越禁欲和复发 II：在具有相似药物使用模式的患者群中，压力、渴望和失败之间的瞬时关系

基本原理

鉴于许多接受阿片类药物使用障碍治疗的患者继续使用药物，识别具有相似使用模式的患者群可能会提供对这种疾病、影响它的过程以及可以个性化治疗的方式的深入了解。

目标和方法

我们应用层次聚类来确定 309 名接受美沙酮或丁丙诺啡（丁丙诺啡-纳洛酮制剂）治疗长达 16 周的参与者的阿片类药物和可卡因使用模式。在研究过程中，每天三个随机时间使用智能手机应用程序评估压力和渴望。

结果

确定了五种基本使用模式：频繁使用阿片类药物、频繁使用可卡因、频繁双重使用（阿片类药物和可卡因）、零星使用和不经常使用。这些模式与药物（美沙酮与丁丙诺啡）、种族、年龄、药物使用史、研究前的药物相关问题、压力应对策略、使用事件的特定触发因素以及线索暴露水平、渴望，和消极的情绪。除了那些偶尔使用的人之外，所有的人在使用前的渴望都会增加。在中度至重度压力后的 90 分钟内，频繁使用的人的渴望急剧增加，但在不经常或零星使用的人中仅适度增加。

结论

在治疗期间具有相似吸毒模式的人也倾向于在围绕使用实例的心理过程方面具有相似性，例如压力引起的渴望。聚类分析与基于智能手机的经验抽样相结合，为研究吸毒与个人和环境因素之间的关系提供了一种有效的策略。