Fancy this: opiate abusers who want to kick their habit can click on their
Palm Pilot (or any other handheld, digital communications device) whenever
they feel the urge to relapse, and the electronic device will quickly provide
them with information to help them resist the craving.
Such on-the-spot feedback intervention may sound scientifically improbable.
But a study reported in the January Archives of General Psychiatry
suggests that it might eventually become a reality.
David Epstein, Ph.D., a staff scientist at the National Institute on Drug
Abuse's Intramural Research Program in Baltimore, and colleagues conducted
this study. A total of 102 individuals who were being given methadone to
counter their heroin addiction agreed to serve as subjects.
Subjects were given a palmtop computer and asked to enter information into
it whenever they felt tempted to use heroin or cocaine, or whenever they
actually used either heroin or cocaine. (Although methadone is highly
effective in countering heroin use, it is not always a cure-all, and it has no
impact on cocaine use.) They were asked to make written entries into the
device describing what mood they were in, where they were, whom they were
with, and what they were doing. To enhance accuracy of reporting, subjects
were assured that the information they provided would be kept
The subjects provided daily entries anywhere from six days to 189 days,
which, in total, added up to almost 15,000 person-days.
"The first thing that struck us—I won't call it a surprise, but
I will say it was a pleasure to see—was the orderly quality of the
data," Epstein told Psychiatric News. "In a scientific
sense, this was a high-risk study. No one had ever asked 102 cocaine and
heroin users to walk around all day with palmtop computers and report on their
moods and activities, so there was always the possibility that the responses
would be perfunctory and haphazard, leaving us with little or nothing to
analyze. When we saw the results, we knew that our participants had taken the
Epstein and his group then used the data to see what types of moods
preceded subjects' urges to use heroin or cocaine or their use of these
"The main thing we can say from these analyses is that the harbingers
of cocaine craving and use were not quite the same as the harbingers of heroin
craving and use," Epstein said. "I don't think anyone could have
guessed in advance the pattern of differences we found." For example,
although negative emotions such as feeling sad, angry, worried, or down after
being criticized by others tended to precede heroin craving or use, those
types of emotions were not the only catalysts to precede cocaine craving or
use; just being in a good mood could be the trigger for cocaine abusers.
The researchers will analyze the data to learn what types of locations,
companions, or activities preceded the subjects' urges to use heroin or
cocaine or their relapses into using these drugs. It might then be possible to
design a palmtop-computer program to help individuals handle moods or
situations that tend to trigger craving or use of these drugs.
"That sort of on-the-spot feedback intervention is already a reality
for several kinds of behavioral problems—at the level of clinical trials
anyway," Epstein noted. "A person with, say, generalized anxiety
disorder can put information into a palmtop computer during an acute episode
of anxiety, and the palmtop can respond by giving relaxation exercises or
generating suggestions for cognitively reframing the situation.... A more
ambitious intervention would be to have the palmtop learn, over time, what
constitutes a risky pattern of behavior for the person using it and to tailor
the feedback on that basis."
The study was funded by the Intramural Research Program of the National
Institute on Drug Abuse.
An abstract of "Real-Time Electronic Diary Reports of Cue
Exposure and Mood in the Hours Before Cocaine and Heroin Craving and
Use" is posted at<http://archpsyc.ama-assn.org/cgi/content/short/66/1/88>.▪