Could Addiction-Fighting Tool Be in Palm of Your Hand?

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 confidential.

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 study seriously.”

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 substances.

“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>.▪