JMIR Publications

ABSTRACT

Background:

Patients with substance use disorders (SUD) are at increased risk for symptom deterioration following treatment, with up to 60% resuming substance use the first-year post treatment, and craving, together with neurocognitive and mental health variables play important roles in the understanding of the trajectories from abstinence to substance use.

Objective:

This study aims to improve our understanding of specific profiles of variables explaining SUD symptom deterioration. Specifically how individual variability in mental health, neurocognitive functioning, and smartphone use is associated with craving and substance use in a young adult clinical population.

Methods:

In this pilot study, 26 patients with SUD were included 2 weeks prior to discharge from inpatient SUD treatment. Patients underwent baseline neuropsychological and mental health assessments and were equipped with smartwatches and downloaded an app for mobile sensor data collection on their smartphones. Every 2 days for up to 8 weeks the patients were administered mobile ecological momentary assessments (EMA) assessing substance use, craving, mental health, cognition, and a mobile go/no-go performance task. Repeated EMAs, as well as battery use sensor data was averaged across all days per subject and used as candidate input variables in models of craving intensity and relapse.

Results:

A total of 455 momentary assessments were completed. Using EMA and baseline data as candidate input variables, and craving and substance use as responses, automated model selection identified mean craving intensity as the most important predictor of substance use, with variability in self-reported impulsivity, mental health, and battery use as the significant predictors of craving intensity.

Conclusions:

This study adds novelty by collecting high intensity data, for a considerable period of time, including both mobile sensor and mobile cognitive assessment data. The study also contributes to our knowledge about the most severe part of this clinical population in a vulnerable period during and after discharge from inpatient treatment. We confirmed the importance of temporal variability in executive dysfunction and mood in explaining variability in craving, and in addition that phone use may add to this understanding. Finally, we found that craving intensity is an important explanatory variable in relapse prediction. Our results inform further work towards precision medicine and just-in-time interventions with young adults with substance use disorders and may serve as decision support for clinicians evaluating discharge.