Stimulant Craving and Drug Use Dynamics: A Cross-Lagged Residual Dynamic Structural Equation Modeling Study

AimsTo examine the longitudinal dynamic interactions of craving and drug use in the course of treatment of stimulant use disorders. DesignCross-lagged residual dynamic structural equation modeling (R-DSEM) was used to examine the reciprocal (bidirectional) longitudinal associations between craving and drug use. SettingPooled data from 11 randomized controlled trials of pharmacotherapies for methamphetamine and cocaine use disorders in the United States sponsored by the National Institute on Drug Abuse. Participants1,936 adults with cocaine or methamphetamine use disorder. MeasurementsCraving was measured using Brief Substance Craving Scale (BSCS), drug use was measured using Timeline Followback and urine drug screen (UDS). FindingsCraving and stimulant drug use were dynamically associated over time (within-person association). Daily craving significantly predicted drug use in subsequent days (estimate=0.092, 95% credible interval [CrI]=0.081, 0.103 for self-reported drug use and estimate=0.081, 95% CrI=0.069, 0.095 for UDS-ascertained drug use). In turn, drug use predicted subsequent craving (estimate=0.361, 95% CrI=0.325, 0.398 and estimate=0.060, 95% CrI=0.028, 0.094, respectively). There was substantial between-person heterogeneity in these cross-lagged effects, as reflected in the coefficients of variation ranging from 0.78 to 2.88. ConclusionsThere is a bidirectional interaction between stimulant drug craving and drug use. The heterogeneity in the interaction of craving with stimulant drug use may partly explain between-person variability in responses to anti-craving medications in treatment of stimulant use disorders.