Role of Craving in the Transition Across Level of Addiction Severity: A Longitudinal Study.

Condition(s) studied

Investigational drug(s) / intervention(s)

Observational assessments (EMA and annual DSM-5 evaluations): Participants are observed over two years. Annual DSM-5 diagnostic criteria for substance use disorders (SUD) are assessed, and participants complete 2-week EMA protocols measuring substance use, craving, and related factors four times per day. No intervention is administered.

Study summary

Substance/Alcohol Use disorders are defined as a loss of control over the use despite harmul consequences, as well as an intense and persistent urge to use, also called craving. Previous research has shown that craving is central among the diagnostic criteria for addiction, suggesting that it may be important in the onset and persistence of addiction.

Addiction develops progressively, and it appears crucial to identify predictive markers of the transition from one level of severity to another over time. One hypothesis is that more closely linked symptoms (meaning symptoms that influence each other more) could be associated with greater severity and/or with the evolution of addiction severity over time.

The aim of this project is to explore how the characteristics of the association between addiction symptoms (diagnostic criteria and symptoms as they occur in daily life), and the importance of craving relative to other symptoms, could serve as markers of different addiction severities and of the transition across these levels of severity.

Eligibility

Primary outcome measure(s)

• Craving centrality in the DSM-5 Substance Use Disorder diagnostic criteria network — Baseline, 1-year follow-up, 2-year follow-up
  Craving centrality will be quantified as the expected influence centrality of the DSM-5 craving criterion within a cross-sectional network including the 11 DSM-5 Substance Use Disorder diagnostic criteria. Expected influence values will be estimated for each assessment (baseline, 1-year and 2-year follow-up) and compared across addiction severity groups and severity transition groups.
• Global connectivity of the DSM-5 Substance Use Disorder diagnostic criteria network — Baseline, 1-year follow-up, 2-year follow-up
  Global network connectivity will be quantified as global strength (sum of absolute edge weights) of the DSM-5 diagnostic criteria network. Global strength estimates will be compared across addiction severity groups and severity transition groups.
• Predictability of nodes in the DSM-5 Substance Use Disorder diagnostic criteria network — Baseline, 1-year follow-up, 2-year follow-up
  Node predictability will be calculated as the proportion of variance explained (R²) for each DSM-5 diagnostic criterion by its neighboring nodes within the network. Mean node predictability will be reported and compared across addiction severity groups and severity transition groups.
• Differences in DSM-5 Substance Use Disorder diagnostic criteria network structure — Baseline, 1-year follow-up, 2-year follow-up
  Differences in overall network structure and global strength between addiction severity groups and severity transition groups will be evaluated using the Network Comparison Test (NCT). The reported outcome will be the statistical significance of differences in network structure.
• Temporal network structure of ecological momentary assessment (EMA) symptoms — Baseline, 1-year follow-up, 2-year follow-up
  Temporal directed network parameters estimated from ecological momentary assessment data including primary substance use, craving, affect, self-efficacy, withdrawal symptoms, cues, stress, coping, sleep, impulsivity and other daily-life variables. Temporal edge weights will be estimated using multilevel vector autoregressive models and compared across severity groups and severity transition groups.
• Contemporaneous network structure of ecological momentary assessment (EMA) symptoms — Baseline, 1-year follow-up, 2-year follow-up
  Contemporaneous partial correlation network estimated from ecological momentary assessment variables. Network structure will be compared across severity groups and severity transition groups.
• Between-subject network structure of ecological momentary assessment (EMA) symptoms — Baseline, 1-year follow-up, 2-year follow-up
  Between-subject partial correlation network estimated from ecological momentary assessment variables. Network structure will be compared across severity groups and severity transition groups.
• Individual network invariance assessed by the Individual Network Invariance Test (INIT) — Baseline, 1-year follow-up, 2-year follow-up
  Individual Network Invariance Test (INIT) results will assess whether each participant's symptom network significantly differs from the group-level network. The proportion of significant INIT tests will be reported and compared across severity groups.

Trial sites (1)

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