Substance Abuse and Rehabilitation (Oct 2023)
Recovery Capital Gains May Precede Craving Reduction in Opioid Use Disorder
Abstract
Nicholas L Bormann,1 Andrea N Weber,2,3 Benjamin Miskle,2,4 Stephan Arndt,2,5 Alison C Lynch2,6 1Psychiatry and Psychology, Mayo Clinic Health System, Albert Lea, MN, USA; 2Psychiatry, University of Iowa, Iowa City, Iowa, USA; 3Internal Medicine, University of Iowa, Iowa City, Iowa, USA; 4Pharmacy, University of Iowa, Iowa City, Iowa, USA; 5Biostatistics, University of Iowa, Iowa City, Iowa, USA; 6Family Medicine, University of Iowa, Iowa City, Iowa, USACorrespondence: Nicholas L Bormann, Psychiatry and psychology, Mayo Clinic Health System, 408 W Fountain St, Albert Lea, MN, 56007, USA, Tel +1 507 377 6411, Fax +1 507 377 6443, Email [email protected]: Cravings for drugs and alcohol have been significantly associated with worse treatment outcomes. We investigated if improvements in recovery capital (RC) (eg, a measure of social capital/network, financial resources, education, and cultural factors) over time were associated with decreased reported cravings.Patients and Methods: The original cohort consisted of 133 participants (63 females) with opioid use disorder seeking outpatient treatment, who completed the Assessment of Recovery Capital (ARC) (range 0 to 50) and the Brief Addiction Monitor (BAM) thrice over the 6-month study. Intervention was medication and case management. Analysis included one-way mixed models testing change over time for ARC total scores and single question craving rating (5-point Likert scale). Cross-lagged panel estimates used structural equation models with variables z-scored, allowing for path coefficient evaluation as standard deviations (sd).Results: Total ARC significantly increased over the study (χ 2 = 33.77, df = 2, p < 0.0001), with baseline of 36.6 (n = 114, sd = 11.1) and 6-month of 41.2 (n = 107, sd = 9.5). Craving also changed significantly (χ 2 = 8.51, df = 2, p < 0.015), with baseline of 1.1 (n = 101, sd = 1.2) and 6-month of 0.9 (n = 107, sd = 1.1). The cross-lag from baseline RC to 3-month craving was significant (β = − 0.28, SE = 0.11, z = − 2.53, p < 0.011). The converse was not true; baseline craving did not affect later RC. Results were similarly significant when comparing 3-month to 6-month. The majority of sample was on buprenorphine.Conclusion: As RC improves, the reported cravings at both 3- and 6-month study time points are significantly reduced. When evaluated inversely, there was not a significant association with baseline cravings and follow-up RC. Significant path coefficients provide an estimation of a directional effect from increased RC towards craving reduction.Keywords: substance-related disorders, epidemiologic measurements, cohort studies, opiate substitution treatment, drug users
