Effects of anxiety and mood disorders on craving and substance use among patients with substance use disorder: An ecological momentary assessment study

Background: Despite recognition of the negative impact of psychiatric comorbidity on addictive disorders, the mechanisms underlying this association remain poorly understood. The present investigation applied mobile technologies to examine the effect of comorbid mood or anxiety disorders on craving intensity and substance use within the natural conditions of daily life. Methods: A total of 159 participants were recruited from a French outpatient addiction clinic and completed two weeks of computerized ambulatory monitoring of daily life experiences using Ecological Momentary Assessment (EMA). Patients described in real-time their emotional states, craving intensity, and substance use. Current mood and/or anxiety disorders were diagnosed according to DSM-IV criteria. The main substances of dependence were alcohol (n = 48), tobacco (n = 43), cannabis (n = 35), or opiates (n = 33). Results: Craving intensity strongly predicted substance use reported over subsequent hours of the day both in groups with (OR = 1.13, p = .009, n = 95) and without (OR = 1.20, p = .002, n = 64) current comorbid psychiatric disorders. Current comorbid mood and/or anxiety disorders were associated with higher craving intensity (gamma coef = 0.632, SE = 0.254, p = .014) and consequently more frequent substance use (gamma coef = 0.162, SE = 0.052, p = .003). A portion of increased substance use associated with current mood and/or anxiety disorders was independent of increases in craving intensity. Conclusions: Attention to craving management is particularly important for patients with substance use disorders and comorbid mood and/or anxiety disorders, but additional interventions are also needed that address other mechanisms through which these disorders lead to an increase in substance use frequency, independently from craving.