156. Daily Association of Drug Use Cravings and Physical and Emotional Well-Being among Students Attending a Recovery High School during COVID-19: Results from an EMA Study

Abstract

Purpose: Ongoing COVID-19 restrictions are now well-known to increase youth substance use. Little research has addressed this vulnerability among adolescents in substance use recovery (AIR), who may be at heightened risk for relapse within ongoing pandemic management. We used ecological momentary assessment-focused (EMA) to characterize daily shifts in recovery management among adolescents attending a recovery high school. We engage the first wave of these EMA-data collected during third wave of the pandemic (January-February 2022) to: 1) document day-to-day changes in drug craving context (e.g., frequency, temporality, duration, and intensity) and; 2) examine its association with daily shifts in physical and emotional well-being.

Methods: Data were from an EMA-study (ongoing through 2022-2023 school-year) intended to understand the social/emotional context of drug use cravings among a cohort of AIR attending a recovery high school in Indianapolis, IN. Our analytic-sample includes six-students (N=40 total) who were enrolled during the second pandemic wave (57.3% female, 42.5% heterosexual, 71.0% White, 52.3% 12th-grade, 57.4% had weekly urges use). Drug use context measures: any drug-use urge (no/yes), urge frequency (5-point item: once-6+ times), urge temporality/duration (6-point item: AM, aft or PM only, more than half the day, all day) and urge intensity (single item: 0-10). Physical and emotional variables: emotional pain (5-point single item: not at all-extremely), self-perceived health (5-point single item: poor to excellent), positive and negative mood (PANAS) and somatic symptoms (summed 12-point: all no/yes). Descriptive statistics and intraclass correlation coefficients (ICC) examined the prevalence and day-to-day variability of each outcome; random intercept mixed effects binary or ordinal regression assessed the impact of physical and emotional predictors on each outcome (Stata v. 18).

Results: Participants contributed 81.2% (147/180) of expected EMAs, one-third of which were associated with an urge to use drugs. 6% of urge days also involved a report of drug-use (4/48; ns sample size for additional-analysis). Median within-day urge frequency was 3-5x/day (35.3% of all urge events). We observed significant day-to-day variability in reports of drug urges and the intensity of urges (ICC: 0.209-0.601), but not in temporality and duration of urges. Greater daily emotional pain nearly quadrupled the odds of reporting having drug urges (OR=3.75) and was associated with three-fold higher within-day urge frequency (OR=2.42) and urge intensity (OR=2.92). Higher positive mood was positively associated with urge to use (OR=1.36), urge frequency (OR=1.17) and urge intensity (OR=1.18). More somatic symptoms were associated with greater odds of having drug urges (OR=1.26) and urge frequency during the day (OR=1.10).

Conclusions: Our research demonstrates that daily emotional valence and greater somatic symptoms are associated with daily drug urge occurrence, daily urge frequency and daily drug urge intensity among AIR. These EMA data have important clinical implications for “just in time” mental and behavioral health interventions that could focus on mood stability and physical wellness as scaffolds in adolescent recovery management.