Implicit and explicit drug-related cognitions during detoxification treatment are associated with drug relapse: An ecological momentary assessment study

Objective: Relapse is a major problem in drug addiction treatment. Both drug craving and drug-related cognitions (e.g., attentional bias and implicit attitudes to drugs) may contribute to relapse. Using ecological momentary assessments, we examined whether craving and cognitions assessed during drug detoxification treatment were associated with relapse. Method: Participants were 68 heroin-dependent inpatients undergoing clinical detoxification at an addiction treatment center. Participants carried around a personal digital assistant for 1 week. Participants completed up to 4 random assessments (RAs) per day. They also completed an assessment when they experienced a temptation to use drugs (TA). At each assessment, participants reported their craving and attitudes to drugs. Implicit cognitions were assessed with a drug Stroop task (attentional bias) and an Implicit Association Test (implicit attitudes). Results: Individuals who relapsed during the study week exhibited a larger attentional bias and more positive implicit attitudes to drugs than did nonrelapsers at TAs (but not RAs). In addition, compared to nonrelapsers, relapsers reported higher levels of craving and more positive explicit attitudes to drugs at TAs than at RAs. Additional within-subject analyses revealed that attentional bias for drugs at TAs increased before relapse. Conclusions: Drug-related cognitive processes assessed with ecological momentary assessments were associated with relapse during drug detoxification. Real-time assessment of craving and cognitions may help to identify which individuals are at risk of relapse and when they are at risk of relapse.