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Early Signs and Symptoms of Relapse among Adults with Opioid Use Disorder: A Mixed-Methods Study

Moon, Seol Ju Esther (2023) Early Signs and Symptoms of Relapse among Adults with Opioid Use Disorder: A Mixed-Methods Study. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Background: Despite advances, the treatment of opioid use disorders (OUD) is exceptionally challenging because of its relapsing nature and continuous care to sustain recovery. Timely detection and management of early signs and symptoms (ESS) of relapse are crucial to treating OUD, and heart rate variability (HRV) is suggested to be a potential biomarker for indicators of relapse. The purpose of this mixed-methods pilot study is to understand the ESS of relapse among adults receiving medications for OUD (MOUD) and to explore the correlations between self-report ESS of relapse and HRV as a physiological indicator of relapse.
Methods: A prospective mixed-methods observational design was employed. Convenience sampling was used to recruit patients receiving MOUD with buprenorphine in outpatient settings for less than six months. HRV data were collected nightly for eight weeks using a wearable device. Correlations between HRV data and self-reports of ESS of relapse (i.e., craving, self-efficacy, coping, and emotional distress) were examined. Seven virtual focus groups with 23 adults were conducted. Each discussion followed a semi-structured interview guideline. Audio-recorded interviews were transcribed verbatim and analyzed through thematic analysis. A cross-methodological triangulation was used to integrate findings.
Results: Of 69 people screened, 55 (79.7%) enrolled in the study, and 23 (41.8%) completed the baseline (week 1) (mean age= 40.1±11.2 years; 60.8% female; and 86.9% white). A significant decrease in self-efficacy and coping, and an increase in depression were found at different study time points (p<0.05). Statistically significant negative correlations were found between HRV, craving, and emotional distress (p<0.05). Qualitative findings identified four emerged themes: 1) relapse as a cognitive-behavioral control process, 2) risk factors for relapse, 3) protective factors for relapse, and 4) challenges. Integration of findings provide insight in understanding of the dynamic process of relapse to substance use.
Implications: There is a need for greater clinical attention to the management of self-efficacy, coping, and emotional distress for this population. Understanding the relapsing nature of OUD, triggers, and relapse prevention strategies is critical in providing comprehensive interventions to avoid relapse and cope with high-risk situations. Future research should explore the role of HRV as a potential biomarker to predict other ESS of relapse in a larger longitudinal sample. Monitoring of HRV may be beneficial in developing tailored relapse prevention strategies to minimize the ESS of relapse and promote full recovery.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Moon, Seol Ju Esthersem214@pitt.edusem2140000-0003-2403-4523
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairLee, Heeyoungleehee@pitt.eduUNSPECIFIEDUNSPECIFIED
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairLee,
Committee MemberKraemer,
Date: 3 May 2023
Date Type: Publication
Defense Date: 30 March 2023
Approval Date: 3 May 2023
Submission Date: 28 April 2023
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 157
Institution: University of Pittsburgh
Schools and Programs: School of Nursing > Nursing
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Relapse prevention, opioid use disorder, signs and symptoms of relapse, substance use
Date Deposited: 03 May 2023 21:51
Last Modified: 03 May 2023 21:51


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