Sex differences in daily life stress and craving in opioid-dependent patients

Figures & data

Table 1. Clinical and demographic characteristics.

	Men (n = 135)		Women (n = 47)		Comparison
	Mean/%	SD	Mean/%	SD
Opioid agonist treatment					χ^2 (1, n = 182) = 0.05, p = 0.83
Methadone	59.3		57.4
Buprenorphine/naloxone	40.7		42.6
Age (years)	42.0	9.6	41.6	9.3	t(180) = −0.2, p = 0.82
Race					χ^2 (1, n = 178) = 0.82, p = 0.36
African American	63.9		70.2
European American	35.3		27.6
Years of education	12.0	1.5	12.2	1.6	t(180) = 0.8, p = 0.42
Marital status					χ^2 (2, n = 182) = 1.45, p = 0.48
Married	14.9		8.5
Never married	24.6		29.8
Separated/divorced/widowed	60.4		61.7
Employment status					χ^2 (3, n = 182) = 4.46, p = 0.22
Full time	50.0		36.2
Part time	23.1		21.3
Unemployed	21.6		36.2
Retired/disability/controlled	5.2		6.4
Drug use history
Days used in last 30
Heroin	19.6	11.6	18.2	12.8	t(180) = −0.7, p = 0.50
Other opioids	8.0	6.2	8.5	10.4	t(180) = 0.32, p = 0.75
Cocaine	4.4	8.8	4.7	7.6	t(180) = 0.18, p = 0.85
Years using
Heroin	15.6	10.0	11.5	10.4	t(180) = −2.4, p < 0.05
Other opioids	1.2	2.4	2.1	3.3	t(180) = 1.6, p = 0.13
Cocaine	6.0	8.2	6.1	7.7	t(180) = 0.11, p = 0.91
Route of administration
Heroin					χ^2 (2, n = 170) = 1.88, p = 0.39
Intranasal	57.8		69.0
Intravenous	41.4		31.0
Other opioids
Intranasal	7.9		5.7		χ^2 (2, n = 136) = 0.79, p = 0.67
Oral	91.1		91.4
Smoking	1.0		2.9
Cocaine					χ^2 (2, n = 133) = 6.69, p < 0.05
Intranasal	26		18.2
Smoking	48		72.7
Intravenous	26		2.3
Urine drug screen results
Opioids mean % negative	64.1	35.7	55.3	37.3	t(180) = 1.45, p = 0.15
Cocaine mean % negative	67.6	38.6	61.9	42.4	t(180) = 0.86, p = 0.39

Table 2. Reasons for stress during self-initiated reports of stress events in women versus men.

	Odds Ratio (95% CI)^a	p
	df = 156
Was the feeling mostly because…
you had an injury or health problem?	0.69 (0.30–1.60)	0.38
your surroundings were unsafe or threatening?	0.84 (0.30–2.36)	0.74
you just started thinking about stressful things?	0.84 (0.57–1.25)	0.39
you had a conflict with someone?	0.87 (0.60–1.28)	0.48
you had problems with money?	0.91 (0.60–1.39)	0.66
you had a legal problem?	1.01 (0.37–2.74)	0.99
you were inconvenienced?	1.34 (0.79–2.27)	0.28
you had too much to do?	1.57 (0.93–2.66)	0.09

^aReference group - Women.

Table 3. Companions, location, and activities reported during randomly prompted entries and self-initiated reports of stress events in women versus men.

	Random Prompts		Stress Events
	Odds Ratio (95% CI)^a		Odds Ratio (95% CI)^a
	df = 180	P	df = 156	p
Companion
Child(ren)	0.59 (0.53–0.66)	<0.0001	0.66 (0.35–1.28)	0.22
Spouse/Partner	0.63 (0.58–0.68)	<0.0001	0.82 (0.52–1.30)	0.39
Out the gate partner	2.26 (1.47–3.46)	<0.0001	0.82 (0.20–3.34)	0.78
No one	1.23 (1.15–1.32)	<0.0001	0.94 (0.65–1.36)	0.75
Acquaintances	1.21 (1.02–1.42)	<0.05	0.94 (0.53–1.68)	0.84
Clinic staff/Patients	0.85 (0.75–0.96)	<0.01	0.96 (0.45–2.07)	0.92
Friends	1.58 (1.40–1.78)	<0.0001	1.26 (0.70–2.26)	0.43
Coworkers	1.22 (1.03–1.44)	<0.05	1.28 (0.53–3.12)	0.58
Other family	1.56 (1.41–1.72)	<0.0001	1.36 (0.76–2.42)	0.30
Strangers	1.57 (1.36–1.82)	<0.0001	1.64 (0.75–3.63)	0.22
Were you with at least one person who you have ever used with?	0.59 (0.53–0.66)	<0.0001	0.47 (0.23–0.94)	<0.05
Were you with at least one person who still uses?	0.67 (0.59–0.76)	<0.0001	0.42 (0.21–0.86)	<0.05
Location Store	1.42 (1.19–1.68)	<0.0001	0.47 (0.25–0.89)	<0.05
Restaurant	1.24 (0.97–1.58)	0.09	0.61 (0.17–2.23)	0.45
Walking from one place to another	0.95 (0.83–1.08)	0.43	0.78 (0.42–1.42)	0.41
Home	0.65 (0.62–0.69)	<0.0001	0.81 (0.57–1.14)	0.22
Clinic/doctor	0.92 (0.83–1.02)	0.11	0.88 (0.49–1.58)	0.67
Another’s home	1.30 (1.18–1.46)	<0.0001	1.06 (0.48–2.38)	0.9
Outside hanging out	1.50 (1.25–1.80)	<0.0001	1.17 (0.48–2.84)	0.73
Vehicle (car, bus, train)	1.10 (1.02–1.19)	<0.01	1.19 (0.74–1.90)	0.47
Work	1.86 (1.61–2.16)	<0.0001	1.67 (0.74–3.79)	0.22
Waiting for ride, bus, etc.	1.22 (1.10–1.35)	<0.0005	2.07 (1.10–3.90)	<0.05
Bar/club	2.84 (1.34–6.01)	<0.01	2.41 (0.31–18.72)	0.40
Activity On Internet	1.02 (0.86–1.22)	0.83	0.57 (0.22–1.49)	0.25
Arguing	1.33 (1.01–1.75)	<0.05	0.78 (0.43–1.44)	0.43
Talking on phone	1.48 (1.25–1.75)	<0.0001	0.82 (0.47–1.43)	0.48
Walking/riding/travelling	1.12 (1.05–1.18)	<0.0005	0.86 (0.60–1.22)	0.40
Shopping/Errands	1.27 (1.07–1.51)	<0.01	0.86 (0.35–2.08)	0.73
Household chores or personal hygiene	0.77 (0.69–0.86)	<0.0001	0.90 (0.47–1.71)	0.74
Eating or preparing food	0.88 (0.81–0.97)	<0.01	0.95 (0.50–1.80)	0.86
Talking/Socializing	1.11 (1.02–1.21)	<0.05	1.04 (0.70–1.56)	0.84
Sports/Games/Other recreation	1.47 (1.14–1.89)	<0.005	1.04 (0.23–4.69)	0.96
Resting/Sleeping	1.00 (0.93–1.07)	0.97	1.12 (0.70–1.78)	0.63
Working	1.87 (1.63–2.13)	<0.0001	1.12 (0.57–2.19)	0.74
Listening to music	1.93 (1.63–2.29)	<0.0001	1.22 (0.52–2.90)	0.65
Waiting	1.20 (1.06–1.35)	<0.005	1.22 (0.66–2.26)	0.52
Watching TV/videos/DVD	0.83 (0.78–0.88)	<0.0001	1.51 (0.90–2.55)	0.12
Thinking/planning	1.87 (1.65–2.11)	<0.0001	1.76 (1.04–2.96)	<0.05
Reading	1.04 (0.88–1.23)	0.66	2.06 (0.58–7.38)	0.26
Child care/Elder care	3.03 (2.21–4.16)	<0.0001	4.09 (0.27–61.87)	0.31

^aReference group - Women.

Figure 1. Mean (±SEM) ecological momentary assessment (EMA) ratings of craving on a 1 to 5 scale (1 indicating no craving) for opioids (top panel) and cocaine (bottom panel) across ratings of stress in random prompt entries. The increase in opioid craving as a function of stress was greater for women than men [sex × stress severity, F(4,550) = 6.7, p < 0.0001]; whereas men showed a greater increase in cocaine craving as a function of stress [sex × stress severity, F(4,403) = 20.4, p < 0.0001].

Figure 2. Mean (±SEM) ecological momentary assessment (EMA) ratings of craving on a 1 to 5 scale (1 indicating no craving) for opioids (top panel) and cocaine (bottom panel) across ratings of stress in stress event entries. Opioid and cocaine craving ratings increased linearly across stress-severity ratings, [opioids: F(1,130) = 53.1, p < 0.0001; cocaine: F(1,117) = 6.4, p < 0.05]. Men showed a linear increase in opioid craving, F(1,110) = 54.3, p < 0.0001, and cocaine craving, F(1,100) = 4.17, p < 0.05, with stress severity, but there was not enough data to determine a relationship between craving and stress in women (i.e., there were 10 or fewer stress events reported at each level of stress, on the 0–10 scale).

Figure 3. Mean (±SEM) ecological momentary assessment (EMA) ratings of craving on a 1 to 5 scale (1 indicating no craving) for opioids (top panel) and cocaine (bottom panel) in random prompt entries in which participants either reported no stress or any stress (on a 1 to 5 scale; 1 indicating no stress), and reported the absence or presence of any drug cues. Women showed a greater increase in opioid craving relative to men in the presence of both stress and cues compared to either alone [sex × stress × cue, F(1,140) = 7.6, p < 0.01]. Men showed a greater increase in cocaine craving relative to women when stress was present [sex × stress, F(1,127) = 61.0, p < 0.0001]. The effect of cues on cocaine craving was greater when stress was also present [stress × cue, F(1,100) = 5.8, p < 0.05]; this relationship is more apparent in men.