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Alcohol consumption and stimulant use are major public health problems and contribute to morbidity and mortality in the United States. To inform interventions for substance use, there is a need to identify the day-level correlates of substance use by collecting repeated measures data in one’s natural environment. There is also a need to use crowdsourcing platforms like Amazon Mechanical Turk (MTurk) to efficiently engage larger populations of people who use alcohol and stimulants in research.
We aimed to (1) utilize daily diaries to examine the temporal relationship between day-level cravings for alcohol and stimulant/substance use (ie, heavy drinking or any drug use) in a given day over 14 days and (2) assess whether depression, negative affect, and self-esteem measured at baseline predict substance use in a given day over 14 days among people who use alcohol and/or stimulants in the United States.
Individuals aged ≥18 years in the United States, who reported alcohol or stimulant (ie, cocaine, crack cocaine, and methamphetamine) use in the past year, were recruited using MTurk between March 26 and April 13, 2018. Eligible participants completed a baseline survey and 14 daily surveys online. The baseline survey assessed sociodemographics and psychosocial (ie, depression, affect, self-esteem, and stress) factors. Daily surveys assessed substance use and cravings for alcohol and stimulants. Four multivariable random-intercept logistic regression models were built to examine psychosocial constructs separately along with other significant predictors from bivariate analyses while controlling for age and education.
Among a total of 272 participants, 220 were White, 201 were male, and 134 were men who have sex with men (MSM). The mean age was 36.1 years (SD 10.5). At baseline, 173 participants engaged in any current or past hazardous alcohol consumption, 31 reported using cocaine, 19 reported using methamphetamine, 8 reported using crack cocaine, and 104 reported any noninjection or injection drug use in the past 6 months. Factors independently associated with substance use were depression (adjusted odds ratio [aOR] 1.11, 95% CI 1.02-1.21;
Interventions for substance use should utilize evidenced-based approaches to reduce depression, negative affect, and cravings; increase self-esteem; and engage MSM. Interventions may also consider leveraging technology-based approaches to reduce substance use among populations who use crowdsourcing platforms.
Alcohol consumption and drug use are major public health problems and contribute to a substantial amount of morbidity and mortality among adults in the United States [
The relationship between craving and substance use is difficult to measure with accuracy because of the transient nature of craving [
Substance use research generally relies on traditional recruitment methods (eg, targeted sampling and respondent driven sampling), which are expensive and time consuming [
In order to reduce this gap in research, we utilized daily dairies to identify the day-level correlates of substance use in a given day over a 2-week follow-up period among people who use alcohol or stimulants and who were recruited using MTurk in the United States. In addition, we assessed the relationship between key psychological factors measured at baseline and substance use in a given day over the 2-week follow-up period. More specifically, the main two objectives of this study were to (1) examine the relationship between day-level cravings for alcohol and/or stimulants (ie, crack cocaine, cocaine, or methamphetamine) and substance use in a given day, and (2) determine whether certain psychosocial factors, such as depression, negative affect, self-esteem, and stress measured at baseline, were associated with substance use in a given day over the follow-up period. We hypothesized that both day-level cravings for alcohol and stimulants, and psychosocial stressors would be key predictors of substance use among MTurk users. Taken together, this research aimed to identify the daily correlates and baseline predictors of substance use among people who use alcohol and/or stimulants and who were recruited using MTurk, which may help inform the development of interventions for populations who utilize crowdsourcing platforms in the United States.
Baseline and follow-up data were drawn from the Stimulants and Alcohol use in MTurk Behavioral Assessments Study (“SAMBA”), a study designed to examine substance use and HIV-related sexual risk behaviors among men who have sex with men (MSM) and non-MSM who use alcohol and/or stimulants in the United States. All study procedures and materials were reviewed and approved by the Institutional Review Board at the University of California, San Francisco. All participants provided informed consent using an online consent form during the screening process.
A total of 272 participants in the United States were enrolled using MTurk between March 26 and April 13, 2018. Participants were recruited online using MTurk [
All surveys were administered online and completed using computers or smartphones. First, participants completed an initial survey to be screened for eligibility, and if they were considered eligible, they completed a baseline assessment followed by 14 daily surveys. Participants were compensated US $0.80 for completing the screener, US $5.00 for completing the baseline survey, and US $1.00 for completing each daily diary, and those who completed all 14 daily surveys received a US $6.00 bonus, resulting in a maximum of US $25.80 in compensation per participant. Research staff contacted participants through their individual MTurk accounts and provided a link to complete the assessments using a unique authenticator known as a single sign on token.
We assessed sociodemographic factors, including age in years and race/ethnicity (White, Asian, African American/Black, Native American/Alaskan Native, and Hawaiian/Pacific Islander). Being a sexual minority male (ie, MSM) was assessed using a dichotomous measure created from the responses to the following questions: (1) “
We measured alcohol consumption in the past 6 months (yes/no) and current or past hazardous drinking (yes/no) using the three-item Alcohol Use Disorders Identification Test-Concise (AUDIT-C), where scores ≥4 for males and ≥3 for females indicate hazardous drinking [
Methamphetamine use, cocaine use, crack cocaine use, and any drug use, which included reporting any injection or noninjection drug use in the past 6 months (yes/no), were also assessed.
Self-esteem was assessed using the 10-item Rosenberg Self-Esteem Scale (RSES) [
Positive affect and negative affect were measured using the 20-item Positive and Negative Affect Schedule (PANAS) [
Stress was measured using the 10-item Perceived Stress Scale (PSS) [
Depression was measured using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) [
Our outcome of interest was a dichotomous measure of substance use in a given day that was created by combining heavy drinking and any drug use in the past 24 hours (yes/no). This measure included all individuals who reported heavy drinking or any drug use in the past 24 hours over the 14-day follow-up period (not at baseline). Heavy drinking in the past 24 hours (yes/no) was a dichotomous measure defined according to the National Institute on Alcohol Abuse and Alcoholism guidelines, which state that six or more drinks for males and five or more drinks for females per day can be considered heavy drinking [
In addition to alcohol and drug use, participants were asked to report their day-level cravings for alcohol and/or stimulants (ie, cocaine, crack cocaine, and methamphetamine) in the past 24 hours as appropriate. Craving scales ranged from 0 to 100, where 100 represents the strongest craving one has ever experienced and 0 represents no craving at all. Data on cravings were collected after baseline via 14 daily diaries.
Descriptive statistics were used to describe the study sample. For categorical variables, frequencies and percentages were used, and depending on distributional assumptions for continuous data (ie, normal distribution versus nonnormal distribution), means and SDs or medians and IQRs were used.
Logistic mixed effects regression models were used to analyze the associations between substance use and both time-invariant and time-varying factors over 14 days. Time-varying covariates were measured via 14 daily surveys, and day-level cravings for alcohol and stimulants (ie, cocaine, crack cocaine, and methamphetamine) were assessed. All models included a random intercept to account for repeated measures per person [
We first built bivariate models to test each factor on substance use individually (a conservative Bonferroni multiple comparison correction for 24 tests would be
For all longitudinal data, including the outcome substance use in a given day and cravings for alcohol and stimulants in the past 24 hours, the overall percentage of missing data was calculated by summing the total number of missing responses and then dividing that number by the total number of potential responses (272×14=3808). The overall percentage of surveys completed was calculated by summing the number of surveys completed and dividing that number by the total number of surveys (3808). The average number of surveys completed per person was calculated by dividing the total number of surveys completed by the total sample size. All analyses were conducted using Stata 14.2 (Stata Corp).
A total of 3897 individuals responded to the MTurk task posted for this study. Of these, 2910 were screened out because they did not meet the eligibility criteria and another 41 were not included because they did not complete the screening survey. Of the 946 individuals who were considered eligible according to screening data, 161 were MSM and 785 were non-MSM. Of the 161 eligible MSM, 152 agreed to participate, and of the 785 eligible non-MSM, 781 agreed to participate, resulting in a total of 13 individuals who declined or opted out. However, this study only had the capacity to enroll 272 participants and had to waitlist the remaining 661. All of the participants who were enrolled consented at baseline. Completion rates for the 14 daily surveys were as follows: day 1, 99.3%; day 2, 98.2%; day 3, 99.3%; day 4, 95.9%; day 5, 94.1%; day 6, 91.9%; day 7, 95.9%; day 8, 95.2%; day 9, 95.9%; day 10, 94.8%; day 11, 92.6%; day 12, 90.8%; day 13, 92.3%; and day 14, 89.7%.
Baseline characteristics of the study sample are described in
Baseline sociodemographic characteristics, substance use, and psychosocial factors among people who use alcohol and/or stimulants recruited from MTurk between March 26 and April 13, 2018, in the United States (N=272).
Variable | Value | ||||
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Age (years), mean (SD) | 36.1 (10.4) | |||
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White | 220 (80.8%) | ||
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Asian | 17 (6.2%) | ||
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African American | 22 (8.0%) | ||
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Native American or Alaskan Native | 3 (1.1%) | ||
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Other | 10 (3.6%) | ||
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Male | 201 (73.9%) | ||
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Female | 71 (26.1%) | ||
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Men reporting sex with other men, n (%) | 134 (65.3%) | |||
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Single | 112 (41.1%) | ||
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Married/committed | 158 (58.0%) | ||
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Divorced | 2 (0.7%) | ||
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Full-time employment | 180 (66.1%) | ||
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Part-time employment | 45 (16.5%) | ||
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Unemployed | 47 (17.2%) | ||
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Higher education (bachelor’s degree/any postgraduate studies), n (%) | 163 (59.9%) | |||
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≥125,000 (reference) | 20 (7.3%) | ||
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75,000-124,999 | 64 (23.5%) | ||
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40,000-74,999 | 89 (32.7%) | ||
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<40,000 | 99 (36.4%) | ||
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Has health insurance, n (%) | 229 (84.1%) | |||
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Yes | 170 (62.5%) | ||
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No | 95 (34.9%) | ||
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Do not know | 7 (2.5%) | ||
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Alcohol consumption in the past 6 months, n (%) | 261 (99.2%) | |||
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AUDIT-C score, mean (SD)a | 4.2 (2.4) | |||
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Hazardous alcohol consumptionb, n (%) | 173 (63.8%) | |||
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Methamphetamine use in the past 6 months, n (%) | 19 (10.1%) | |||
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Cocaine use in the past 6 months, n (%) | 31 (15.3%) | |||
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Crack cocaine use in the past 6 months, n (%) | 8 (4.4%) | |||
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Any drug use in the past 6 months including injection drug use, n (%) | 104 (38.2%) | |||
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Day-level craving for alcohol in the past 24 hours, median (IQR) | 5 (0-26) | ||
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Day-level craving for methamphetamine in the past 24 hours, median (IQR) | 54 (20-88) | ||
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Day-level craving for cocaine in the past 24 hours, median (IQR) | 39 (1-71) | ||
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Day-level craving for crack cocaine in the past 24 hours, median (IQR) | 52 (51-87) | ||
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Self-esteem scored, median (IQR) | 30 (26-35) | |||
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Positive affect, median (IQR) | 31 (26-37) | ||
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Negative affect, median (IQR) | 15 (11-20) | ||
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17 (11-21) | |||
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Low stress, n (%) | 93 (34.1%) | ||
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Moderate stress, n (%) | 152 (55.8%) | ||
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High stress, n (%) | 27 (9.9%) | ||
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Depression scoreg, median (IQR) | 7.7 (3.3-12.2) |
aAlcohol Use Disorders Identification Test-Concise (AUDIT-C) scores were calculated using the three-item AUDIT-C.
bHazardous drinking was measured at baseline using the three-item AUDIT-C. Scores range from 0 to 12. Scores of 4 or more for men indicate hazardous drinking and scores of 3 or more for women indicate hazardous drinking.
cDay-level craving scores range from 0 to 100.
dSelf-esteem was measured using the “Rosenberg Self-Esteem Scale” (RSES). Higher scores represent higher self-esteem.
eAffect was measured using the “Positive and Negative Affect Schedule” (PANAS). Scores range from 10 to 50, with higher scores indicating higher levels of positive or negative affect. Positive and negative affect were measured by summing different items from the PANAS scale.
fStress was measured using the “Perceived Stress Scale” (PSS). Scores range from 0 to 40, with higher scores representing higher perceived stress. Scores ranging from 0 to 13 are considered low stress, 14 to 26 are considered moderate stress, and 27 to 40 are considered high stress.
gDepression was measured using the 10-item Center for Epidemiologic Studies Depression Scale Revised (CESD-10). A score of ≥10 is considered to indicate depression.
Nearly all (261/272, 99.2%) participants reported consuming alcohol in the past 6 months. The mean AUDIT-C score for any current or past drinking was 4.2 (SD 2.4), and 173 (63.8%) participants engaged in any current or past hazardous alcohol consumption. In the past 6 months, 31 (15.3%) participants reported using cocaine, 19 (10.1%) reported using methamphetamine, 8 (4.4%) reported using crack cocaine, and 104 (38.2%) reported any noninjection or injection drug use. On a scale from 0 to 100, median day-level craving scores at baseline for alcohol, methamphetamine, cocaine, and crack cocaine were 5 (IQR 0-26), 54 (IQR 20-88), 39 (IQR 1-71), and 52 (IQR 51-87), respectively.
The median score for self-esteem was 30 (IQR 26-35). On a scale from 10 to 50, median scores for positive affect and negative affect were 31 (IQR 26-37) and 15 (IQR 11-20), respectively. On a scale from 0 to 40, the median perceived stress score was 17 (IQR 11-21), and just over half (152/272, 55.8%) of the sample reported experiencing moderate stress, followed by low stress (93/272, 34.1%) and high stress (27/272, 9.9%). On a scale from 0 to 30, where a score ≥10 is considered to indicate depression, the median score was 7.7 (IQR 3.3-12.2).
Overall, there was a minimal amount of missing data. Out of a total of 3,808 possible responses, there were 201 (5.2%) missing responses for the primary outcome of interest (substance use in the past 24 hours over the follow-up period) and for day-level cravings for alcohol in the past 24 hours. With regard to day-level cravings for cocaine, crack cocaine, and methamphetamine in the past 24 hours, there were 253 (6.6%) missing responses for each measure of craving.
Results from bivariate logistic regression models examining the predictors of substance use in a given day measured at baseline and each day over the follow-up period are summarized in
Bivariate random-intercept logistic regression models of the predictors of substance use in a given day among people who use alcohol and/or stimulants recruited from MTurk between March 26 and April 13, 2018, in the United States (N=272).
Variable | Substance use in the past 24 hours on day 1a (n=50) | No substance use in the past 24 hours on day 1a (n=220) | Unadjusted odds ratio (95% CI) | |||
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Age (years), mean (SD) | 35.50 (10.44) | 36.32 (10.34) | 0.99 (0.94-1.03) | .66 | |
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White (reference) | 40 (80.0%) | 178 (80.9%) | N/Ad | N/A |
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Asian | 1 (2.0%) | 16 (7.3%) | 0.19 (0.26-1.40) | .10 |
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African American | 5 (10.0%) | 17 (7.7%) | 3.61 (0.62-21.05) | .15 |
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Native American or Alaskan |
1 (2.0%) | 2 (0.9%) | 13.61 (0.10-1726.21) | .29 |
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Hawaiian or Pacific Islander | 3 (6.00%) | 7 (3.2%) | 3.57 (0.28-44.84) | .32 |
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Married/committed (reference) | 28 (56.0%) | 128 (58.2%) | N/A | N/A |
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Single | 22 (44.0%) | 90 (40.9%) | 1.53 (0.59-3.96) | .37 |
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Divorced | 0 (0%) | 2 (0.9%) | N/A | N/A |
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Full-time employment (reference) | 31 (62.0%) | 149 (67.7%) | N/A | N/A |
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Part-time employment | 13 (26.0%) | 32 (14.5%) | 5.70 (1.54-21.00) | .009 |
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Unemployed | 6 (12.0%) | 39 (17.7%) | 0.63 (0.18-2.18) | .46 |
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Higher education (bachelor’s degree or any postgraduate), n (%) | 24 (48.0%) | 138 (62.7%) | 0.23 (0.08-0.59) | .003 | |
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≥125,000 (reference) | 4 (8.0%) | 16 (7.3%) | N/A | N/A |
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75,000-124,999 | 3 (6.0%) | 61 (27.7%) | 0.39 (0.05-2.67) | .33 |
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40,000-74,999 | 14 (28.0%) | 75 (34.1%) | 1.03 (0.16-6.53) | .97 |
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<40,000 | 29 (58.0%) | 68 (30.9%) | 6.84 (1.09-42.81) | .04 |
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Has health insurance, n (%) | 42 (84.0%) | 185 (84.1%) | 0.44 (0.12-1.64) | .22 | |
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Ever tested for HIV, n (%) | 36 (72.0%) | 132 (60.0%) | 0.69 (0.46-1.04) | .07 | |
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Men reporting sex with other men, n (%) | 37 (82.2%) | 96 (60.8%) | 7.35 (2.40-22.56) | <.001 | |
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Day-level craving for |
10.5 (0-50) | 3 (0-15) | 1.03 (1.02-1.04) | <.001 | |
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Day-level craving for |
0 (0-9) | 0 (0-0) | 1.03 (1.01-1.05) | <.001 | |
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Day-level craving for cocaine in the past 24 hours, median (IQR) | 0 (0-1) | 0 (0-0) | 1.04 (1.02-1.06) | <.001 | |
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Day-level craving for crack |
0 (0-0) | 0 (0-0) | 1.04 (1.02-1.06) | <.001 | |
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Self-esteem scoreg, median (IQR) | 27.5 (23-32) | 30 (27-36) | 0.87 (0.81-0.93) | <.001 | |
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Positive affect scoreh, median (IQR) | 30 (25-34) | 32 (26-38) | 0.94 (0.89-1.00) | .07 | |
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Negative affect scoreh, median (IQR) | 19.5 (15-32) | 14 (11-18.5) | 1.14 (1.08-1.21) | <.001 | |
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Perceived stress scorei, median (IQR) | 20 (15-23) | 16 (10-20) | 1.13 (1.06-1.20) | <.001 | |
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Depression scorej, median (IQR) | 11.66 (4.44-17.77) | 6.66 (2.22-12.22) | 1.19 (1.11-1.27) | <.001 |
aIn the bivariate logistic regression models, substance is the outcome and is a composite variable that includes those who reported heavy drinking and/or any drug use in the past 24 hours over a 2-week follow-up period. Substance use is the outcome and includes those who reported heavy drinking and/or any drug use in the past 24 hours on day 1.
b
cTime invariant covariates measured at baseline.
dN/A: not applicable.
eTime varying covariates measured at day 1 over the follow-up period.
fDay-level cravings in the past 24 hours were assessed on a scale ranging from 0 to 100, where 0 is no craving at all and 100 is the strongest craving one has ever experienced.
gSelf-esteem was measured using the “Rosenberg Self-Esteem Scale” (RSES). Higher scores represent higher self-esteem.
hAffect was measured using the “Positive and Negative Affect Schedule” (PANAS). Scores range from 10 to 50, with higher scores indicating higher levels of positive or negative affect. Positive and negative affect were measured by summing different items from the PANAS scale.
iStress was measured using the “Perceived Stress Scale” (PSS). Scores range from 0 to 40, with higher scores representing higher perceived stress. Scores ranging from 0 to 13 are considered low stress, 14 to 26 are considered moderate stress, and 27 to 40 are considered high stress.
jDepression was measured using the 10-item Center for Epidemiologic Studies Depression Scale Revised (CESD-10). A score of ≥10 is considered to indicate depression.
Every 1-point increase in self-esteem was associated with a lower odds of engaging in substance use in a given day. Every 1-point increase in negative affect was associated with a higher odds of engaging in substance use in a given day. Similarly, increases in perceived stress and depression were associated with higher odds of engaging in substance use in a given day. Higher day-level craving scores in the past 24 hours for alcohol, cocaine, crack cocaine, and methamphetamine were all associated with a higher odds of engaging in substance use in a given day over the follow-up period.
Results from all four multivariable logistic regression models examining baseline predictors and daily correlates of substance use in a given day while controlling for age in years and education are summarized in
Multivariable random-intercept logistic regression models of the predictors of substance use in a given day among people who use alcohol and/or stimulants recruited from MTurk between March 26 and April 13, 2018, in the United States (N=272).
Variable | Adjusted odds ratio (95% CI) Model 1a,b | Adjusted odds ratio (95% CI) Model 2a,d | Adjusted odds ratio (95% CI) Model 3a,e | Adjusted odds ratio (95% CI) Model 4a,f | |||||
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Mean age in years | 1.01 (0.95-1.07) | .64 | 1.01 (0.95-1.07) | .62 | 1.01 (0.95-1.07) | .73 | 1.00 (0.95-1.06) | .78 |
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Higher education (bachelor’s degree/any postgraduate) | 0.18 (0.05-0.61) | .006 | 0.17 (0.05-0.59) | .005 | 0.17 (0.05-0.60) | .006 | 0.19 (0.05-0.65) | .009 |
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Men reporting sex with other men | 4.90 (1.28-18.70) | .02 | 5.47 (1.43-20.87) | .01 | 5.99 (1.55-23.13) | .009 | 4.94 (1.29-18.84) | .01 |
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Day-level craving for alcohol in the past 24 hours | 1.02 (1.01-1.03) | <.001 | 1.02 (1.01-1.03) | <.001 | 1.02 (1.01-1.03) | <.001 | 1.02 (1.01-1.03) | <.001 |
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Day-level craving for cocaine in the past 24 hours | 1.03 (1.01-1.04) | .01 | 1.02 (1.01-1.04) | .001 | 1.03 (1.01-1.04) | .001 | 1.02 (1.01-1.04) | .001 |
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Self-esteem scorek | 0.90 (0.82-0.98) | .02 | N/Al | N/A | N/A | N/A | N/A | N/A |
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Negative affect scorem | N/A | N/A | 1.08 (1.01-1.16) | .01 | N/A | N/A | N/A | N/A |
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Perceived stress scoren | N/A | N/A | N/A | N/A | 1.06 (0.98-1.16) | .11 | N/A | N/A |
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Depression scoreo | N/A | N/A | N/A | N/A | N/A | N/A | 1.11 (1.02-1.21) | .01 |
aAll adjusted models (1-4) are controlled for age in years and education (eg, having at least a BA degree).
bTotal effect of self-esteem on substance use in a given day.
c
dTotal effect of negative affect on substance use in a given day.
eTotal effect of perceived stress on substance use in a given day.
fTotal effect of depression on substance use in a given day.
gTime invariant covariates measured at baseline.
hTime varying covariates measured at day 1 over the follow-up period.
iDay-level cravings in the past 24 hours were assessed on a scale ranging from 0 to 100, where 0 is no craving at all and 100 is the strongest craving one has ever experienced.
jSubstance use includes those who reported heavy drinking and/or any drug use in the past 24 hours over a 2-week period.
kSelf-esteem was measured using the “Rosenberg Self-Esteem Scale” (RSES). Higher scores represent higher self-esteem.
lN/A: not applicable.
mNegative affect was measured by summing certain items from the “Positive and Negative Affect Schedule” (PANAS).
nStress was measured using the “Perceived Stress Scale” (PSS). Scores range from 0 to 40, with higher scores representing higher perceived stress.
oDepression was measured using the 10-item Center for Epidemiologic Studies Depression Scale Revised (CESD-10). A score of ≥10 is considered to indicate depression.
This daily diary study, which measured the predictors and day-level correlates of substance use in a given day among people who use alcohol and/or stimulants in the United States and who were recruited via MTurk, identified several important findings. Higher day-level craving scores for alcohol and stimulants predicted substance use in a given day over the 14-day follow-up period. Negative affect and depression measured at baseline were both associated with substance use in a given day. We also found that higher levels of self-esteem measured at baseline were associated with a lower odds of engaging in substance use in a given day over the follow-up period. These findings may have important implications for behavioral interventions that aim to reduce day-to-day patterns of heavy drinking and drug use among people who use alcohol and stimulants in the United States.
Using the daily dairy method, our study found day-level cravings for alcohol and stimulants to be correlated with substance use in a given day. Our study adds to existing research that supports the link between craving and substance use [
Negative affect was independently associated with substance use in a given day over the 2-week follow-up period in this study, which is consistent with prior research [
Depression was associated with substance use in a given day in this study. Individuals who experience depression and engage in substance use tend to have worse treatment outcomes for both depression and substance use compared to those who experience one of these conditions alone [
Higher levels of self-esteem were associated with a reduced odds of engaging in substance use over the follow-up period in our study. Previous studies have shown that self-esteem is protective against substance use and mediated by adaptive coping mechanisms among multiracial youth and college students in the United States [
MSM had significantly higher odds of engaging in substance use in a given day over the follow-up period compared to those who were not MSM in our study. Drug and alcohol use are common among MSM and have been linked to chronic stress due to sexual stigma, depression, sexual anxiety, gay community attachment, and internalized homophobia [
Perceived stress was not independently associated with substance use in a given day in our study. One possible explanation for this is that our baseline measure of stress was not collected close enough to the repeated measures outcome of interest to detect an association. Stress may be a more transient experience that should be captured using repeated measures data. We recommend that future studies leveraging a repeated measures deign collect data on stress closer to the outcome measure of substance use to better understand the potential temporal effect of stress on substance use. Further, since the relationship between stress and substance use has been established in other studies [
This study has limitations. We relied on self-reported data of sensitive behaviors, such as drug and alcohol use, that were collected via daily diaries, which may be subject to social desirability bias and recall bias. These biases may threaten the reliability and validity of our findings by dampening the effect or pushing the results toward the null. However, it should be noted that the daily diary method is known to enhance the ecological validity of substance use research by collecting repeated measures over time in one’s natural environment [
In summary, day-level cravings for alcohol and stimulants, depression, negative affect, and being in the MSM group predicted substance use, and higher levels of self-esteem were protective against substance use in our sample of people who used alcohol and/or stimulants. Interventions that target biobehavioral circuitries, such as craving, should be investigated in conjunction with programs that are designed to reduce negative psychosocial stressors like depression. Substance use treatment programs may also consider employing cognitive behavioral strategies to enhance self-esteem and improve adaptive coping. Further, culturally tailored approaches should be developed to effectively engage MSM in interventions. Finally, we recommend delivering interventions for substance use using mHealth or other technology-based platforms, in order to increase the accessibility to efficacious treatments for people living with SUD in the United States.
adjusted odds ratio
Alcohol Use Disorders Identification Test-Concise
Center for Epidemiologic Studies Depression Scale
mobile health
men who have sex with men
Amazon Mechanical Turk
Positive and Negative Affect Schedule
Perceived Stress Scale
Stimulants and Alcohol use in MTurk Behavioral Assessments Study
substance use disorder
The authors gratefully acknowledge the valuable contributions made by all research staff and participants. JPJ is supported by a postdoctoral fellowship award program from the National Institute on Drug Abuse (T32DA007250).
None declared.