Daily motivation for and perceived accessibility of nondrug reward among people in long-term recovery from opioid use disorder.

Abstract

Enjoyment from experiences not involving drugs (nondrug rewards) can support recovery from addiction. Elegant experiments have shown that alternative reinforcers reduce drug use. However, investigations outside a laboratory may offer insight into the "real-world" complexities of nondrug reward. We used ecological daily assessment (daily electronic diaries) to examine how motivation for, and perceived accessibility of, nondrug rewards were associated with likelihood of experiencing same-day nondrug rewards. 130 adults in recovery from OUD (M=3.8 years in recovery) receiving opioid agonist treatment (M age=41.1, SD=9.0; 57% women; 85% non-Hispanic White) completed daily diary assessments for three weeks (1752 person-days). Multilevel logistic regression, controlling for baseline anhedonia and time in recovery, was used to predict days experiencing nondrug reward, using motivation for and perceived accessibility of nondrug rewards (5-point scale, "not at all" to "very") as both person-level predictors and within-person, day-level predictors. In separate models, people with higher average motivation (OR=2.64 [1.67-4.19]) or higher average perceived accessibility (OR=2.67 [1.58-4.51]) had significantly higher odds of reporting daily nondrug rewards. At the within-person level, days with higher-than-typical morning ratings of motivation (OR=1.23 [0.97-1.55]) or perceived accessibility (OR=1.32 [0.97-1.79]) were marginally associated with higher odds of experiencing nondrug rewards, but the associations were not statistically significant. Person-level characteristics were particularly strong in predicting motivation for and perceived access to daily nondrug rewards. Removing barriers to accessing nondrug rewards (e.g., financial, geographic, and social) is important to consider alongside other factors that contribute to experiencing nondrug rewards in recovery (e.g., motivation, anhedonia).