A network perspective on heroin use associations between craving, withdrawal symptoms, dependence, loss of control, and psychosocial consequences

Background. Opioid use disorder (OUD) is a complex diagnosis characterized by symptoms such as craving, tolerance, withdrawal, and impaired social, occupational, or recreational activities. However, there is a lack of data about the interconnectedness of these symptoms, in particular the links between withdrawal symptoms and psychosocial impairment. The present study uses symptom network analysis to better understand these associations surrounding heroin use.
Methods. We used data from individuals who reported heroin use during the past 12 months in the National Survey on Drug Use and Health (NSDUH) (year 2021, n = 207). We estimated a cross-sectional network that included heroin use-related aspects, including coping and withdrawal symptoms, consequences, loss of control, craving, and dependence symptoms. To examine key ‘bridge nodes’ that connect these different clusters, we computed a measure of bridge expected influence for each node.
Results. The network model revealed several symptom connections within and between clusters. The withdrawal symptom, sleep problems, had the strongest bridge centrality. The dependence symptom “increased use for an effect”, was a key bridge node connecting to withdrawal symptoms and consequences. Craving was connected with two withdrawal symptoms (depressed mood and sweating). Additional symptom connections emerged between the loss of control and other dependence symptom nodes.
Conclusions. Our network analysis model provides additional insight into how heroin use symptoms and relevant characteristics are interconnected. Craving and loss of control (time spent using, amount of use) map onto specific withdrawal symptoms.