Table 4.

An Illustrative Example of Incorporating Multiple Contextual Factors

Study Design  • Randomized controlled trial comparing mindfulness-based relapse prevention (MBRP) and    twelve-step facilitation (TSF) in the treatment of substance use disorder  • Participants complete EMA measures via smartphones for a 2-week period immediately before    treatment and then again immediately after treatment  • Participants are prompted to answer a set of questions on their smartphone on a quasi-random    basis 5 times per day, with one randomly scheduled prompt in each of five 3-hour time periods    from 8:00AM to 10:00PM.  • Substance use will be measured via smartphones during treatment and at 3 months following the    completion of treatment.

EMA Items for each prompt:  • Urge → “Right now, how strong is your urge to drink/use?” (0 = none/minimal, 4 = very strong)  • Substance Use Availability → Right now, are you in a situation where BOTH of the following    are true: you can get access to alcohol/drugs and it would be possible to actually drink/use if you    decided to? (0 = No, 1 = Yes)  • Urge-Specific Self-Regulation → Please indicate whether you did any of the following since the    last recording to STOP YOURSELF FROM USING DRUGS OR DRINKING HEAVILY    WHEN YOU HAD AN URGE: (0 = No, 1 = Yes) Display items on self-regulation skills    emphasized in TSF (seeking social support and stimulus control) and items on self-regulation    skills emphasized in MBRP (emotional awareness and acceptance)

Analytic Strategy  • Use multilevel modeling where assessment prompts (Level 1) are nested within person (Level 2)  • Only use data from prompts in which urge is 1 or greater and substances are available (i.e.,    answered yes to substance use availability question).  • Moderator variable # 1: Percent substance users in social network (“percent users in network”)  • Moderator variable # 2: Psychiatric severity  • Conduct double moderated mediation analyses which test the following path:    Treatment X percent users in network X psychiatric severity → momentary self-regulation →    momentary substance use    (i.e., the three-way interaction among treatment, percent user in network, and psychiatric severity    predicts momentary self-regulation, which in turn predicts momentary substance use)

Hypotheses:  • Among individuals with high psychiatric severity and a low to moderate percentage of users in    network, the use of self-regulation skills emphasized in MBRP (emotional awareness and    acceptance) during urge episodes will mediate the effect of receiving MBRP on momentary    substance use  • Among individuals with high percentage of users in network and low to moderate psychiatric    severity, the use of the self-regulation skill emphasized in TSF (seeking social support and    stimulus control) will mediate the effect of receiving TSF on momentary substance use