Stress and drug-cue-induced craving in opioid-dependent individuals in naltrexone treatment
Stress and drug-cue-induced craving in opioid-dependent individuals in naltrexone treatment
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DOI：
10.1037/1064-1297.15.2.134
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发表时间：
2007-04-01
影响因子：
2.3
通讯作者：
Sinha, Rajita
中科院分区：
文献类型：
--
作者：
Hyman, Scott M.;Fox, Helen;Sinha, Rajita
背景：纳洛酮是一种非成瘾性药物，可阻断阿片类药物的欣快感。然而，纳洛酮治疗与高不依从性和阿片类药物复发率相关，可能是因为它不能减少早期恢复期间的压力和长期戒断症状。先前的临床和临床前研究表明，压力和药物提示相关的唤醒反应与一系列吸毒人群的渴望和复发的脆弱性有关。目的：研究阿片类药物成瘾者的阿片类药物渴求以及对纳洛酮治疗的阿片类药物滥用者对压力和药物线索的主观和心血管反应。方法：11名男性和3名女性从事纳洛酮治疗阿片类药物依赖。他们在一次实验室会议中暴露于个性化的压力、药物提示和中性放松图像。主观（渴望，情绪）和心血管（心率，收缩压和舒张压）的措施进行了评估。结果如下：与中性意象相比，压力和药物线索相关意象显著增加了阿片类药物的渴望，焦虑和消极情绪，并显著降低了积极情绪。选择性的情绪反应更大的压力条件下比药物提示条件。只有压力相关的图像与心血管反应增加。结论：纳洛酮治疗的阿片类药物滥用者表现出对压力和药物线索诱导的渴望和唤醒反应的脆弱性，这可能导致接受纳洛酮治疗的阿片类药物依赖者的高不依从率和复发率。专门针对与药物线索和压力诱导的渴望共同发生的负面情感的药理学和行为干预可能有助于改善阿片类药物依赖的纳洛酮治疗结果。
Background: Naltrexone is a nonaddictive medication that blocks the euphoric effects of opioids. However, naltrexone treatment is associated with high rates of noncompliance and opioid relapse, possibly because it does not reduce stress and protracted withdrawal symptoms during early recovery. Prior clinical and preclinical research has indicated that both stress and drug-cue-related arousal response is associated with craving and vulnerability to relapse in a range of drug-using populations. Aims: To examine opioid craving and the subjective and cardiovascular response to stress and drug cues in naltrexone-treated opioid abusers. Method: Eleven men and three women engaged in naltrexone treatment for opioid dependence. They were exposed to personalized stress, drug-cue, and neutral-relaxing imagery in a single laboratory session. Subjective (craving, emotion) and cardiovascular (heart rate, systolic blood pressure, and diastolic blood pressure) measures were assessed. Results: Stress and drug-cue-related imagery significantly increased opioid craving, anxiety, and negative emotions and significantly decreased positive emotions compared to neutral imagery. Selective emotional responses were greater in the stress condition than in the drug-cue condition. Only stress-related imagery was associated with an increased cardiovascular response. Conclusions: Naltrexone-treated opioid abusers demonstrate vulnerability to stress and drug-cue-induced craving and arousal responses that may contribute to the high rates of noncompliance and relapse among opioid-dependent individuals undergoing naltrexone treatment. Pharmacological and behavioral interventions that specifically target the negative affectivity that co-occurs with drug-cue and stress-induced craving could be of benefit in improving naltrexone treatment outcomes in opioid dependence.