Neural Links of Approach Bias Modification in Heavy Drinking Veterans

拟议项目的总体目标是改善对酗酒和酗酒退伍军人的护理 不健康的水平。大量饮酒在退伍军人中非常普遍，这与许多其他精神疾病有关 健康和慢性医疗条件，导致暴力和自杀等高危行为，是一种 导致发病率和死亡率的主要可预防原因。一种自动接近酒精的趋势是 在大量饮酒的学生和欧洲住院人群中发现。这种饮酒方法--偏见 导致持续饮酒，尽管有明确的戒酒愿望。酒精法--偏差修正 (AABM)，一项认知训练计划已被证明可以纠正酒精偏向并减少酒精 复发率。然而，我们目前还不知道酒精偏向相关的神经活动在多大程度上 酗酒退伍军人伴有高度普遍的并发症(如创伤后应激障碍和轻度创伤性脑损伤)， 或者这些退伍军人将在多大程度上对AABM培训做出反应。此外，功能的机制 酒精途径-偏向奖赏神经回路的连通性在很大程度上仍不清楚。 因此，拟议的CSR&D CDA-2试图通过进行纵向观测来填补这些空白 这项研究旨在评估酒精偏向和AABM训练之间的神经联系。这项研究 这项研究有三个主要目标：目标1：研究酒精过程中的神经激活和连接 接近-回避任务和酒精线索-反应任务；目标2：研究以下神经变化 AABM培训；目标3：测量和调查神经、认知和精神行为的预测因素 对AABM培训的回应。为了测试这些目标，50名重度饮酒退伍军人和20名健康的轻度饮酒/不饮酒的退伍军人 退伍军人控制中心将从旧金山退伍军人事务医疗中心和附属诊所招募人员。 我们将比较这两组患者的基线神经和行为特征。酗酒 然后，退伍军人将完成为期3周(9节)的AABM培训。训练结束后，酗酒 退伍军人将重复在基线上完成的神经和行为评估。酗酒退伍军人 还将在基线后3个月完成后续评估，以评估持续的行为变化 (例如，减少饮酒)。拟议的工作将直接利用神经解剖学的精确度和空间 功能磁共振成像(FMRI)数据的分辨率。 提议的CDA-2将是第一个：1)研究潜在的神经和认知机制 酒精方法-在大量饮酒的退伍军人中的偏见，2)检查在 酒精方法-回避任务，3)调查fMRI激活和连接数据的程度 预测对AABM的反应，4)调查神经认知和精神症状的程度 在大量饮酒的退伍军人中常见的是预测AABM后的行为变化。建议的调查结果 该项目预计将改善对酗酒和不健康的退伍军人的护理，进而， 援助受这些问题后遗症影响的家庭和社区。此外，有助于 不健康饮酒的退伍军人也可能适用于患有以下疾病的普通人群 这些问题。

The overall goal of the proposed project is to improve the care of Veterans who consume alcohol at heavy and unhealthy levels. Heavy alcohol use is highly prevalent among military Veterans, related to many other mental health and chronic medical conditions, contributes to high-risk behaviors such as violence and suicide, and is a leading preventable cause of morbidity and mortality. A tendency to automatically approach alcohol has been identified in heavy drinking students and European in-patient populations. This alcohol approach-bias contributes to continued alcohol use despite an explicit desire to quit. Alcohol approach-bias modification (AABM), a cognitive training program has been shown to remediate alcohol approach-bias and reduce alcohol relapse rates. However, we currently do not know the extent of alcohol approach-bias related neural activity in heavy drinking Veterans with highly prevalent comorbid conditions (i.e., PTSD and mild traumatic brain injury), or the extent to which these Veterans will respond to AABM training. Additionally, the mechanisms of functional connectivity in alcohol approach-bias reward neural circuitry remain largely unknown. Therefore, the proposed CSR&D CDA-2 seeks to fill these gaps by conducting a longitudinal observational study designed to evaluate the neural associations of alcohol approach-bias and AABM training. The research study has three overarching aims: Aim 1: To investigate neural activation and connectivity during an alcohol approach-avoidance task and an alcohol cue-reactivity task; Aim 2: To investigate neural change following AABM training; Aim 3: To measure and investigate neural, cognitive, and psychiatric predictors of behavioral response to AABM training. To test these aims, 50 heavy drinking Veterans and 20 healthy light/non-drinking Veteran controls will be recruited from the San Francisco Veterans Affairs Medical Center and affiliated clinics. We will compare baseline neural and behavioral characteristics between these two groups. Heavy drinking Veterans will then complete 3 weeks (9 sessions) of AABM training. Following training, heavy drinking Veterans will repeat the neural and behavioral assessments completed at baseline. Heavy drinking Veterans will also complete a follow-up assessment at 3 months post-baseline to evaluate sustained behavioral change (e.g., reduced alcohol use). The proposed work will directly harness the neuroanatomical precision and spatial resolution of functional magnetic resonance imaging (fMRI) data. The proposed CDA-2 will be the first to: 1) investigate the underlying neural and cognitive mechanisms of alcohol approach-bias in a population of heavy drinking Veterans, 2) examine functional connectivity during an alcohol approach-avoidance task, 3) investigate the extent to which both fMRI activation and connectivity data predict response to AABM, 4) investigate the extent to which neurocognitive and psychiatric symptoms common in heavy drinking Veterans predict behavioral change following AABM. Findings from the proposed project are expected to improve the care of Veterans with heavy and unhealthy alcohol use, and by extension, aid families and communities affected by the sequelae of these problems. Moreover, treatments that help Veterans with unhealthy alcohol use are also likely to be applicable to the general population of individuals with these problems.