Applying behavioral economics to screen medications for alcohol use disorder

应用行为经济学筛选酒精使用障碍药物

• 批准号: 10315908
• 负责人: Steven J Nieto
• 金额: $ 6.85万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10315908
• 关键词: Alcohol consumption; Alcohols; Behavioral; Bulla; Characteristics; Choice Behavior; Clinical; Clinical Research; Clinical Trials; Cocaine Dependence; Compulsive Behavior; Decision Making; Development; Disease; Distant; Dose; Double-Blind Method; Fostering; Funding; Future; Human; Impairment; Individual; Laboratories; Laboratory Study; Measures; Mediating; Methods; Modeling; Naltrexone; National Research Service Awards; Outcome; Parents; Participant; Pathologic; Pathology; Patients; Pharmaceutical Preparations; Pharmacology Study; Pharmacotherapy; Placebos; Prediction of Response to Therapy; Procedures; Process; Prognostic Marker; Psychology; Questionnaires; Randomized; Reporting; Research; Research Personnel; Rewards; Scientist; Telephone; Testing; Titrations; Training; Training Activity; Translations; Treatment outcome; Visit; Woman; addiction; alcohol cue; alcohol demand; alcohol reinforcement; alcohol screening; alcohol use disorder; behavioral economics; behavioral pharmacology; chronic alcohol ingestion; cognitive process; cost; cue reactivity; discounting; drinking; drinking behavior; drug efficacy; economic behavior; efficacy evaluation; efficacy study; experimental study; indexing; intrinsic motivation; men; non-drug; novel; novel strategies; pre-clinical; precision medicine; preclinical study; preference; reinforcer; response; three-arm study; varenicline; virtual; virtual visit

ABSTRACT Maladaptive decision-making processes are a hallmark of alcohol use disorder (AUD). A behavioral economic approach to AUD synthesizes concepts and methods from psychology and microeconomics to understand cognitive processes that contribute to overconsumption of alcohol. The excessive delay discounting of temporally distant rewards and increased alcohol demand is characteristic of individuals with AUD and provide support for dysfunctional decision-making processes. Thus, there is critical need to develop and identify treatments that can shift decision-making biases toward more adaptive choices. The multiple-choice procedure (MCP) was developed to efficiently investigate the relationship between drug preferences and alternative reinforcers. While the MCP has been used to examine the efficacy of medications for cocaine dependence, it has yet to be used to screen medications for AUD. The objective of this F32 NRSA application is to foster my development as an independent researcher with a focus on behavioral pharmacology for AUD and behavior economics applied to AUD. This application seeks to leverage an R21 human laboratory paradigm to screen AUD medications by adding an MCP. This addition will allow the applicant valuable training in conducting a behavioral pharmacology study, while using a robust behavioral economic approach to assess the clinical utility of medication effects on choice behaviors. A total of 64 men and women with current AUD and reporting intrinsic motivation to change their drinking, will be randomly assigned to receive naltrexone (50 mg QD), varenicline (1 mg BID), or matched placebo. Post-randomization, all participants will complete an alcohol cue- reactivity paradigm prior to the initial dose of study medication. After a week-long medication titration period, participants are asked to come into the laboratory to receive their second medication blister pack and to begin a 7-day practice quit attempt, during which they will have daily virtual (online and phone) visits where they will report on their alcohol. Additionally, a second cue-reactivity paradigm will be conducted 90 minutes following study drug administration on the final day of the practice quit attempt (Day 14). After the cue-reactivity paradigm, participants will complete the MCP, wherein participants choose between a standard alcohol drink immediately or a monetary reinforcer in one week, a delay discounting task, and a hypothetical purchase task to assess alcohol demand. Aim 1 tests the hypothesis that naltrexone and varenicline will decrease alcohol choice compared to placebo. Aim 2 tests the hypothesis that alcohol drinking during the practice quit attempt will predict alcohol choice and that medication effects will moderate this relationship. This represents an important step in: 1) evaluating the efficacy of AUD medications on alcohol choice over an alternative reinforcer and 2) my scientific development and maturity as an independent translational alcohol researcher with a focus on behavioral pharmacology and behavioral economics to study AUD.

摘要 不适应的决策过程是酒精使用障碍(AUD)的一个标志。行为经济学 AUD方法综合心理学和微观经济学的概念和方法来理解 导致过度饮酒的认知过程。的过度延迟折扣 时间上遥远的奖励和增加的酒精需求是患有AUD和 支持功能失调的决策过程。因此，迫切需要制定和确定 治疗可以改变决策偏见，使其倾向于更具适应性的选择。多项选择程序 (MCP)是为了有效地研究药物偏好和替代品之间的关系而开发的 增强剂。虽然MCP已被用于检查药物治疗可卡因依赖的疗效，但它 尚未用于筛选治疗AUD的药物。此F32 NRSA应用程序的目标是促进我的 发展成为一名独立研究人员，专注于治疗AUD和行为的行为药理学 经济学适用于澳元。这个应用程序试图利用R21人体实验室范例来筛选 通过添加MCP进行药物治疗。这项补充将给予申请人宝贵的培训，使其能够进行 行为药理学研究，同时使用稳健的行为经济学方法评估临床 药物效用对选择行为的影响。目前共有男女澳元和报道 改变饮酒的内在动机，将被随机分配给纳曲酮(50 mg，qd)， Varenicline(1 mg，2次)，或匹配的安慰剂。随机化后，所有参与者都要完成酒精提示- 在研究药物初始剂量之前的反应性范式。在长达一周的药物滴定后， 参与者被要求到实验室接受他们的第二个药物泡罩包装，并开始 一次为期7天的戒烟练习，在此期间，他们将每天进行虚拟(在线和电话)访问 报告他们的酒精含量。此外，第二次线索-反应范式将在90分钟后进行 在戒烟尝试的最后一天(第14天)学习药物管理。在提示-反应之后 范式，参与者将完成MCP，参与者在标准酒精饮料之间进行选择 立即或一周内货币增强器、延迟折扣任务和假想购买任务 来评估酒精需求。目的1验证纳曲酮和伐伦克林可减少酒精含量的假设 与安慰剂相比，选择。Aim 2测试了在练习过程中饮酒戒烟的假设 会预测酒精的选择，药物效应会缓和这种关系。这表示一个 重要的一步：1)评估AUD药物在酒精选择上的疗效 增强剂和2)作为一名独立的翻译酒精研究人员的科学发展和成熟 以行为药理学和行为经济学为重点研究AUD。