Neural Links of Approach Bias Modification in Heavy Drinking Veterans

拟议项目的总体目标是改善对大量饮酒的退伍军人的护理 不健康的水平。退伍军人中酗酒的现象非常普遍，这与许多其他精神问题有关。 健康和慢性疾病会导致暴力和自杀等高风险行为，并且是 发病率和死亡率的主要可预防原因。人们有一种自动接近酒精的倾向 在酗酒的学生和欧洲住院患者中发现。这种酒精方法偏见 尽管明确希望戒烟，但仍会导致继续饮酒。酒精方法偏差修正 (AABM)，一项认知训练计划已被证明可以纠正酒精方法偏差并减少饮酒 复发率。然而，我们目前不知道酒精偏向相关神经活动的程度 酗酒的退伍军人，患有高度普遍的合并症（即创伤后应激障碍（PTSD）和轻度创伤性脑损伤）， 或这些退伍军人对 AABM 训练的反应程度。此外，功能机制 酒精趋向偏向奖励神经回路的连接性仍然很大程度上未知。 因此，拟议的 CSR&D CDA-2 旨在通过进行纵向观察来填补这些空白 旨在评估酒精方法偏差和 AABM 训练之间的神经关联的研究。研究 研究有三个总体目标： 目标 1：研究饮酒期间的神经激活和连接 接近-回避任务和酒精提示反应任务；目标 2：研究以下神经变化 防空弹道导弹训练；目标 3：测量和研究行为的神经、认知和精神预测因素 对 AABM 训练的反应。为了测试这些目标，50 名酗酒的退伍军人和 20 名健康的轻度/不饮酒的退伍军人 退伍军人控制人员将从旧金山退伍军人事务医疗中心及其附属诊所招募。 我们将比较这两组之间的基线神经和行为特征。大量饮酒 然后退伍军人将完成为期 3 周（9 节）的 AABM 训练。训练后大量饮酒 退伍军人将重复在基线时完成的神经和行为评估。酗酒的退伍军人 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精度和空间 功能磁共振成像（fMRI）数据的分辨率。 拟议的 CDA-2 将首先：1）研究潜在的神经和认知机制 酗酒退伍军人群体中的酒精方法偏差，2）检查饮酒期间的功能连接 酒精接近-避免任务，3) 研究功能磁共振成像激活和连接数据的程度 预测对 AABM 的反应，4) 研究神经认知和精神症状的程度 酗酒退伍军人中常见，他们预测 AABM 后行为会发生变化。拟议的调查结果 该项目预计将改善对酗酒且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，治疗有助于 不健康饮酒的退伍军人也可能适用于患有这种疾病的一般人群 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.