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退伍军人的照顾， 不健康的水平。退伍军人中酗酒非常普遍，这与许多其他精神疾病有关 健康和慢性疾病，有助于高风险行为，如暴力和自杀，是一个 是发病率和死亡率的主要可预防原因。一种自动接近酒精的倾向已经被 在大量饮酒的学生和欧洲住院患者中发现。这种酒精接近偏见 尽管有明确的戒烟愿望，但仍会导致继续饮酒。酒精接近偏差修正 （AABM），一个认知训练计划已被证明可以纠正酒精接近偏见和减少酒精 复发率然而，我们目前还不知道酒精接近偏见相关的神经活动的程度， 重度饮酒的退伍军人与高度流行的共病条件（即，PTSD和轻度创伤性脑损伤）， 或者这些退伍军人对AABM训练的反应程度。此外，功能性 酒精接近偏向奖励神经回路的连接仍然是未知的。 因此，拟议的CSR & D CDA-2试图通过进行纵向观察来填补这些空白。 这项研究旨在评估酒精接近偏见和AABM训练的神经联系。研究 这项研究有三个首要目标：目标1：研究酒精过程中的神经激活和连接 目的2：研究酒精刺激后的神经变化， AABM训练;目的3：测量和调查行为障碍的神经、认知和精神病学预测因素 对AABM训练的回应。为了测试这些目标，50名重度饮酒的退伍军人和20名健康的轻度/非饮酒者 退伍军人控制将从旧金山弗朗西斯科退伍军人事务医疗中心和附属诊所招募。 我们将比较这两组之间的基线神经和行为特征。大量饮酒 退伍军人将完成为期3周（9节）的AABM培训。训练后，大量饮酒 退伍军人将重复在基线完成的神经和行为评估。酗酒的退伍军人 还将在基线后3个月完成随访评估，以评价持续的行为变化 (e.g.,减少酒精使用）。拟议的工作将直接利用神经解剖学的精确性和空间 功能性磁共振成像（fMRI）数据的分辨率。 提出的CDA-2将是第一个：1）调查潜在的神经和认知机制， 酗酒退伍军人人群中的酒精接近偏见，2）检查功能连接， 酒精接近回避任务，3）调查在何种程度上，功能磁共振成像激活和连接数据 预测对AABM的反应，4）调查神经认知和精神症状 在酗酒中很常见退伍军人预测AABM后的行为变化。建议的调查结果 该项目预计将改善对大量和不健康饮酒的退伍军人的护理，并进一步扩大， 援助受这些问题影响的家庭和社区。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.