Enhancing treatment outcomes among veterans with alcohol use disorder: Clinical and neural markers of adjunctive approach-avoidance training

提高患有酒精使用障碍的退伍军人的治疗效果：辅助接近-避免训练的临床和神经标志物

• 批准号: 10533497
• 负责人: Jessica Bomyea
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-10-01 至 2026-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10533497
• 关键词: Address; Affect; Alcohol consumption; Alcohols; Amygdaloid structure; Back; Behavior; Behavioral; Beverages; Brain; Caring; Characteristics; Clinical; Clinical Trials; Cognitive; Communities; Complex; Computers; Corpus striatum structure; Cues; Data; Desire for food; Development; Equipment and supply inventories; Foundations; Functional Magnetic Resonance Imaging; Goals; Heavy Drinking; Impairment; Individual; Informal Social Control; Inpatients; Intervention; Life; Measures; Medial; Methods; Mission; Modeling; Motivation; Neurobiology; Neurocognitive; Neurosciences; Occupational; Outcome; Patients; Prediction of Response to Therapy; Prefrontal Cortex; Process; Quality of life; Randomized Controlled Trials; Reaction; Reaction Time; Recovery; Recovery of Function; Relapse; Rewards; Role; Services; Severities; Substance of Abuse; Techniques; Testing; Therapeutic; TimeLine; Training; Treatment outcome; Veterans; Work; adverse outcome; alcohol abstinence; alcohol abuse therapy; alcohol cue; alcohol intervention; alcohol response; alcohol use disorder; base; comorbidity; confirmatory trial; cost; cue reactivity; disability; drinking; drinking behavior; effective intervention; efficacy evaluation; functional disability; functional independence; hazardous drinking; improved; improved outcome; innovation; neuroimaging; novel; portability; reduced alcohol use; relating to nervous system; response; reward processing; skills; social; standard care; substance use; treatment program

Veterans with alcohol use disorders (AUD) would be greatly served by development of effective interventions to address high relapse rates and difficulty with resuming optimal functional recovery (i.e., re-engaging in vocational, social, and daily life roles that are critical to maintaining alcohol consumption goals). Approach bias toward alcohol, an implicit motivational response to alcohol cues observable across behavioral and neural indicators, is a core feature of AUD that impedes recovery but is not routinely treated in standard care. Treatment options that target approach bias may improve outcomes by decreasing the appetitive pull of alcohol, so that individuals are better able to disengage from habitual drinking behaviors in the service of their functional goals and objectives. Approach Avoidance Training (AAT) is a computer-delivered treatment program that shifts behavioral and neural indicators of approach bias for alcohol and has been shown to improve drinking-related outcomes in AUD when used in conjunction with standard care. Given the promise of this intervention for AUD, there is a critical need to determine if this treatment can be successfully used for Veterans who commonly present with complex comorbidities, and to pinpoint cognitive and neurobiological processes of change. The overall objectives of this proposal are to determine whether Alcohol Approach Avoidance Training (AAT) improves recovery outcomes in Veterans undergoing standard care for AUD with co-occurring conditions, and to identify the underlying cognitive and neural substrates modified. The central hypothesis is that AAT training will improve critical recovery outcomes for Veterans and improve behavioral and neural indicators of approach bias. We will explore whether effects of AAT generalize to related top-down and bottom-up neurocognitive processes. We will also explore potential predictors of treatment response. The overall objectives will be addressed in a randomized controlled trial of 136 Veterans completing standard care in our local VA setting with either AAT or a control condition. Aim 1 will determine if repeatedly practicing avoidance of alcohol cues through AAT can improve recovery outcomes and hazardous drinking. Aim 2 will determine if AAT modifies approach bias by measuring this construct with multiple assessment methods (i.e., behavioral, fMRI). Exploratory aims will examine if AAT modifies inhibition (top-down) and cue reactivity (bottom up) processing, and the extent to which baseline comorbidity severity, treatment engagement characteristics, or baseline approach bias (behavioral task reaction times, brain response during fMRI) are associated with clinical outcomes. The project is expected to determine if AAT shows clinical potential that would warrant expansion to other substances of abuse and a larger multisite confirmatory efficacy trial in Veterans with AUD. Results of the study will inform the utility of AAT as an adjunctive AUD treatment for Veterans, potentially offering a novel, low-cost, and portable alternative option to improve recovery in these individuals. Consistent with the RR&D mission to maximize “functional independence, quality of life and participation in their lives and community,” the project will provide a foundation for neuroscience-based alternative therapeutic options to improve recovery in Veterans with AUD.

通过开发有效的干预措施，将为有饮酒障碍的退伍军人（AUD）提供极大的服务 解决高继电器速率，并且在恢复最佳功能恢复时难以解决（即重新参与 职业，社会和日常生活角色对于维持饮酒目标至关重要）。接近偏见 对酒精，对酒精提示的隐性动机反应在行为和神经元中可观察到 指标是AUD的核心功能，它阻碍了恢复，但在标准护理中没有常规处理。治疗 靶向方法偏见的选择可以通过减少酒精的胃口来改善结果，以便 个人可以更好地从习惯性饮酒行为中脱离服务目标 和目标。避免培训（AAT）是一项计算机交付的治疗计划，转移 饮酒的行为和神经指标，已被证明可以改善与饮酒有关的 与标准护理结合使用时，AUD的结果。鉴于对AUD进行干预的承诺 迫切需要确定是否可以成功地使用这种治疗的退伍军人 具有复杂的合并症，并指出了变化的认知和神经生物学过程。 该提案的总体目标是确定是否避免酒精方法避免培训（AAT） 改善经过同时发生条件的AUD的退伍军人的恢复结果，并 确定所修改的潜在认知和神经底物。中心假设是AAT培训 将改善退伍军人的关键恢复结果并改善方法的行为和神经指标 偏见。我们将探讨AAT的影响是否概括为相关的自上而下和自下而上的神经认知 过程。我们还将探索治疗反应的潜在预测指标。总体目标将是 在136名退伍军人的随机对照试验中，在我们当地的VA设置中完成标准护理 AAT或控制条件。 AIM 1将确定是否反复练习通过 AAT可以改善恢复结果和危险饮酒。 AIM 2将确定AAT是否修改方法 通过使用多种评估方法（即行为，fMRI）测量该构建体来偏差。探索目的会 检查AAT是否修改了抑制（自上而下）和提示反应性（自下而上）处理，以及在多大程度上 基线合并症的严重程度，治疗特征或基线方法偏见（行为任务 反应时间，fMRI期间的大脑反应与临床结局有关。该项目有望 确定AAT是否显示出需要扩展到其他滥用物质和更大物质的临床潜力 AUD退伍军人的多站点确认效率试验。该研究的结果将告知AAT的实用性 对退伍军人的辅助AUD处理，有可能提供新颖，低成本和便携式的替代选择 改善这些人的恢复。与RR＆D任务一致，以最大化“功能 独立，生活质量和参与他们的生活和社区的参与，”该项目将提供一个 基于神经科学的替代治疗选择基金会，以改善AUD退伍军人的恢复。