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

通过发展有效的干预措施，患有酒精使用障碍(AUD)的退伍军人将得到极大的帮助 解决高复发率和恢复最佳功能恢复的困难(即重新参与 对维持酒精消费目标至关重要的职业、社会和日常生活角色)。接近偏差 对于酒精，一种对酒精暗示的内隐动机反应，可以在行为和神经上观察到 指标，是澳门氏症的一个核心特征，阻碍康复，但不在标准护理中进行常规治疗。治疗 针对方法偏差的选择可能会通过减少酒精的胃口拉动来改善结果，因此 个人能够更好地摆脱习惯性饮酒行为，为他们的功能目标服务 和目标。接近回避训练(AAT)是一种由计算机提供的治疗程序，它可以 酒精偏向的行为和神经指标，并已被证明可以改善与饮酒相关的 当与标准护理一起使用时，澳元病的结果。鉴于此次干预澳元的承诺， 迫切需要确定这种治疗方法是否能成功地用于那些通常 目前有复杂的共病，并准确地指出认知和神经生物学的变化过程。这个 这项建议的总体目标是确定酒精接近避免训练(AAT) 改善接受AUD标准护理的退伍军人的康复结果 以确定潜在的认知和神经底物的修饰。中心假设是AAT训练 将改善退伍军人的关键康复结果，并改善方法的行为和神经指标 偏见。我们将探索AAT的影响是否推广到相关的自上而下和自下而上的神经认知 流程。我们还将探索治疗反应的潜在预测因素。总体目标将是 在一项随机对照试验中解决了136名退伍军人在我们当地退伍军人环境中完成标准护理的问题 AAT或控制条件。目标1将确定是否通过反复练习避免饮酒提示 AAT可以改善康复结果和危险饮酒。目标2将决定AAT是否修改进场 通过使用多种评估方法(即，行为、功能磁共振)来测量这一结构的偏差。探索性目标将 检查AAT是否改变了抑制(自上而下)和线索反应性(自下而上)加工，以及在多大程度上 基线共病严重程度、治疗投入特征或基线方法偏差(行为任务 反应时间、功能磁共振期间的脑反应)与临床结果相关。该项目预计将 确定AAT是否显示出临床潜力，需要扩展到其他滥用物质和更大的 退伍军人AUD多点验证性疗效试验。研究结果将为学能测验作为一种 退伍军人辅助AUD治疗，潜在地提供了一种新颖、低成本和便携的替代选择 改善这些人的康复。与RR&D的使命保持一致，以最大限度地发挥功能 独立、生活质量和参与他们的生活和社区，“该项目将提供一个 以神经科学为基础的替代治疗选择基金会，以改善患有AUD的退伍军人的康复。

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.