Reinforcer-specific value-based decision-making in persistence of and recovery from alcohol use disorder

在酒精使用障碍的持续和恢复中基于强化剂特定价值的决策

• 批准号: MR/W028476/1
• 负责人: Matt Field
• 金额: $ 85.75万
• 依托单位: University of Sheffield
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2022
• 资助国家: 英国
• 起止时间: 2022 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FW028476%2F1
• 关键词: Reinforcer; specific; value; based; decision

Alcohol places a considerable burden on society; it was responsible for more than 25,000 deaths and over one million hospital admissions in England in 2019. Much of the burden of alcohol-related harm can be attributed to the heaviest drinkers, of whom there are half a million (people with Alcohol Use Disorder; AUD) in the United Kingdom. The majority of people with AUD in the UK do not receive treatment and of those that do, most do not benefit from it. Scientific progress in our understanding of AUD and other addictions, and the search for new evidence-based treatments, has been slow. This is partly because many addiction scientists believe that addiction is compulsive and habitual, meaning that drinking and drug use are behaviors that become insensitive to their consequences. However, there is evidence that all motivated behaviour, including the apparently irrational behaviour of people with addiction, is determined by the goals that people have, and the values that underlie their goals. Behavioural economics has applied this idea to the study of addiction, and has amassed a large body of evidence and coherent theories that can explain how addictions develop and persist, how treatments work, and how people recover from addiction even if they do not receive treatment. Despite these important advances, the mechanisms through which addiction disrupts the psychological and neural processes that underlie value-based decision-making (VBDM), are largely unknown. Therefore, there is a need for neuroscience-informed methods that can characterise the internal processes that determine choice for alcohol and other rewards (particularly activities that are incompatible with drinking alcohol), and demonstrate how those processes are implicated in the persistence of AUD, recovery, and treatment response. To this end, we developed a computerized VBDM task and used computational methods to interpret participants' responses on the task. Our preliminary findings suggest that the task can discriminate people who currently have addictions from people who have recovered, and it is sensitive to intense alcohol cravings. In this project we will apply these methods to systematically characterise the internal mechanics of value-based choice in AUD. The overarching aim is to demonstrate how distortions in VBDM contribute to important features of AUD, specifically characterisation of people with AUD versus people who have recovered, the influence of powerful cravings on drinking behaviour, and the response to treatment. To achieve these aims we will complete the following package of work. First, we will attempt to distinguish people who currently have AUD, people who have recovered from AUD, and a control group of light drinkers, on the basis of their VBDM. Second, we will conduct a laboratory study in which we will experimentally increase alcohol craving in people with AUD before measuring their VBDM and recording how much alcohol they voluntarily consume. This will tell us how VBDM changes during craving episodes, and which specific aspects of VBDM are predictive of alcohol consumption. Third, we will track changes in VBDM over the course of a three-week community-based behavioural economic treatment for AUD in which participants receive financial incentives proportional to the extent that they are able to reduce their drinking (contingency management). This will identify which specific aspects of VBDM are predictive of reductions in drinking at follow-up. Important outcomes from the project include advancing the conceptual understanding of addiction by corroborating a novel framework of the drivers of value-based choice of alcohol versus alternative reinforcers. We will also validate a new measurement tool of individual differences in the cognitive-motivational constructs that distinguish people who are on track to recover from their addictions, and those who require additional support; this tool can be exploited in future work.

酒精给社会带来了相当大的负担; 2019年，它在英格兰造成了25，000多人死亡和100多万人住院。酒精相关伤害的大部分负担可以归因于最严重的饮酒者，其中有50万人（酒精使用障碍患者; AUD）在英国。在英国，大多数患有AUD的人没有接受治疗，而那些接受治疗的人中，大多数人并没有从中受益。我们对AUD和其他成瘾的理解以及寻找新的循证治疗方法的科学进展一直很缓慢。这部分是因为许多成瘾科学家认为成瘾是强迫性和习惯性的，这意味着饮酒和吸毒是对后果不敏感的行为。然而，有证据表明，所有有动机的行为，包括成瘾者明显的非理性行为，都是由人们的目标以及作为其目标基础的价值观决定的。行为经济学将这一思想应用于成瘾研究，并积累了大量证据和连贯的理论，可以解释成瘾如何发展和持续，治疗如何起作用，以及人们如何从成瘾中恢复，即使他们没有接受治疗。尽管有这些重要的进展，成瘾破坏基于价值的决策（VBDM）的心理和神经过程的机制在很大程度上是未知的。因此，我们需要一种神经科学方法，可以解释决定酒精和其他奖励选择的内部过程（特别是与饮酒不相容的活动），并证明这些过程如何与AUD的持续性，恢复和治疗反应有关。为此，我们开发了一个计算机化的VBDM任务，并使用计算方法来解释参与者对任务的反应。我们的初步研究结果表明，这项任务可以区分目前上瘾的人和已经康复的人，而且它对强烈的酒精渴望很敏感。在这个项目中，我们将应用这些方法来系统地分析澳元中基于价值的选择的内在机制。总体目标是证明VBDM的扭曲如何影响AUD的重要特征，特别是AUD患者与已恢复患者的特征，强烈渴望对饮酒行为的影响以及对治疗的反应。为了实现这些目标，我们将完成以下一揽子工作。首先，我们将尝试区分目前患有AUD的人，从AUD中恢复的人，以及对照组的轻度饮酒者，基于他们的VBDM。其次，我们将进行一项实验室研究，在测量他们的VBDM并记录他们自愿摄入的酒精量之前，我们将通过实验增加AUD患者的酒精渴望。这将告诉我们VBDM在渴望发作期间如何变化，以及VBDM的哪些特定方面可以预测酒精消费。第三，我们将在为期三周的以社区为基础的澳元行为经济治疗过程中跟踪VBDM的变化，参与者将获得与他们能够减少饮酒的程度成比例的经济激励（应急管理）。这将确定VBDM的哪些特定方面可以预测随访时饮酒的减少。该项目的重要成果包括通过证实一个新的框架，即基于价值的酒精与替代酒精选择的驱动因素，来推进对成瘾的概念性理解。我们还将验证一个新的测量工具的个体差异的认知动机的结构，区分谁是轨道上的人从他们的成瘾恢复，和那些需要额外的支持;这个工具可以在未来的工作中加以利用。