Neuro-Cognitive Aspects of Opiate Abuse & Antisocial Behavior

描述（由申请人提供）：全球海洛因成瘾率正在上升，随之而来的是法律和健康成本，包括艾滋病毒和丙型肝炎病毒传播风险的增加。然而，目前很难甚至不可能研究“纯”使用海洛因的后果，因为大多数成瘾者都依赖多种物质。此外，合并症，如反社会人格障碍（APD）和精神病，也使海洛因依赖者的临床表现和日常功能复杂化。药物滥用对大脑和成瘾发展的影响的研究尤其困难，因为很难将药物对认知的影响与与合并症相关的功能障碍分开。我们建议制定一个长期目标的研究计划，以调查有或没有诊断为反社会人格障碍/精神病的吸毒成瘾者的大脑功能的神经认知方面。这一方案将在保加利亚制定，保加利亚是东南欧的一个中低收入国家，海洛因成瘾率非常高。保加利亚的地理位置使它成为“巴尔干毒品路线”上的一个关键国家。“巴尔干毒品路线”是从西南亚到西欧的国际毒品贩运的主要路线之一，西欧目前使用的海洛因约有80%都是通过这条路线。因此，海洛因在该国很容易获得，事实上，海洛因成瘾已成为最严重的健康和法律问题之一。保加利亚海洛因成瘾的模式是独特的，因为对多种物质的依赖并不常见。因此，对保加利亚成瘾者的研究为评估相对“纯”海洛因使用的神经认知和精神后果提供了一个独特的机会。此外，保加利亚法律制度的性质为研究海洛因依赖者提供了机会，无论是否有麻醉品滥用，因为所有因与毒品有关的指控而被捕的被拘留者在处理案件之前都要接受强制性的医疗和精神评估。我们与索非亚的医生和心理健康专业人员合作，他们可以接触到大量审前被拘留者，其中绝大多数是因与毒品有关的犯罪而被拘留的。保加利亚对成瘾及其神经认知后果的研究很少，尽管迫切需要解决这些问题。在拟议的项目中，PI和她在伊利诺伊大学芝加哥分校的同事，以及保加利亚索非亚州立大学神经病学和精神病学医院法医精神病学和心理学诊所的同事，将开始开发研究海洛因成瘾者的神经认知功能的资源，这些成瘾者有或没有APD/精神病，没有多种物质依赖。这项初步工作将在海洛因成瘾者的神经认知的初步研究中达到高潮，该研究有或没有反社会人格障碍/精神病，并基于这些初步发现和在两年中发展起来的其他假设进行R01应用。

DESCRIPTION (provided by applicant): Rates of heroin addiction are increasing worldwide with concomitant legal and health costs, including increased risk of HIV and hepatitis C viral transmission. However, at present it is difficult to impossible to study the consequences of "pure" heroin use since the majority of addicts are polysubstance-dependent. Further, co-morbid conditions, such as Antisocial Personality Disorder (APD) and psychopathy, additionally complicate the clinical picture and daily function of heroin-dependent persons. Study of the effect of drugs of abuse on the brain and the development of addiction are particularly difficult, due to difficulty in isolating drug effects on cognition from dysfunction associated with co-morbid conditions. We propose to develop a program of studies with the long-term goals of investigating neurocognitive aspects of brain function in drug addicts with and without a diagnosis of ASPD / psychopathy. This program will be developed in Bulgaria, a low-middle income country in Southeastern Europe with significantly high prevalence of heroin addiction. Bulgaria's geographical position make it a key country on the "Balkan Drug Route", one of the main routes for international drug traffic from South-West Asia to Western Europe, through which approximately 80% of the heroin currently used in Western Europe passes. Consequently, heroin is easily available in the country, and in fact heroin addiction has become one of the most significant health and legal problems. Patterns of heroin addiction in Bulgaria are unique in that polysubstance dependence is uncommon. Consequently study of Bulgarian addicts provides a unique opportunity to evaluate neurocognitive and psychiatric consequences of relatively "pure" heroin use. In addition, the nature of the Bulgarian legal system facilitates the opportunity to study heroin dependent subjects both with and without APD because all detainees arrested for drug-related charges undergo mandated medical and psychiatric evaluation prior to disposition of their cases. We have partnered with physicians and mental health professionals in Sofia who have access to a large population of pre-trial detainees, a large majority of whom have been detained for drug-related crimes. Research on addiction and its neuro-cognitive consequences is minimal in Bulgaria, despite a significant need to address these concerns. In the proposed project the PI, her colleagues the University of Illinois-Chicago, and at the Clinic of Forensic Psychiatry and Psychology at the State University Hospital of Neurology and Psychiatry in Sofia, Bulgaria, will initiate the development of resources for studies of neuro-cognitive function in heroin addicts with and without APD/psychopathy, and without polysubstance dependence. This preliminary work will culminate in a pilot study of neuro-cognition in heroin addicts with and without ASPD/psychopathy and an R01 application based on these pilot findings and other hypotheses developed in the course of the two years.