Stress, Distress Intolerance, and Drug Dependence

描述（由申请人提供）： 尽管早期认识到内部线索（渴望的感觉和情绪状态）对物质使用障碍复发的重要性，但相对较少关注针对这些线索的基于焦虑的治疗。作为NIDA第一阶段试验的一部分，我们开发并试点测试了一种强调物质使用障碍的内部（主要是情感）线索暴露的治疗方法。我们的治疗模型是基于暴露于恐惧的焦虑感在治疗惊恐障碍和苯二氮卓类药物停药中的作用，以及在治疗创伤后应激障碍（PTSD）等应激相关疾病时关注这些恐惧的重要性。这种治疗模式从最近关于吸毒动机与对内部线索的不容忍之间的联系的研究中得到了进一步的支持，这些研究是通过生物激发程序和焦虑敏感指数等措施进行评估的。根据这项研究，我们的治疗重点是内部线索暴露策略的价值，这些策略适用于使用物质作为科普负面影响和压力的一种方式的个体。特别是，我们不是专注于“减弱压力引起的情感信号”，而是专注于：（1）增强患者对各种形式的痛苦的耐受性-悲伤，无聊，焦虑，退缩感等-与药物依赖者的紧张生活有关，以及（2）打破这些情绪线索与药物相关的尝试之间的联系，以避免情绪困扰。由于它专注于改变对内部线索的反应，我们将我们的治疗命名为内感受性线索的认知行为疗法（CBT-IC）。 作为对RFA DA-04-001的回应，我们提出了一项为期5年的研究，旨在进一步测试CBT-IC干预慢性应激和治疗抵抗性阿片类药物依赖门诊患者的疗效。本研究与RFA特别相关的特点包括：（1）关注经历慢性压力的阿片类药物依赖患者;（2）慢性压力转化为慢性药物使用的模式;（2）关注压力相关症状作为药物使用触发因素的方式;（3）关注治疗的中介者和调节者，这将为治疗匹配工作提供信息，包括关注性别差异和情绪回避/痛苦不耐受，以及（4）在第II阶段治疗试验中检查治疗结果。

DESCRIPTION (provided by applicant): Despite early recognition of the importance of internal cues (craving sensations and emotional states) for relapse in substance use disorders, relatively little attention has been devoted to exposure-based treatments targeting these cues. As part of a NIDA Phase I trial, we developed and pilot tested a treatment that emphasizes internal (largely emotional) cue exposure for substance use disorders. Our model for this treatment was based on the role of exposure to feared sensations of anxiety in the treatment of panic disorder and benzodiazepine discontinuation, as well as the importance of attending to these fears in treatments of stress-related conditions such as posttraumatic stress disorder (PTSD). This model of treatment gained further support from recent research on the link between drug-use motives and intolerance to internal cues as assessed by biological provocation procedures and measures such as the Anxiety Sensitivity Index. In accordance with this research, our treatment focuses on the value of internal cue exposure strategies for individuals who use substances as a way to cope with negative affect and stress. In particular, rather than focusing on "attenuating the affective signal" arising from stress, we focus on: (1) enhancing a patient's tolerance to the myriad forms of distress--sadness, boredom, anxiety, withdrawal sensations, etc.--that are linked to the stressful lives of drug-dependent individuals, and (2) breaking the link between these emotional cues and drug-related attempts to avoid emotional distress. Because of its focus on changing responses to internal cues, we titled our treatment, Cognitive-Behavioral Therapy for Interoceptive Cues (CBT-IC). In response to RFA DA-04-001 we are proposing a 5-year study designed to test further the efficacy of CBT-IC for intervening with chronically stressed and treatment-resistant opiate-dependent outpatients. Features of this study of particular relevance to the RFA include: (1) a focus on opiate-dependent patients undergoing chronic stress; (2) a model for the way in which chronic stress translates into chronic drug use; (2) a focus on the way in which stress-related symptoms serve as trigger for drug use; (3) a focus on both mediators and moderators of treatment that will inform treatment-matching efforts, including a focus on gender differences and emotional avoidance/distress intolerance and (4) the examination of treatment outcome in a Stage II treatment trial.