Self-Regulation in Co-Occurring TBI and Substance Abuse

描述(申请人提供)：创伤性脑损伤(TBI)最常见的继发并发症之一是药物滥用。物质滥用影响创伤性脑损伤后的健康和功能，并与更糟糕的结果相关。自我调节缺陷是脑损伤和药物滥用的共同之处，可能是较差结果的来源之一。由于测量困难，研究人员研究自我调节缺陷的影响的能力一直受到阻碍。Bechara的赌博任务可能为研究脑外伤和药物滥用患者的自我调节和对意外事件的敏感性提供理想的模拟，因为它最初是为了研究局灶性损伤对眶前皮质的影响而开发的，并已用于药物使用障碍患者。在这项任务中的表现表明，眼眶前额叶皮质受损的人基于直接后果而行事，而不考虑他们的选择对未来后果的影响。一些有药物使用障碍的人表现出类似的表现，而另一些人似乎对奖励非常敏感，对惩罚反应迟钝。目前的项目试图确定赌博任务是否可以用于研究同时患有脑外伤和药物使用障碍的人的自我调节，因为前者与先前研究的局灶性病变组相比，与弥漫性缺陷有关。具体地说，本项目的目的是：1)在使用Bechara的赌博任务评估脑外伤患者的自我调节和对意外事件的敏感性时，确定共存的认知缺陷所构成的障碍；2)确定绩效评分方法，并描述可能的潜在过程，以帮助区分对照、仅脑损伤患者、仅药物使用障碍患者和两种疾病患者的绩效；以及3)确定检测对照组、脑外伤患者、物质使用障碍患者和两种疾病患者之间赌博任务绩效显著差异所需的样本量。

DESCRIPTION (provided by applicant): One of the most common secondary complications of traumatic brain injury (TBI) is substance abuse. Substance abuse affects health and function after TBI, and has been associated with worse outcomes. Deficits in self-regulation are common to both TBI and substance abuse, and may be one source of the poorer outcomes. Researchers have been hampered in their ability to study the effects of self-regulation deficits due to difficulties with measurement. Bechara's Gambling Task may provide the ideal analog for studying self-regulation and sensitivity to contingencies in persons with TBI and substance abuse, as it was originally developed to study the effects of focal damage to the orbitofrontal cortex and has been used with persons with substance use disorders. Performance on this task has shown persons with lesions in the orbitofrontal cortex to behave based on immediate consequences, without regard to the effects of their choices on future consequences. Some persons with substance use disorders show similar performance, while others appear to be extremely sensitive to rewards and under-responsive to punishment. The current project seeks to determine if the Gambling Task can be used to study self-regulation in persons with both TBI and a substance use disorder, given that the former is associated with more diffuse deficits than the group with focal lesions previously studied. Specifically, this project aims to: 1) Identify the impediments posed by co-existing cognitive deficits when using Bechara's Gambling Task to evaluate self-regulation and sensitivity to contingencies in persons with TBI; 2) Identify methods of scoring performance and describing possible underlying processes which can assist with discriminating between the performance of controls, persons with TBI only, persons with a substance use disorders only, and persons with both disorders; and 3) Determine the sample size required to detect meaningful differences in performance on the Gambling Task between controls, persons with TBI, persons with substance use disorders, and persons with both disorders.