Predictors of Drug Related Attentional Biases among Crack/Cocaine Users with PTSD

描述（由申请人提供）：物质使用障碍（SUD）与创伤后应激障碍（PTSD; Kessler等人，1995），并且该合并症与重大问题相关，包括物质使用治疗失败的更大可能性（例如，Ouimette，Brown等人，1998年）。此外，研究表明，并不是创伤暴露本身使物质使用者面临更严重后果的更大风险，而是PTSD的发展（Chilcoat & Breslau，1998）。尽管有证据表明PTSD有一些独特的东西会对物质使用治疗的过程和结果产生负面影响，但研究尚未确定可能影响PTSD患者维持物质使用的具体机制。有研究表明，选择性注意偏差可能在药物使用行为的发展和维持以及治疗后药物使用的复发中起着核心作用（Marlatt & Gordon，1985;罗宾逊& Berridge，1993; Tiffany，1990）。这可能特别是在PTSD的物质使用者中的情况，因为研究表明，PTSD的物质使用者可能更容易对药物线索敏感，这是由于物质使用在PTSD症状减轻方面提供的负强化。也就是说，与罗宾逊和贝里奇（1993）的激励-敏化模型一致，随着药物越来越多地用于自我抑制PTSD症状，与药物相关的刺激可能变得更加突出和“吸引注意力”，因为它们能够预测奖励（即，症状减轻）。这是特别可能的，当创伤后应激障碍症状正在经历，考虑到潜在的物质提供立即缓解某些创伤后应激障碍症状，如过度觉醒或重新体验。然而，这并没有得到直接测试。为了解决文献中的这一差距，我们将研究在市中心住宅治疗中心患有PTSD的快克/可卡因使用者是否对药物相关线索表现出更大的注意力偏差，与有创伤史但没有PTSD当前或终身病史的同行相比，暴露于创伤线索。在PTSD-SUD参与者中存在创伤相关线索的情况下，对快克/可卡因图像的更多选择性注意的证据表明PTSD与更高复发率相关的可能途径，并且有可能帮助最终开发有效的干预措施，这些干预措施可以整合到住宅治疗中心使用的标准治疗中。此外，通过利用市中心的少数民族人口，这项研究有可能减少与研究和治疗的PTSD和SUD之间的差距市中心的物质使用者。这项研究对服务不足和研究不足的人群具有特殊意义。在患有PTSD的快克/可卡因使用者中暴露于创伤线索后，识别与药物相关的注意力偏差升高，有可能有助于制定有效的干预措施，这些干预措施可以整合到市中心住宅治疗环境中使用的标准治疗中，从而减少该人群中治疗失败的可能性。因此，这项研究将具有巨大的公共卫生效益。

DESCRIPTION (provided by applicant): Substance use disorders (SUDs) are highly comorbid with posttraumatic stress disorder (PTSD; Kessler et al., 1995), and this comorbidity is associated with significant problems, including a greater likelihood of substance use treatment failure (e.g., Ouimette, Brown et al., 1998). Further, research suggests that it is not traumatic exposure per se that puts substance users at greater risk for worse outcomes, but instead the development of PTSD (Chilcoat & Breslau, 1998). Despite evidence that there is something unique to PTSD that negatively affects the course and outcome of substance use treatment, studies have yet to identify the specific mechanisms that may influence the maintenance of substance use among individuals with PTSD. It has been suggested that selective attentional biases may play a central role in the development and maintenance of drug use behavior, as well as relapse to substance use following treatment (Marlatt & Gordon, 1985; Robinson & Berridge, 1993; Tiffany, 1990). This may especially be the case among substance users with PTSD, as research suggests that substance users with PTSD may be more susceptible to become sensitized to drug cues as a result of the negative reinforcement substance use provides in regard to PTSD symptom reduction. That is, consistent with Robinson & Berridge's (1993) incentive-sensitization model, as drugs are increasingly used to self-medicate PTSD symptoms, drug-related stimuli may become more salient and "attention-grabbing" due to their ability to predict reward (i.e., symptom reduction). This is especially likely when PTSD symptoms are being experienced, given the potential for substances to provide immediate relief from certain PTSD symptoms, such as hyperarousal or re-experiencing. Nevertheless, this has not been tested directly. To address this gap in the literature, we will examine if crack/cocaine users with PTSD in an inner-city residential treatment center exhibit a greater attentional bias for drug-related cues, compared to their counterparts with a history of trauma but no current or lifetime history of PTSD, following exposure to a trauma cue. Evidence for greater selective attention for crack/cocaine imagery in the presence of trauma-related cues among PTSD- SUD participants would suggest a possible pathway through which PTSD is associated with greater relapse rates, and has the potential to aid in the eventual development of effective interventions that could be integrated into standard treatments utilized in residential treatment centers. Further, by utilizing an inner-city minority population, this study has the potential to reduce disparity associated with research in and the treatment of PTSD and SUDs among inner-city substance users. This study has specific relevance for underserved and understudied populations. The identification of heightened drug-related attentional biases following exposure to a trauma cue among crack/cocaine users with PTSD has the potential to aid in the development of effective interventions that could be integrated into standard treatments utilized in inner-city residential treatments settings, thus reducing vulnerabililty for treatment failure within this population. Consequently, this study will have tremendous public health benefits.