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(SODS)与创伤后应激障碍(PTSD；Kessler等人，1995)高度并存，这种共病与重大问题相关，包括更大的物质使用治疗失败的可能性(例如，Ouimette，Brown等人，1998)。此外，研究表明，创伤性暴露本身并不会使吸毒者面临更大的不良后果风险，而是创伤后应激障碍的发展(Chilcoat&Breslau，1998)。尽管有证据表明，创伤后应激障碍有一些独特的东西会对药物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创伤后应激障碍患者维持药物使用的具体机制。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的药物使用复发中发挥核心作用(Marlatt&Gordon，1985；Robinson&Berbridge，1993；Tiffany，1990)。患有创伤后应激障碍的药物使用者尤其如此，因为研究表明，患有创伤后应激障碍的药物使用者可能更容易对药物线索敏感，因为使用药物在减轻创伤后应激障碍症状方面提供了负面的强化作用。也就是说，与Robinson&Berbridge(1993)的激励敏感化模型一致，随着药物越来越多地被用来自我治疗创伤后应激障碍症状，与药物相关的刺激可能会变得更加突出，并因其预测奖励(即症状减轻)的能力而变得更加引人注目。这在经历创伤后应激障碍症状时尤其有可能，因为物质有可能立即缓解某些创伤后应激障碍症状，如过度唤醒或再次经历。尽管如此，这还没有得到直接的检验。为了解决文献中的这一差距，我们将研究市中心居民治疗中心的患有创伤后应激障碍的可卡因/可卡因使用者，与有创伤史但没有创伤后应激障碍现史或终身史的同龄人相比，是否对与药物相关的线索表现出更大的注意偏向。有证据表明，在创伤相关线索存在的情况下，PTSD-SUD参与者对可卡因/可卡因图像有更高的选择性注意，这将表明PTSD可能通过一条途径与更高的复发率相关，并有可能最终帮助开发有效的干预措施，将其整合到居民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市中心药物使用者中的创伤后应激障碍和肥胖症的研究和治疗相关的差异。这项研究对服务不足和研究不足的人群具有特定的相关性。在患有创伤后应激障碍的可卡因/可卡因吸毒者中发现暴露于创伤线索后与药物相关的高度注意偏差，这可能有助于制定有效的干预措施，这些干预措施可以被整合到市中心居民治疗环境中使用的标准治疗中，从而降低这一人群中治疗失败的易感性。因此，这项研究将对公众健康产生巨大的好处。

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.