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（SUDs）与创伤后应激障碍（PTSD; Kessler et al., 1995）高度共病，并且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 et al., 1998）。此外，研究表明，并不是创伤性暴露本身使物质使用者面临更大的不良后果风险，而是PTSD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PTSD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药物使用的复发中发挥核心作用（Marlatt & Gordon, 1985; Robinson & Berridge, 1993; Tiffany, 1990）。在PTSD患者中尤其如此，因为研究表明，PTSD患者可能更容易对药物线索敏感，因为药物使用在减轻PTSD症状方面提供了负强化作用。也就是说，与Robinson & Berridge（1993）的激励-敏感化模型一致，随着药物越来越多地用于自我治疗PTSD症状，药物相关刺激可能会变得更加突出和“吸引注意力”，因为它们能够预测奖励（即症状减轻）。这在经历PTSD症状时尤其可能，因为药物有可能立即缓解某些PTSD症状，如过度觉醒或重新体验。然而，这还没有得到直接的验证。为了弥补文献中的这一空白，我们将研究在市中心住宅治疗中心的创伤后应激障碍快克/可卡因使用者在暴露于创伤提示后，与有创伤史但没有当前或终身创伤后应激障碍史的对照组相比，是否对药物相关提示表现出更大的注意偏倚。PTSD- SUD参与者在出现创伤相关线索时对快克/可卡因图像有更大选择性关注的证据表明，PTSD与更高复发率相关的可能途径，并有可能帮助最终开发有效的干预措施，并将其纳入住院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，本研究有可能减少与研究和治疗PTSD和sud在市中心物质使用者之间的差异。这项研究对服务不足和研究不足的人群具有特殊的相关性。在患有创伤后应激障碍的快克/可卡因使用者中，暴露于创伤提示后药物相关的注意偏差加剧的识别有可能有助于开发有效的干预措施，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，从而减少这一人群中治疗失败的脆弱性。因此，这项研究将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.