Varieties of Impulsivity in Opiate and Stimulant Users

描述（由申请人提供）：这个项目的总体目标是更好地理解冲动在吸毒成瘾中的作用。“冲动”的缺陷与几乎所有的成瘾行为都有关系，并且与危险性行为和注射行为有关，这些行为是艾滋病毒传播的一些主要媒介。然而，冲动性是文献中描述的最多方面的结构之一，它具有各种各样的特征，如人格和精神维度，以及基于表现的神经行为表现。尽管许多物质依赖个体（sdi）在冲动的表现神经行为测量中表现出冲动控制受损，但肯定不是所有的sdi都表现出这种损伤。这表明一些额外风险因素的个体差异，如更稳定的人格和冲动的精神维度，可能会增加sdi患者对基于性能的神经行为冲动控制缺陷的脆弱性。这种基于表现的缺陷也可能是滥用的特定药物的独特药理学/毒理学特性造成的。因此，该项目的主要目标之一是调查冲动性的不同概念方法在sdi中的表现如何不同，以及这种差异是否与所使用的特定类型的非法药物有关。该项目的另一个目标是检查冲动的各种方面中哪一个与高风险的性行为和注射风险行为最密切相关，以及这些高风险行为是否因滥用特定药物而有所不同。本研究的具体目的如下：(1)探讨“纯”兴奋剂使用者、“纯”阿片类药物使用者和非药物使用对照组中不同类别药物（阿片类药物和兴奋剂）、类人格和精神病（ADHD和精神病）冲动性指标与认知和运动冲动性神经行为测量的关系。(2)利用运动冲动性和认知冲动性的性能测试，探讨时间稳定型人格的个体差异与冲动性精神指标之间的关联模式。(3)评估冲动的不同特征和表现与增加HIV感染和传播风险的高危行为（如阿片类和兴奋剂使用者的性行为和注射风险行为）之间的关系。这项研究将在保加利亚进行，保加利亚的药物使用模式是独特的，对多种物质的依赖并不常见，这将有助于我们避免在SDIs中使用多种物质的具有挑战性的方法问题。该研究的数据将为sdi患者的冲动性提供新的知识，以及不同类别的滥用药物对冲动性各个方面的具体影响，并弥合冲动性个体差异如何影响关键危险行为的差距。因此，预计这项研究将对发展发展中国家的生物和心理干预措施以及在保加利亚建立可持续的研究能力产生重要影响。公共卫生相关性：预计该项目将对药物依赖者制定生物和心理预防和干预战略产生重要影响。更具体地说，该项目将特别与帮助提高治疗效果相关，通过根据冲动性各个方面的个体差异来匹配治疗，这可以通过各种治疗方式或技术来解决。该项目还可能对艾滋病毒预防工作产生重大影响，为旨在减少吸毒者高危性行为和注射行为的减少危害预防和干预战略提供信息，因为吸毒者是艾滋病毒传播的一些主要媒介。

DESCRIPTION (provided by applicant): The overall aim of this project is to better understand the role of impulsivity in drug addiction. Deficits in "impulsivity" are implicated in virtually all kinds of addictive behaviors and are related to risky sexual and injection practices, some of the primary vectors of HIV transmission. However, impulsivity is one of the most multifaceted constructs described in the literature that has a variety of trait-like personality and psychiatric dimensions, as well as performance-based neurobehavioral manifestations. Although many substance dependent individuals (SDIs) show impaired impulse control on performance-based neurobehavioral measures of impulsivity, certainly not all SDIs manifest such impairments. This suggests that individual differences in some additional risk factors such as the more temporally stable personality and psychiatric dimensions of impulsivity may increase vulnerability to performance-based neurobehavioral impulse control deficits in SDIs. Such performance-based deficits may also be a function of the unique pharmacological / toxicological properties of the specific drug of abuse. Therefore, one of the main goals of the project is to investigate how different conceptual approaches to impulsivity differ in their manifestations in SDIs and whether such differences are a function of the specific type of illicit drug used. An additional goal of the project is to examine which of the various dimensions of impulsivity are most closely related to high-risk sexual and injection risk behaviors and whether such high-risk behaviors differ as a function of the specific drug of abuse. The study has the following specific aims: (1) To investigate the associations of different classes of drugs (opiates and stimulants) and trait-like personality and psychiatric (ADHD and psychopathy) indices of impulsivity on performance on neurobehavioral measures of cognitive and motor impulsivity among groups of "pure" stimulant users, "pure" opiate users, and non-drug using controls. (2) To investigate the patterns of associations between individual differences in temporally stable trait-like personality and psychiatric indices of impulsivity with performance-based measures of motor and cognitive impulsivity. (3) To evaluate the associations between different trait- and performance-based manifestations of impulsivity with high risk behaviors that increase risk for HIV infection and transmission, such as sexual and injection risk practices among opiate and stimulant users. The research will be conducted in Bulgaria, where patterns of drug use are unique in that polysubstance dependence is uncommon, which will help us avoid the challenging methodological problem of polysubstance use among SDIs. Data from the proposed study will provide new knowledge on impulsivity in SDIs, on the specific effects of different classes of drugs of abuse on various dimensions of impulsivity, and bridge the gap on how individual differences in impulsivity might influence critical risky behaviors. Therefore, the study is expected to have important implications for the development of biological and psychological interventions for SDIs and for building sustainable research capacity in Bulgaria. PUBLIC HEALTH RELEVANCE: The project is expected to have important implications for the development of biological and psychological prevention and intervention strategies for substance dependent individuals. More specifically, the project will be particularly relevant for helping increase treatment efficacy by matching clients to treatment, based on individual differences in various dimensions of impulsivity, which could be addressed by various treatment modalities or techniques. The project could also have significant implications for HIV prevention efforts by informing harm-reduction prevention and intervention strategies aimed at reducing high-risk sexual and injection behaviors in drug users, who are some of the primary vectors for HIV transmission.