Prevention of Relapse in Addiction

预防成瘾复吸

• 批准号: 7966911
• 负责人: Kenzie Preston
• 金额: $ 108.66万
• 依托单位: NATIONAL INSTITUTE ON DRUG ABUSE
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/7966911
• 关键词: Abstinence; Acute; Adrenergic alpha-Agonists; Alcohols; Anger; Attention; Behavioral; Chicago; Clonidine; Cocaine; Collaborations; Cues; Data; Data Analyses; Data Collection; Devices; Drug usage; Electronics; Environment; Exposure to; Goals; Handheld Computers; Heroin; Heroin Abuse; Hour; Human; Illicit Drugs; Individual; Intervention; Laboratory Animals; Life; Logistic Regressions; Manuscripts; Measurement; Measures; Methadone; Modeling; Monitor; Moods; Nicotine; Obesity; Outcome; Outpatients; Participant; Patient Self-Report; Patients; Pattern; Persons; Pharmaceutical Preparations; Population; Preparation; Randomized Clinical Trials; Relapse; Reporting; Research; Research Personnel; Role; Site; Smoker; Stress; Testing; Time; Universities; addiction; animal data; aripiprazole; base; cocaine use; cohort; craving; design; diaries; disorder later incidence prevention; drug craving; improved; multidrug abuse; pre-clinical; preclinical study; prevent; programs; response; weight maintenance

A major initiative for our section is to examine the role of exposure to putative relapse triggers (such as environmental cues and stress) through the use of ecological momentary assessment (EMA). We are conducting studies in heroin/cocaine-using methadone-maintained outpatients and in obese individuals who are in a weight-maintenance program. Participants carry electronic diaries to record the base rates of exposure to putative relapse triggers as well as the presence of these triggers during relapse. In the first completed study, we prospectively monitored the acute daily-life precipitants of craving for, and use of, cocaine and heroin. In a cohort design, 114 methadone-maintained cocaine- and heroin-abusing outpatients provided EMA data on handheld computers for up to 14,918 person-days (mean 130.9 days per participant, range 6-189). Of those 114, a total of 102 provided acute pre-craving or pre-use data and were thus included in the present analyses. Changes in reports of mood and exposure to putative drug-use triggers at random intervals during the five hours preceding each self-reported episode of drug craving or use, analyzed via repeated-measures logistic regression (SAS GLIMMIX macro). The five hours preceding drug use showed orderly increases in reports of Saw Drugs, Offered Drugs, Wanted to see what would happen if I used, Tempted to use out of the blue, Handled $10 or more, Angry, Worried, Criticized by others, Uncomfortable, and Good mood, but not Bored or Sad. The five hours preceding drug craving showed a different pattern of reports, e.g. an orderly increase in Sad but no increase in Good mood. These findings confirm that polydrug-abusing individuals can provide behavioral data in their daily environments using handheld computers, and that those data can reveal orderly patterns, including prospectively detectable harbingers of craving and use. We are also exploring the use of handheld electronic devices for treatment delivery in patients daily environment. In addition, we are using handheld electronic devices to improve outcome measurement in our randomized clinical trials. This aspect of our research derives from laboratory-animal data showing that stress-induced reinstatement of cocaine seeking and/or heroin seeking can be prevented with the alpha-adrenergic agonist clonidine, while cue-induced reinstatement of such drug seeking can be prevented with aripiprazole. We are conducting two trials of clonidine, one to evaluate its effect on response to stress and drug cues, and the second to evaluate its efficacy in relapse prevention. We are currently conducting a study in which methadone-maintained outpatients carry handheld computers throughout the day to provide real-time data on cravings for heroin and cocaine, lapses to drug use, and base rates of putative lapse precipitants. We have demonstrated the feasibility of this form of data collection in our population and are using it in the clonidine trial to determine whether clonidines relapse-prevention effect is specific to subtypes of relapse. Finally, we completed a collaboration with investigators at the University of Chicago on a two-site study to investigate the time course of craving in abstinent smokers, with particular attention to the possibility of incubation, a phenomenon seen in preclinical studies, in which craving increases with duration of abstinence. Data analysis is underway, and a manuscript is in preparation. Incubation of craving may help explain the long-lasting vulnerability to relapse in individuals formerly dependent on nicotine, alcohol, or illicit drugs.

我们这一部分的一个主要举措是通过使用生态瞬时评估(EMA)来检查暴露于假定的复发触发因素(如环境线索和压力)中的作用。我们正在对海洛因/可卡因-使用美沙酮-维持门诊的患者和参加体重维持计划的肥胖者进行研究。参与者携带电子日记，以记录可能的复发诱因的基本暴露比率，以及在复发期间这些诱因的存在。 在第一项已完成的研究中，我们前瞻性地监测了渴望和使用可卡因和海洛因的急性日常生活沉淀物。在队列设计中，114名美沙酮维持的可卡因和海洛因滥用门诊患者在掌上电脑上提供EMA数据长达14,918人日(每个参与者平均130.9天，范围6-189)。在这114个国家中，共有102个国家提供了严重的使用前渴望或使用前数据，因此纳入了本分析。在每个自我报告的药物渴求或使用发作之前的五个小时内，情绪和暴露于假定的药物使用触发因素的报告的随机间隔的变化，通过重复测量Logistic回归(SAS GLIMMIX宏观)进行分析。吸毒前五个小时的报告显示，我看到的毒品报告有序增加，提供毒品，想看看如果我使用会发生什么，突然使用，处理10美元或更多，愤怒，担心，被别人批评，不舒服，心情好，但不无聊或悲伤。在吸毒前的五个小时内，出现了一种不同的报告模式，例如，悲伤的人数有序增加，但好心情没有增加。这些发现证实，多药滥用者可以使用手持计算机提供日常环境中的行为数据，这些数据可以揭示有序的模式，包括可能检测到的渴望和使用的先兆。 我们还在探索在患者的日常环境中使用手持电子设备进行治疗。此外，在我们的随机临床试验中，我们正在使用手持电子设备来改进结果测量。我们研究的这一方面来自实验室动物数据，该数据表明，阿尔法肾上腺素能激动剂可乐定可以防止应激诱导的可卡因和/或海洛因寻找的恢复，而阿立哌唑可以防止提示诱导的这种药物寻找的恢复。我们正在进行两项可乐定试验，一项是评估其对压力和药物提示的反应的效果，另一项是评估其预防复发的效果。我们目前正在进行一项研究，在这项研究中，服用美沙酮的门诊患者全天携带手持计算机，以提供有关海洛因和可卡因的渴望、吸毒失误和假定失误沉淀剂的基本比率的实时数据。我们已经在我们的人群中证明了这种形式的数据收集的可行性，并正在将其用于可乐定试验，以确定可乐定预防复发的效果是否针对复发亚型。最后，我们与芝加哥大学的研究人员合作，完成了一项两点研究，调查戒烟者渴望的时间过程，特别关注潜伏期的可能性，这是临床前研究中看到的一种现象，渴望随着戒烟时间的延长而增加。数据分析正在进行中，手稿正在准备中。潜伏的渴望可能有助于解释以前依赖尼古丁、酒精或非法药物的人长期易复发的原因。