The Neuroeconomics of Behavioral Therapies for Adolescent Substance Abuse

青少年药物滥用行为疗法的神经经济学

• 批准号: 8247031
• 负责人: Clinton D Kilts
• 金额: $ 16.72万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-04-01 至 2015-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8247031
• 关键词: Abstinence; Address; Adolescent; Alcohol consumption; Alcohols; Amygdaloid structure; Behavior Therapy; Behavioral; Biological Models; Brain; Cognitive; Cognitive Therapy; Controlled Clinical Trials; Corpus striatum structure; Data; Decision Making; Development; Evaluation; Exhibits; Family; Future; Globus Pallidus; Image; Incentives; Individual; Intake; Intervention; Investigation; Laboratories; Marijuana; Marijuana Abuse; Marijuana Smoking; Measures; Mediating; Neurobiology; Neurosciences; Outcome; Outpatients; Pattern; Performance; Prefrontal Cortex; Prevention Research; Preventive Intervention; Process; Psychological reinforcement; Public Health; Randomized Clinical Trials; Recruitment Activity; Rewards; Role; Sampling; Specificity; Structure; System; Testing; Treatment outcome; Variant; addiction; adolescent alcohol abuse; adolescent substance abuse; arm; base; contingency management; discounting; drug abstinence; effective therapy; improved; neural patterning; neurodevelopment; neuroeconomics; neuroimaging; novel; preference; programs; public health relevance; relating to nervous system; response; substance abuse treatment; substance abuser; treatment effect; treatment response; trial comparing

DESCRIPTION (provided by applicant): Little is known about the role of adolescent neurodevelopment in adolescent substance abuse treatment outcomes. The development and evaluation of adolescent substance abuse treatments rarely includes consideration of varying cognitive capacities and their neural representations as determinants of individual variation in treatment response. This proposed R21 project would address this gap by identifying associations among decision making, task-related neural processing, and treatment outcome among adolescents participating in two ongoing randomized clinical trials for adolescent substance abuse. Increasing our understanding of neural processes that underlie decision making in adolescent marijuana and alcohol users would inform the development of future intervention and prevention efforts. This complementary project would draw subjects from two ongoing studies investigating contingency- management (CM) based treatments "Behavioral Treatment of Adolescent Marijuana Abuse" (DA015186), and "Family Based Contingency Management for Adolescent Alcohol Abuse" (AA016917). Both trials compare a unique CM intervention that involves an abstinence-based reinforcement program to a standard, state of the art cognitive behavioral intervention. Analyses would be performed separately for the two samples, with hypotheses tested first using the Marijuana sample, and assessed for replication/specificity using the Alcohol sample. The proposed project would explore novel neurobiological predictors of response to CM interventions. Adolescents recruited into the Marijuana Trial (n=69; 23 per treatment arm) and the Alcohol Trial (n=54; 27 per treatment arm) during the period of this R21 project would participate in a neuroimaging session. During the neuroimaging session, adolescents would make intertemporal choice decisions in a Delay Discounting task. Preliminary data from the Marijuana trial demonstrates significant association between performance on this behavioral delay discounting task and abstinence achieved during treatment over and above the significant effect of treatment condition. We seek to understand the neural processes that underlie performance on this laboratory task, and the degree to which variation in these neural processes relate to and predict adolescent substance abuse treatment outcomes. The conceptual framework for the proposed project is a competing neural systems model which hypothesizes a biased competition between an "impulsive" (or ''reflexive") neural system and the "executive" (or "reflective") neural system in understanding patterns of suboptimal decision making among substance-dependent individuals. An overarching hypothesis is that differing responses to distinct treatment approaches (CM vs. CBT) depend on the pattern of activation or functional connectivity within and across these competing neural systems. Specifically, we will determine the degree to which performance on a laboratory delay discounting task correlates with activity in impulsive and/or executive neural systems. We will also determine the degree to which performance on a laboratory delay discounting task and neural processing predict adolescent substance abuse treatment outcome over and above the effects of treatment condition. Finally, we will explore interactions between response to CM and delay discounting-related neural processing. This neuroimaging project will provide a springboard for the development of future projects with this newly formed interdisciplinary team. Conducting the proposed imaging study in the context of a controlled clinical trial has potential to guide the development/refinement of more efficacious treatments tailored to the individual, and may have strong implications for prevention research and intervention as well. The significance of this specific proposal is enhanced by our proposed investigation of neural predictors of response to one of the most common outpatient interventions (i.e., MET/CBT) and one of the most promising interventions for improving outcomes of MET/CBT (i.e., CM). Last, the focus on temporal discounting of rewards represents a significant test of a major theoretical construct thought to drive the addiction process. Decision making and incentive valuation represent novel targets of future treatment interventions. PUBLIC HEALTH RELEVANCE: This study will measure the brain activity of adolescent substance abusers while they make decisions about their preferences to receive smaller, immediate rewards vs. larger delayed rewards. We expect that patterns of brain activity while engaged in this decision making task will predict response to treatment among adolescent substance users. We expect to use the results of this study to develop more effective treatments for adolescent substance abuse.

描述(由申请人提供)：关于青少年神经发育在青少年药物滥用治疗结果中的作用，人们知之甚少。青少年药物滥用治疗的发展和评估很少考虑不同的认知能力及其神经表征，作为治疗反应中个体差异的决定因素。这个拟议的R21项目将通过在参与两个正在进行的青少年药物滥用随机临床试验的青少年中确定决策制定、任务相关的神经处理和治疗结果之间的关联来解决这一差距。增加我们对青少年大麻和酒精使用者决策基础的神经过程的了解，将为未来干预和预防工作的发展提供信息。这一补充项目将从两项正在进行的研究中吸引受试者，这两项研究调查的是基于应急管理(CM)的治疗方法“青少年滥用大麻的行为治疗”(DA015186)和“青少年酗酒的基于家庭的应急管理”(AA016917)。两项试验都将一种独特的CM干预与一种标准的、最先进的认知行为干预进行了比较。将分别对两个样本进行分析，首先使用大麻样本检验假设，然后使用酒精样本评估复制/特异性。拟议的项目将探索对CM干预反应的新的神经生物学预测因子。在R21项目期间，被招募到大麻试验(n=69；每治疗组23人)和酒精试验(n=54，每治疗组27人)的青少年将参加神经成像课程。在神经成像过程中，青少年会在延迟折扣任务中做出跨期选择决定。大麻试验的初步数据表明，在这一行为延迟折扣任务中的表现与治疗期间实现的戒烟之间存在显著关联，而不是治疗条件的显著影响。我们试图了解在这项实验室任务中表现的神经过程，以及这些神经过程中的变化与青少年药物滥用治疗结果的关系和预测的程度。拟议项目的概念框架是一个竞争的神经系统模型，该模型假设在理解物质依赖型个人的次优决策模式时，“冲动”(或“自反式”)神经系统和“执行”(或“自反式”)神经系统之间存在有偏见的竞争。一个重要的假设是，对不同的治疗方法(CM和CBT)的不同反应取决于这些相互竞争的神经系统内和之间的激活或功能连接的模式。具体地说，我们将确定实验室延迟折扣任务的表现与冲动和/或执行神经系统活动的相关性程度。我们还将确定在实验室延迟折扣任务和神经处理方面的表现在多大程度上预测青少年药物滥用治疗结果，而不是治疗条件的影响。最后，我们将探索对CM的反应与延迟折扣相关的神经加工之间的交互作用。这个神经成像项目将为这个新成立的跨学科团队未来项目的发展提供一个跳板。在对照临床试验的背景下进行拟议的成像研究，有可能指导针对个人量身定做的更有效治疗的开发/改进，并可能对预防研究和干预产生强烈的影响。这一具体建议的重要性通过我们建议的对最常见的门诊干预措施(即MET/CBT)和最有希望改善MET/CBT结果的干预措施之一(即CM)的神经预测因子的研究而得到加强。最后，对奖励时间贴现的关注代表着对推动成瘾过程的主要理论构建思想的重大考验。决策和激励评估是未来治疗干预的新目标。 与公共健康相关：这项研究将测量青少年物质滥用者在做出决定时的大脑活动，他们决定接受较小的、即时的奖励还是较大的延迟奖励。我们预计，参与这项决策任务的大脑活动模式将预测青少年药物使用者对治疗的反应。我们希望利用这项研究的结果来开发更有效的青少年药物滥用治疗方法。