Risk-Taking Following Trauma Cue Exposure in Substance Users with PTSD

描述(由申请人提供)：创伤后应激障碍(PTSD)和物质使用障碍(SUDS)共同出现的频率很高(Brady等人，2004；Cottler等人，1992；Jacobson等人，2001)，这种诊断性的共同出现具有重大的临床和公共卫生意义。特别是，研究表明，在患有创伤后应激障碍的个体中，共同发生的创伤后应激障碍与各种危险和冲动行为的风险增加以及相关的负面临床结果有关，包括更严重的药物使用模式(Back等人，2000年；Cottler等人，1992年；Najavits等人，2007年；Salgado等人，2007年)，更大的法律问题(Najavits等人，1999,2007；更危险的性行为和吸毒行为(Plotzker等人，2007年)，更大的艾滋病毒感染风险(Hoff等人，1997年)，以及从Sud治疗出院后更快地复吸药物(Hien等人，2000年；Ouimette等人，1999,2007年)。此外，有(与没有)创伤后应激障碍患者观察到的更差的治疗结果并不是简单地由于总体上更大的共病(Ouimette等人，1999年)或创伤性暴露史(Hien等人，2000年)的结果，这表明在药物使用者中存在创伤后应激障碍的独特之处，使他们面临更大的负面临床结果风险。尽管有这些发现，以及初步发现在患有创伤后应激障碍的可卡因依赖住院患者(与没有创伤后应激障碍的患者相比；Tull，Trotman等人，2009年)中有更高水平的冒险行为(通过基于实验室的任务进行评估)，但还没有研究检查在创伤后应激障碍-SUD人群中引发危险行为的因素或背景，或者选择的物质在多大程度上影响PTSD-SUD患者的危险行为。因此，这项拟议的实验研究试图通过检测210名创伤暴露的SUD患者(仅依赖可卡因、仅依赖酒精、或依赖可卡因和酒精)合并或不合并创伤后应激障碍，来研究想象创伤线索暴露对冒险行为的影响。在不同的日子里，有A标准创伤暴露史的SUD患者将接触到中性线索或个性化的想象创伤线索。在线索暴露之后，参与者将完成两项既定的冒险行为测量，即气球模拟风险任务(Lejuez等人，2002年)和爱荷华州赌博任务(Bechara等人，1994年)。我们将考察创伤线索暴露(与中性线索暴露相比)、选择的物质(可卡因与酒精与可卡因-酒精依赖)以及创伤后应激障碍状态(当前创伤后应激障碍与没有创伤后应激障碍病史)对冒险行为的影响。我们期望找到可卡因依赖和创伤后应激障碍对冒险行为的主要影响，以及线索暴露、所选物质和创伤后应激障碍状态之间的三向交互作用。具体地说，我们预计患有创伤后应激障碍的可卡因依赖患者在创伤线索暴露后表现出比所有其他组更高的冒险水平。还将检查生物学(唾液皮质醇)、生理(心率、皮肤电反应)和自我报告的对线索的反应性，以更好地了解可能导致PTSD-SUD患者冒险的因素，从而说明其功能。

DESCRIPTION (provided by applicant): Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) co-occur with high frequency (Brady et al., 2004; Cottler et al., 1992; Jacobson et al., 2001), and this diagnostic co-occurrence has great clinical and public health significance. In particular, research indicates that the presence of co-occurring PTSD among individuals with a SUD is associated with heightened risk for a variety of risky and impulsive behaviors and associated negative clinical outcomes, including more severe substance use patterns (Back et al., 2000; Cottler et al., 1992; Najavits et al., 2007; Salgado et al., 2007), greater legal problems (Najavits et al., 1999, 2007; Ouimette et al., 1999), greater risky sexual and drug use behavior (Plotzker et al., 2007), greater risk for HIV infection (Hoff et al., 1997), and quicker relapse to substance use following discharge from SUD treatment (Hien et al., 2000; Ouimette et al., 1999, 2007). Further, findings that the worse treatment outcomes observed among SUD patients with (vs. without) PTSD are not the result of simply greater comorbidity in general (Ouimette et al., 1999) or a history of traumatic exposure (Hien et al., 2000) suggest that there is something unique to the presence of PTSD among substance users that places them at greater risk for negative clinical outcomes. Despite these findings, as well as preliminary findings of higher levels of risk-taking (as assessed through a laboratory-based task) in general among cocaine dependent inpatients with PTSD (vs. those without PTSD; Tull, Trotman, et al., 2009), no studies have examined the factors or contexts that precipitate risky behavior within a PTSD-SUD population, or the extent to which substance of choice influences risky behavior among PTSD-SUD patients. Thus, the proposed experimental study seeks to extend extant research in this area by examining the effect of imaginal trauma cue exposure on risk-taking among 210 trauma-exposed SUD patients (dependent on cocaine only, alcohol only, or cocaine and alcohol) with or without PTSD. On separate days, SUD patients with a history of Criterion A traumatic exposure will be exposed to a neutral cue or a personalized imaginal trauma cue. Following cue exposure, participants will complete two established behavioral measures of risk-taking, the Balloon Analogue Risk Task (Lejuez et al., 2002) and the Iowa Gambling Task (Bechara et al., 1994). We will examine the effect of trauma cue exposure (vs. neutral cue exposure), substance of choice (cocaine vs. alcohol vs. cocaine-alcohol dependence), and PTSD status (current PTSD vs. no history of PTSD) on risk-taking. We expect to find main effects of cocaine dependence and PTSD on risk-taking, as well as a three-way interaction between cue exposure, substance of choice, and PTSD status. Specifically, we expect that cocaine dependent patients with PTSD will exhibit the highest levels of risk-taking following trauma cue exposure than all other groups. Biological (salivary cortisol), physiological (heart rate, electrodermal response), and self-reported reactivity to cues will also be examined to better understand the factors that may lead to risk-taking among PTSD-SUD patients, thus speaking to its function.