Effects of Cocaine and HIV on Decision Making Involving Potential Losses

可卡因和艾滋病毒对涉及潜在损失的决策的影响

• 批准号: 8603122
• 负责人: CHRISTINA S MEADE
• 金额: $ 23.55万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8603122
• 关键词: AIDS prevention; AIDS/HIV problem; Accounting; Address; Adult; Affect; Alcohol or Other Drugs use; Behavior; Behavioral; Brain; Clinical; Clinical Psychology; Cocaine; Cocaine Dependence; Cocaine Users; Complex; Computer Simulation; Decision Making; Development; Disease; Disease Progression; Drug Addiction; Drug Use Disorder; Economic Models; Economics; Evaluation; Figs - dietary; Gambling; Goals; HIV; HIV Infections; HIV Seropositivity; HIV risk; Individual; Individual Differences; Intervention; Lateral; Methods; Modeling; Morbidity - disease rate; NIH Program Announcements; Neurocognitive Deficit; Outcome; Overweight; Persons; Pharmaceutical Preparations; Physics; Population; Prefrontal Cortex; Probability; Process; Relative (related person); Research; Rewards; Risk; Risk Assessment; Risk Behaviors; Risk-Taking; Sampling; Sex Behavior; Sexual Transmission; Substance abuse problem; Technetium Tc 99m ciprofloxacin; Translations; Uncertainty; Ventral Striatum; Vulnerable Populations; Work; case control; clinical practice; cognitive neuroscience; design; executive function; experience; high risk; innovation; insight; mortality; multidisciplinary; neuroeconomics; neuroimaging; neuromechanism; neuropsychiatry; novel; patient oriented research; programs; public health relevance; relating to nervous system; response; reward processing; sex risk; stimulant abuse; theories; transmission process; willingness

DESCRIPTION (provided by applicant): Individuals addicted to stimulant drugs like cocaine are at high risk for engaging in sexual behaviors that contribute to the acquisition of HIV and, once infected, to the forward transmission of HIV to others. HIV-related decision making, like most real-world decisions, involves the valuation of potential gains and losses in the context of uncertain outcomes. Cocaine dependence and HIV infection can each disrupt brain circuits that regulate executive functions involved in decision making. We postulate that these neural changes affect the processing of reward evaluation and outcome uncertainty and contribute to sexual risk behavior. Our preliminary work suggests that cocaine dependence increases loss aversion (i.e., overweighting of potential losses relative to potential gains), and that HIV infecton is associated with greater risk taking propensity among persons with cocaine dependence. Moreover, loss aversion is positively correlated with sexual risk behavior, suggesting that basic decision making processes may be predictive of more complex real-world behavior. The proposed research builds upon our prior work by combining functional neuroimaging, behavioral risk assessment, and computational modeling to: (1) isolate the effects of cocaine dependence and HIV infection on decision making processes, specifically loss aversion and ambiguity tolerance, and (2) examine the relationship between these decision making processes and sexual risk behavior. Using a case-control design, we will examine behavioral choice and brain activity during monetary gambles that vary independently on the value of gains and losses and the certainty of outcomes. The sample will include 80 adults who differ on cocaine and HIV status, comprising four distinct groups (20/group). Our multidisciplinary team, with expertise in clinical psychology, cognitive neuroscience, behavioral neuroeconomics, and MR physics, has extensive experience conducting patient-oriented research on HIV risk behavior in persons with drug dependence and is uniquely poised to successfully implement this innovative and clinically important project. Results of this R21 proposal will provide unique insights into the mechanisms underlying HIV-related decision making, providing support for a subsequent R01 application to further investigate how HIV disease progression may affect neural processes that contribute to "risky" decision making among cocaine users. This research has strong potential for translation to clinical practice, informing the development of novel interventions to more effectively reduce risk behavior by directly targeting underlying neurocognitive deficits, with the ultimate goal of reducing HIV- related morbidity and mortality in persons with drug use disorders.

描述（由申请人提供）：沉迷于可卡因等兴奋剂药物的个人从事性行为的风险很高，这些行为会导致感染艾滋病毒，一旦感染，还会将艾滋病毒向前传播给他人。与大多数现实世界的决策一样，与艾滋病毒相关的决策涉及在不确定结果的情况下评估潜在的收益和损失。可卡因依赖和艾滋病毒感染都会破坏调节决策执行功能的大脑回路。我们假设这些神经变化影响奖励评估和​​结果不确定性的处理，并导致性风险行为。我们的初步研究表明，可卡因依赖会增加损失厌恶（即，相对于潜在收益而言，潜在损失过重），并且艾滋病毒感染与可卡因依赖者更大的冒险倾向相关。此外，损失厌恶与性风险行为呈正相关，这表明基本决策过程可能可以预测更复杂的现实世界行为。拟议的研究建立在我们之前的工作基础上，通过结合功能神经影像、行为风险评估和计算模型来：（1）分离可卡因依赖和艾滋病毒感染对决策过程的影响，特别是损失厌恶和模糊容忍度，以及（2）检查这些决策过程和性风险行为之间的关系。使用病例对照设计，我们将检查金钱赌​​博期间的行为选择和大脑活动，这些行为选择和大脑活动独立于收益和损失的价值以及结果的确定性而变化。样本将包括 80 名可卡因和艾滋病毒状况不同的成年人，分为四个不同的组（每组 20 人）。我们的多学科团队拥有临床心理学、认知神经科学、行为神经经济学和 MR 物理学方面的专业知识，在以患者为导向的药物依赖者艾滋病毒风险行为研究方面拥有丰富的经验，并且有能力成功实施这一创新且具有临床意义的项目。该 R21 提案的结果将为 HIV 相关决策背后的机制提供独特的见解，为后续的 R01 应用提供支持，以进一步研究 HIV 疾病进展如何影响可卡因使用者中做出“危险”决策的神经过程。这项研究具有转化为临床实践的巨大潜力，为开发新的干预措施提供信息，通过直接针对潜在的神经认知缺陷更有效地减少危险行为，最终目标是降低吸毒障碍患者的艾滋病毒相关发病率和死亡率。