Development of a Prospective Memory Intervention to Reduce Drug Use and HIV Risk

描述（由申请人提供）：吸毒成瘾和相关的艾滋病毒危险行为是重大的公共卫生问题，大多数成瘾治疗无法产生持久的行为改变。前瞻性记忆（在未来实现某个意图的能力；例如，记得吃药、参加预定的会议）可能在行为改变中发挥关键作用，例如在成瘾治疗中（即，为了表现得不同，一个人必须记住以不同的方式表现）。尽管前瞻记忆在成瘾中具有直观的作用，并且发现吸毒者的前瞻记忆受损，但没有研究针对前瞻记忆进行治疗。前瞻性记忆还为令人兴奋但理论上具有挑战性的发现提供了机械解释，即工作记忆训练减少了成瘾者的延迟贴现（人们通过在实验室任务中选择较大的后期奖励而不是较小的早期奖励来表现出更强的自我控制力），并减少酗酒者的饮酒。预期记忆（依赖于工作记忆）是缺失的一环，因为更大的工作记忆容量更有可能有空间来记住长期目标（预期记忆），同时面临其他需求，包括与这些长期目标相冲突的诱惑。改善的预期记忆可以使人更成功地获得长期奖励，随着时间的推移，这会增强对延迟奖励的更高估价。工作记忆训练仅涉及预期记忆的多个组成部分之一。因此，这一高度创新的提案将开发第一个前瞻性记忆训练，涵盖前瞻性记忆的多个组成部分（工作记忆、回顾性记忆、执行功能），以增强自我控制（等待延迟奖励的能力），从而减少吸毒和相关的艾滋病毒危险行为。计算机化前瞻记忆训练将使用沉浸式技术来模拟日常生活前瞻记忆挑战。 3项针对使用可卡因的美沙酮患者的研究将从基础研究转向临床干预的细化。过期。 1 将通过确定后续实验的预期记忆任务（记忆意图）的最佳数量来为干预开发提供信息（目标 1a）。过期。图 2 是对预期记忆训练可改善预期记忆这一假设的“概念验证”测试（目标 2a），并将提供“剂量反应”信息以确定最佳训练次数（目标 2b）。过期。图3是一项随机对照试验（3组：前瞻记忆训练、工作记忆训练、对照），测试前瞻记忆训练改善目标行为的初步功效。我们假设，相对于对照，前瞻性记忆训练将减少延迟贴现（目标 3a；主要）、药物使用和 HIV 风险行为（目标 3b；次要）。第二个假设是，前瞻性记忆训练比工作记忆训练会产生更大的延迟折扣减少。除了药物依赖和艾滋病毒之外，该项目的数据对于预防和治疗许多行为改变至关重要的临床疾病（肥胖、心血管疾病、癌症、糖尿病）具有广泛的影响。

DESCRIPTION (provided by applicant): Drug addiction and associated HIV risk behavior are significant public health problems, and most addiction treatments fail to produce lasting behavior change. Prospective memory (ability to implement an intention in the future; e.g., remember to take medication, attend a scheduled meeting) may play a critical role in behavior change such as in addiction treatment (i.e., in order to behave differently, one has to remember to behavior differently). Despite an intuitive role for prospective memory in addiction and findings of impaired prospective memory in drug abusers, no study has targeted prospective memory for treatment. Prospective memory also provides a mechanistic account of exciting but theoretically challenging findings that working memory training decreased delay discounting (people showed greater self-control by choosing larger later rewards over smaller sooner rewards in a lab task) in addicted individuals, and reduced drinking in alcoholics. Prospective memory (which relies on working memory) is the missing link because a larger working memory capacity is more likely to have space to hold long term goals in mind (prospective memory) while faced with other demands including temptations at conflict with those longer term goals. Improved prospective memory results in a person more successfully obtaining longer term rewards, which over time reinforces greater valuation of delayed rewards. Working memory training only addresses 1 of multiple components of prospective memory. Thus, this highly innovative proposal will develop the 1st prospective memory training to encompass the multiple components of prospective memory (working memory, retrospective memory, executive functions), in order to increase self- control (ability to wait for delayed rewards), and therefore reduce drug use and associated HIV risk behavior. The computerized prospective memory training will use immersive technology to simulate everyday life prospective memory challenges. 3 studies in methadone patients who use cocaine will move from basic research to refinement of clinical intervention. Exp. 1 will inform intervention development by determining the optimal # of prospective memory tasks (intentions to remember) for subsequent experiments (Aim 1a). Exp. 2 is a 'proof of concept' test of the hypothesis that prospective memory training improves prospective memory (Aim 2a), and will provide 'dose-response' information to determine the optimal # of training sessions (Aim 2b). Exp. 3 is a randomized controlled trial (3 groups: prospective memory training, working memory training, control) to test the preliminary efficacy of the prospective memory training to improve the target behaviors. We hypothesize that prospective memory training will decrease delay discounting (Aim 3a; primary), drug use, and HIV risk behavior (Aim 3b; secondary), relative to control. A secondary hypothesis is that prospective memory training will produce greater decreases in delay discounting than working memory training. In addition to drug dependence and HIV, data from this project have broad implications for prevention and treatment of the many clinical disorders in which behavior change is critical (obesity, cardiovascular disease, cancer, diabetes).