Evaluation Of Treatments Of Opioid And Cocaine Dependence

阿片类药物和可卡因依赖的治疗评估

• 批准号: 8933802
• 负责人: Kenzie Preston
• 金额: $ 125.97万
• 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/8933802
• 关键词: Abstinence; Address; Amaze; Area; Behavior; Behavioral; Biological Markers; Brain imaging; Businesses; Clonidine; Cocaine; Cocaine Dependence; Commit; Communities; Cues; Data; Drug Use Disorder; Drug usage; Electronics; Employment; Environmental Exposure; Evaluation; Evidence based treatment; Exposure to; Goals; Hour; Individual; Individual Differences; Influentials; Intervention; Laboratories; Measures; Modeling; Moods; Occupations; Opiate Addiction; Outcome; Participant; Patients; Pattern; Pharmaceutical Preparations; Randomized Clinical Trials; Reporting; Research; Schedule; Sex Characteristics; Sexual Development; Solutions; Stress; Stressful Event; Substance Addiction; Taxonomy; Technology; Technology Transfer; Testing; Time; Underemployment; Update; Woman; Work; addiction; base; craving; design; diaries; drug craving; experience; improved; insight; men; mind control; psychosocial; response; self reported behavior; social; stressor; substance abuser; time use; treatment strategy

The Treatment Section continues its long-term projects to improve treatment for substance dependence through behavioral, pharmacologic, and combined behavioral and pharmacologic interventions. In addition to the innovatively designed randomized clinical trial of clonidine that we completed in the past year, we are continuing to study individual differences that might be important for personalized treatment and for patient-treatment matching. We have made a point of addressing sex differences, because men and women with drug-use disorders differ in course, outcome, and possible biomarkers such as cue-induced activation of putative brain control network areas. In our ecological momentary assessment (EMA) study, in which participants report their mood, behavior, and drug use on electronic diaries as they go about their daily lives, we evaluated differences related to drug use in the 72 men and 42 women. We used stringent correction for multiple comparisons, but still found a large number of sex differences. In random-prompt entries, women and men reported significantly different patterns of drug-cue exposure, with women more likely to report having seen cocaine or been tempted to use in the past hour. Women also had higher craving after past-hour exposure to drug cues. In reports of drug use, women, compared to men, were more likely to report that they had used more cocaine than they had meant to, tended to feel guilty more often after drug use, and to have used despite trying not to use. These findings provide real-time behavioral evidence that women respond differently than men to drug cues and to drug use, consistent with laboratory and brain-imaging findings. This information may be useful for development of sex-specific treatment strategies. We also found evidence that our taxonomy of lapse triggers did not include items that were salient for women, suggesting that the classic, still-influential formative research on which it was based needs to be updated. We are currently replicating these analyses in participants in a larger study. In that study, participants initiate EMA reports for each stressful event they experience, as well each time they use drugs. We plan to investigate whether men and women experience stressful events differently and show different relationships between stressful events and drug use; this information will be incorporated into the mobile intervention we are starting to develop. Another factor we are examining for incorporation into treatment, independent of sex differences, is actual patterns of drug craving and drug use. We analyzed ecological momentary assessment (EMA) data on the timing of cocaine craving and use in the context of their relationship with a societal construct of daily temporal organization: 9-to-5 Monday-to-Friday business hours. Few of our participants report full-time work and fewer still report a 9-to-5 job. One possibility is that underemployed polydrug misusers largely disregard such conventions, but another possibility is that, in some ways, they implicitly abide by them. At baseline, 34% of participants reported full-time employment in the preceding 3 years, and most participants' current work status fluctuated throughout the study. In a generalized linear mixed model using current work status as a time-varying predictor, cocaine craving was significantly more frequent during business hours, while actual use was significantly more frequent after business hoursregardless of current work status. This finding suggests that the societal conventions reflected in business hours influence drug-use patterns even in individuals whose daily schedules are not dictated by employment during those hours. This may reflect an internalization of the social sanctions that help keep drug use under some degree of control. Finally we continue to develop Geographical Momentary Assessment (GMA), a descriptive approach to better measure and understand the relationships among mood, drug use, and environmental exposure to psychosocial stressors. We remain committed to transforming description into intervention. For example, we have shown that electronic-diary studies can provide amazing insight into the daily lives of substance abusers during treatment and data that are sensitive to behavioral changes during even brief periods of abstinence. The technologies that enable us to collect data on drug use, craving, and stress in the field may also be used for delivery of treatment in the field, perhaps in response to the patients own self-reported behaviors or previously identified triggers.

治疗科继续其长期项目，通过行为、药理学以及行为和药理学相结合的干预措施来改善物质依赖的治疗。 除了我们去年完成的创新设计的可乐定随机临床试验外，我们还在继续研究个体差异，这对于个性化治疗和患者治疗匹配可能很重要。 我们强调解决性别差异，因为患有吸毒障碍的男性和女性在病程、结果和可能的生物标志物（例如线索诱导的假定大脑控制网络区域的激活）方面存在差异。 在我们的生态瞬时评估 (EMA) 研究中，参与者在日常生活中通过电子日记报告他们的情绪、行为和药物使用情况，我们评估了 72 名男性和 42 名女性与药物使用相关的差异。我们采用了严格的校正进行多重比较，但仍然发现了大量的性别差异。在随机提示条目中，女性和男性报告了明显不同的药物提示暴露模式，女性更有可能报告在过去一小时内看到过可卡因或受到诱惑使用。女性在过去一小时接触药物暗示后也会有更高的渴望。在吸毒报告中，与男性相比，女性更有可能报告称她们使用了比预期更多的可卡因，吸毒后往往更容易感到内疚，并且尽管试图不吸，但还是吸了。这些发现提供了实时行为证据，表明女性对药物提示和药物使用的反应与男性不同，这与实验室和脑成像结果一致。该信息可能有助于制定针对性别的治疗策略。我们还发现证据表明，我们对失误触发因素的分类不包括对女性显着的项目，这表明它所基于的经典的、仍然有影响力的形成性研究需要更新。我们目前正在一项更大规模研究的参与者中重复这些分析。在这项研究中，参与者为他们经历的每一次压力事件以及每次使用药物时启动 EMA 报告。我们计划调查男性和女性经历压力事件是否不同，并显示压力事件与吸毒之间的不同关系；这些信息将被纳入我们正在开始开发的移动干预中。 我们正在研究纳入治疗的另一个因素，与性别差异无关，是药物渴望和药物使用的实际模式。我们分析了关于可卡因渴望和使用时间的生态瞬时评估（EMA）数据，以及它们与日常时间组织的社会结构（周一至周五朝九晚五的工作时间）的关系。我们的参与者很少有全职工作，而仍然从事朝九晚五工作的人就更少了。一种可能性是，就业不足的多种药物滥用者在很大程度上无视这些惯例，但另一种可能性是，他们在某些方面暗中遵守这些惯例。在基线时，34% 的参与者报告在过去 3 年中有全职工作，并且大多数参与者当前的工作状态在整个研究过程中存在波动。在使用当前工作状态作为时变预测变量的广义线性混合模型中，在工作时间内对可卡因的渴望明显更加频繁，而无论当前工作状态如何，在工作时间之后实际使用可卡因的频率明显更高。这一发现表明，工作时间反映的社会习俗会影响吸毒模式，即使对于那些日程安排不受工作时间影响的个人来说也是如此。这可能反映了社会制裁的内在化，有助于在一定程度上控制吸毒。 最后，我们继续开发地理瞬时评估（GMA），这是一种描述性方法，可以更好地测量和理解情绪、药物使用和社会心理压力源环境暴露之间的关系。我们仍然致力于将描述转化为干预。例如，我们已经证明，电子日记研究可以提供对药物滥用者在治疗期间日常生活的惊人洞察，以及对即使是短暂的戒断期间的行为变化敏感的数据。使我们能够在现场收集有关药物使用、渴望和压力数据的技术也可用于在现场提供治疗，也许是为了响应患者自己报告的行为或之前确定的触发因素。