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风险行为是重大的公共卫生问题，大多数成瘾治疗不能产生持久的行为改变。前瞻记忆（在未来实现意图的能力；例如，记得服药，参加预定的会议）可能在成瘾治疗等行为改变中发挥关键作用（例如，为了改变行为，一个人必须记住不同的行为）。尽管前瞻记忆在成瘾中有直观的作用，并且在药物滥用者中发现前瞻记忆受损，但没有研究针对前瞻记忆进行治疗。前瞻记忆也为一些令人兴奋但在理论上具有挑战性的发现提供了一个机制解释，即工作记忆训练减少了成瘾者的延迟折扣（在实验室任务中，人们通过选择较大的后期奖励而不是较小的前期奖励表现出更强的自制力），减少了酗酒者的饮酒。前瞻记忆（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在脑海中保留长期目标（前瞻记忆），同时面对其他需求，包括与这些长期目标相冲突的诱惑。前瞻记忆的改善会让一个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大评价。工作记忆训练只涉及前瞻记忆多个组成部分中的一个。因此，这一高度创新的建议将开发第一个前瞻记忆训练，包括前瞻记忆的多个组成部分（工作记忆，回顾性记忆，执行功能），以增加自我控制（等待延迟奖励的能力），从而减少吸毒和相关的艾滋病毒风险行为。计算机前瞻记忆训练将使用沉浸式技术来模拟日常生活中的前瞻记忆挑战。对使用可卡因的美沙酮患者的研究将从基础研究转向改进临床干预。实验1将通过为后续实验（目的1a）确定前瞻性记忆任务（记忆意图）的最佳#来为干预发展提供信息。实验2是前瞻记忆训练提高前瞻记忆假设的“概念证明”测试（目的2a），并将提供“剂量-反应”信息，以确定最佳训练次数（目的2b）。实验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），旨在检验前瞻记忆训练对目标行为改善的初步效果。我们假设，相对于对照组，前瞻记忆训练将减少延迟折扣（Aim 3a；主要）、药物使用和艾滋病毒风险行为（Aim 3b；次要）。第二个假设是，前瞻记忆训练比工作记忆训练更能降低延迟折扣。除了药物依赖和艾滋病毒之外，这个项目的数据对预防和治疗许多临床疾病（肥胖、心血管疾病、癌症、糖尿病）具有广泛的意义，这些疾病的行为改变是至关重要的。

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).