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

药物成瘾和相关的HIV风险行为是重要的公共卫生问题，大多数成瘾治疗未能产生持久的行为改变。前瞻性记忆（在未来实现意图的能力;例如，记得服药，参加预定的会议）可能在行为改变例如成瘾治疗中起关键作用（即，为了有不同的行为，一个人必须记住要有不同的行为）。尽管前瞻性记忆在成瘾中的直观作用和吸毒者前瞻性记忆受损的研究结果，没有研究针对前瞻性记忆的治疗。前瞻性记忆还提供了一个令人兴奋但理论上具有挑战性的发现的机制，即工作记忆训练减少了成瘾者的延迟折扣（人们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，从而表现出更好的自我控制），并减少了酗酒者的饮酒量。前瞻性记忆（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在面对其他需求（包括与这些长期目标相冲突的诱惑）时有空间记住长期目标（前瞻性记忆）。改善前瞻性记忆会使一个人更成功地获得长期奖励，随着时间的推移，这会加强对延迟奖励的更高评价。工作记忆训练只涉及前瞻记忆的多个组成部分之一。因此，这项高度创新的建议将开发第一个前瞻性记忆训练，以涵盖前瞻性记忆的多个组成部分（工作记忆，回顾记忆，执行功能），以提高自我控制（等待延迟奖励的能力），从而减少药物使用和相关的艾滋病毒风险行为。计算机化的前瞻性记忆训练将使用沉浸式技术来模拟日常生活中的前瞻性记忆挑战。在使用可卡因的美沙酮患者中进行的3项研究将从基础研究转向临床干预的改进。Exp. 1将通过确定后续实验（目标1a）的前瞻性记忆任务（记住的意图）的最佳数量来告知干预开发。Exp. 2是前瞻性记忆训练改善前瞻性记忆（目标2a）的假设的“概念证明”测试，并将提供“剂量-反应”信息以确定最佳训练会话数（目标2b）。Exp. 3是随机对照试验（3组：前瞻记忆训练组、工作记忆训练组、对照组），检验前瞻记忆训练对改善目标行为的初步疗效。我们假设，前瞻性记忆训练将减少延迟折扣（目标3a;主要），药物使用和艾滋病毒的风险行为（目标3b;次要），相对于控制。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外，该项目的数据对预防和治疗许多临床疾病（肥胖症，心血管疾病，癌症，糖尿病）具有广泛的意义，其中行为改变至关重要。

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).