Brain Targets for Alcohol Craving in Veterans with mTBI.

患有 mTBI 的退伍军人对酒精渴望的大脑目标。

• 批准号: 8676119
• 负责人: Amy Herrold
• 金额: --
• 依托单位: EDWARD HINES JR VA HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-05-01 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8676119
• 关键词: Address; Adverse event; Affect; Afghanistan; Alcohol abuse; Alcohol consumption; Alcohol dependence; Alcohols; Anxiety; Area; Award; Behavioral; Brain; Brain Injuries; Brain region; Case Study; Characteristics; Chronic; Chronic Disease; Communities; Complex; Conflict (Psychology); Coupled; Data; Development; Diffusion Magnetic Resonance Imaging; Disease; Dose; Effectiveness; Elements; Evidence based treatment; Fiber; Freedom; Functional Magnetic Resonance Imaging; Future; Goals; Health; Image; Injury; Intervention; Interview; Iraq; Knowledge; Laboratories; Life; Literature; Measures; Mental Depression; Mental disorders; Mentors; Military Personnel; Neurologic Dysfunctions; Neurons; Patient Self-Report; Patients; Peer Review; Post-Traumatic Stress Disorders; Procedures; Process; Protocols documentation; Recovery; Recruitment Activity; Rehabilitation Outcome; Rehabilitation therapy; Relapse; Relative (related person); Research; Research Project Grants; Research Training; Rest; Review Literature; Risk; Role; Safety; Services; Severities; Sleep Disorders; Telephone; Testing; Therapeutic; Traumatic Brain Injury; Underserved Population; Urine; Veterans; Visual; Work; alcohol craving; alcohol cue; alcohol use disorder; base; brain circuitry; breath alcohol measurement; career; combat; craving; drinking; improved; injured; innovation; interest; knowledge base; member; mild traumatic brain injury; neural circuit; neuroimaging; neuromechanism; neurophysiology; neuropsychological; novel; operation; patient population; prevent; public health relevance; relating to nervous system; repetitive transcranial magnetic stimulation; response; white matter

DESCRIPTION : Mild traumatic brain injury (mTBI) is the signature injury of the current military conflicts: Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn (OEF/OIF/OND). In Veterans of these conflicts, mTBI commonly co-occurs with mental health disorders such as post-traumatic stress disorder (PTSD). Hazardous alcohol use or probable alcohol use disorder (AUD) is also extremely prevalent in Veterans. The presence of an AUD has further negative impact on rehabilitation effectiveness for our Veterans with TBI. Craving, or the urge to consume a substance, is a critical characteristic of AUD. Alcohol craving negatively impacts rehabilitation and is associated with relapse in the alcohol-withdrawn addict. No studies to date have examined the role of alcohol craving in Veterans with co-occurring mTBI, PTSD and AUD (mTBI+PTSD+AUD). Therefore, the objectives of the current CDA II application are to characterize alcohol craving, develop a better understanding of the mechanism underlying alcohol craving, and develop a novel treatment intervention for alcohol craving reduction. In order to do so, OEF/OIF/OND Veterans will be recruited and classified into one of two groups based on self-report and neuropsychological assessments: 1) asymptomatic combat control Veterans with probable AUD (AUD alone) and 2) Veterans with mTBI+PTSD+AUD. First, alcohol craving and excessive alcohol use in these two groups will be compared. This will be done by conducting objective measures of alcohol use (e.g., urine and breath alcohol concentration tests), self-reports of alcohol use, and alcohol craving. Second, the neurophysiological mechanisms of alcohol craving will be examined in order to develop a novel treatment intervention for craving reduction. To do so, Veterans will participate in a functional magnetic resonance imaging (fMRI) protocol where brain activation will be measured in response to viewing images relating to alcohol compared to neutral images. Advanced neuroimaging procedures to determine the structural integrity of white matter fibers in the brain and to determine spontaneous activity in neuronal networks, a process called functional connectivity analysis, will also take place. The neuroimaging data will be evaluated collectively to elucidate the mechanism underlying alcohol craving and, along with the literature, these data will be used to develop a protocol for the neurotherapeutic intervention repetitive transcranial magnetic stimulation (rTMS). Third, the safety, feasibility, and the immediate effect of a single rTMS session on alcohol cravings along with neural activity and connectivity in Veterans with mTBI+PTSD+AUD will be examined. Veterans will complete neuroimaging, alcohol craving, and alcohol use measures as described above pre- and post-rTMS. Self-report alcohol craving will also be assessed at one day, one week, and one month post-rTMS via phone interview. It is expected that this innovative project will contribute a missing, fundamental element to our base knowledge, without which alcohol craving in Veterans with mTBI+PTSD+AUD cannot be understood. The acquisition of such knowledge is critical to the development of improved therapeutic strategies for alcohol addiction in Veterans with co-occurring mTBI and PTSD.

描述： 轻度创伤性脑损伤(MTBI)是当前军事冲突的标志性损伤：伊拉克自由行动、持久自由行动和新黎明行动(OEF/OIF/OND)。在这些冲突的退伍军人中，mTBI通常与创伤后应激障碍(PTSD)等精神健康障碍并存。危险酒精使用或可能的酒精使用障碍(AUD)在退伍军人中也非常普遍。AUD的存在对我们的退伍军人脑外伤患者的康复效果有进一步的负面影响。渴望，或消费某种物质的冲动，是澳元的一个关键特征。酒精渴求对康复有负面影响，并与戒酒成瘾者的复发有关。到目前为止，还没有研究探讨酒精渴求在退伍军人合并mTBI、PTSD和AUD(mTBI+PTSD+AUD)中的作用。因此，目前CDA II应用的目标是描述酒精渴求的特征，更好地了解酒精渴求的机制，并开发一种新的治疗干预措施来减少酒精渴求。为此，将招募OEF/OIF/OND退伍军人，并根据自我报告和神经心理学评估将其分为两组：1)可能患有AUD的无症状战斗控制退伍军人(仅AUD)和2)患有mTBI+PTSD+AUD的退伍军人。首先，对这两组人的饮酒欲望和过度饮酒情况进行比较。这将通过对酒精使用进行客观测量(例如，尿液和呼气酒精浓度测试)、酒精使用情况自我报告和酒精渴求来实现。其次，将研究酒精渴求的神经生理机制，以开发一种新的治疗干预措施来减少渴求。为了做到这一点，退伍军人将参加一项功能磁共振成像(FMRI)协议，在该协议中，将测量大脑激活，以响应观看与酒精相关的图像，而不是中性图像。还将进行先进的神经成像程序，以确定大脑中白质纤维的结构完整性，并确定神经元网络中的自发活动，这一过程被称为功能连接分析。将对神经成像数据进行集体评估，以阐明酒精渴求的机制，并与文献一起，将这些数据用于制定神经治疗干预重复经颅磁刺激(RTMS)的方案。第三，对患有mTBI+PTSD+AUD的退伍军人进行单次rTMS治疗对酒精渴求以及神经活动和连接性的安全性、可行性和即刻效果的研究。退伍军人将完成如上所述的rTMS前后的神经成像、酒精渴求和酒精使用测量。自我报告酒精渴求也将在rTMS后的一天、一周和一个月通过电话采访进行评估。预计这一创新项目将为我们的基础知识贡献一个缺失的基本元素，如果没有这些元素，就无法理解患有mTBI+PTSD+AUD的退伍军人对酒精的渴望。这些知识的获得对于改进退伍军人酒精成瘾的治疗策略是至关重要的，这些患者同时患有mTBI和PTSD。