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）是当前军事冲突的签名伤害：伊拉克行动自由，持久自由和新黎明行动（OEF/OIF/OND）。在这些冲突的退伍军人中，MTBI通常与精神健康疾病（如创伤后应激障碍（PTSD））共同占领。在退伍军人中，有害的酒精使用或可能的酒精使用障碍（AUD）也非常普遍。 AUD的存在对使用TBI的退伍军人对康复效力产生了进一步的负面影响。渴望或消耗物质的冲动是AUD的关键特征。渴望酒精会对康复产生负面影响，并与酗酒的瘾君子复发有关。迄今为止，还没有研究渴望在同时发生的MTBI，PTSD和AUD（MTBI+PTSD+AUD）的退伍军人中渴望酒精的作用。因此，当前CDA II应用的目的是表征渴望酒精，对渴望酒精渴望的机制有更好的了解，并开发新的治疗干预措施，以减少酒精饮料。为此，将根据自我报告和神经心理学评估招募OEF/OIF/OND退伍军人，并将其分为两组之一：1）具有MTBI+PTSD+AUD的无症状战斗对照退伍军人，具有可能的AUD（单独）和2）退伍军人。首先，将比较这两组中的酒精渴望和过度使用酒精。这将通过进行酒精使用的客观度量（例如尿液和酒精浓度测试），饮酒的自我报告以及渴望酒精来完成。其次，将检查渴望酒精的神经生理机制，以开发一种新的治疗干预措施以减少。为此，退伍军人将参与功能性磁共振成像（fMRI）方案，其中将根据与中性图像相比观看与酒精相关的图像来衡量脑激活。先进的神经影像学程序，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，这是一个称为功能连通性分析的过程。神经影像数据将集体评估，以阐明酒精渴望的机制，并与文献一起使用这些数据来开发神经治疗性重复的转颅磁刺激（RTMS）的方案。第三，将检查单个RTMS疗程对酒精渴望的安全性，可行性和直接影响，以及具有MTBI+PTSD+AUD的退伍军人的神经活动和连通性。退伍军人将完成神经影像学，渴望和酒精使用措施，如上所述。自我报告的渴望也将在一天，一个星期和一个月后通过电话采访评估。可以预期，这个创新的项目将为我们的基本知识贡献一个缺失的，基本的要素，如果没有MTBI+PTSD+AUD的退伍军人的渴望，就无法理解。获得此类知识对于与同时发生的MTBI和PTSD的退伍军人的饮酒成瘾策略的发展至关重要。