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伤害：伊拉克自由行动、持久自由行动和新黎明行动（OEF/OIF/OND）。在经历过这些冲突的退伍军人中，mTBI 通常与创伤后应激障碍 (PTSD) 等心理健康障碍同时发生。退伍军人中危险饮酒或疑似酒精使用障碍 (AUD) 也极为普遍。 AUD 的存在会对患有 TBI 的退伍军人的康复效果产生进一步的负面影响。渴望或消费某种物质的冲动是澳元的一个关键特征。对酒精的渴望会对康复产生负面影响，并且与酒精戒断成瘾者的复发有关。迄今为止，尚无研究探讨酒精渴望对同时发生 mTBI、PTSD 和 AUD（mTBI+PTSD+AUD）的退伍军人的影响。因此，当前 CDA II 应用的目标是描述酒精渴望的特征，更好地了解酒精渴望的机制，并开发一种新的减少酒精渴望的治疗干预措施。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之一：1) 可能患有 AUD（仅 AUD）的无症状战斗控制退伍军人和 2) 患有 mTBI+PTSD+AUD 的退伍军人。首先，将比较这两组的酒精渴望和过度饮酒。这将通过对酒精使用进行客观测量（例如尿液和呼吸酒精浓度测试）、酒精使用情况和酒精渴望的自我报告来完成。其次，将对酒精渴望的神经生理学机制进行研究，以开发一种新的减少酒精渴望的治疗干预措施。为此，退伍军人将参与功能性磁共振成像（fMRI）方案，在该方案中，将通过观看与酒精相关的图像与中性图像进行比较来测量大脑激活情况。还将进行先进的神经影像程序，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，这一过程称为功能连接分析。神经影像数据将被集中评估，以阐明酒精渴望的机制，并且与文献一起，这些数据将用于制定神经治疗干预重复经颅磁刺激（rTMS）的方案。第三，将检查单次 rTMS 治疗的安全性、可行性以及对患有 mTBI+PTSD+AUD 的退伍军人的酒精渴望以及神经活动和连接的直接影响。退伍军人将在 rTMS 前后完成神经影像学、酒精渴望和酒精使用措施，如上所述。自我报告的酒精渴望也将在 rTMS 后的一天、一周和一个月通过电话访谈进行评估。预计这个创新项目将为我们的基础知识贡献一个缺失的基本要素，没有这个要素就无法理解患有 mTBI+PTSD+AUD 的退伍军人对酒精的渴望。获得这些知识对于制定针对同时发生 mTBI 和 PTSD 的退伍军人酒精成瘾的改进治疗策略至关重要。