Biobehavioral Mechanisms Underlying Improving Sleep to Reduce Risk for Substance Use Disorder

项目总结/摘要 拟议的项目将为申请人提供一个有影响力的独立研究生涯， 物质使用障碍（SUD）的病因学和预防，特别是与创伤和创伤后 应激障碍（PTSD）。为了实现这一职业目标，该项目针对四个关键领域的博士前培训 在2年的奖励期内：预防性干预措施的开发和评估，SUD病因和风险 创伤相关病理学、知识和创伤相关生物学过程的评估所赋予的 SUD（即，睡眠和压力反应）和专业发展。本次培训将在 在这些具体领域的专家指导。拟议的研究培训计划是理想的 申请人获得这些基本技能的途径。具体而言，拟议项目解决了关键的 需要通过整合以下经验观察，在创伤幸存者中进行有针对性的直接SUD预防： 睡眠障碍是SUD危险因素，在创伤幸存者中很常见，2）睡眠障碍是 与直接靶向物质使用相比，可塑性强，可能更容易改变， 3)睡眠在促进SUD关键风险因素中的作用的理论概念化：压力，渴望和 用来减少负面影响物质。在这项工作的基础上，目前的建议将测试以下措施的效果： 短暂行为治疗（BBTI）与等待名单控制相比，SUD风险降低。另一 目的是研究改善睡眠以改善SUD风险的生物行为机制（即，应力 反应，相关的渴望，物质的使用，以减轻负面影响）。选择大麻使用是因为其 与睡眠障碍的密切联系及其广泛使用。为了检验这些目标，一个60人的样本 睡眠不好的年轻人（18-30岁）有SUD的风险（即，每周至少使用一次大麻， 有或没有创伤后应激障碍）。参与者将完成基线评估，包括 自我报告，临床访谈，行为任务和激素测定，然后将被随机分配到 条件，完成指定的干预措施，并参加为期3个月的随访。 假设是：1）BBTI将降低SUD风险（即，更少的大麻使用障碍[CUD]症状， 与等待名单相比， 控制; 2）条件对SUD风险降低的影响将通过改善睡眠来介导; 3） BBTI将在这个弱势群体中获得高水平的治疗满意度; 4）睡眠不佳将是 与此相关，BBTI将改善：增加负面影响，皮质醇分泌，以及以下渴望 创伤意象这项研究的长期目标是为发展的理论模型提供信息， SUD，并指导未来的预防性干预研究。这些目标对公共卫生具有重大意义 考虑到减少与SUD相关的重大公共卫生负担的迫切需要，

PROJECT SUMMARY/ABSTRACT The proposed project will prepare the applicant for an impactful independent research career studying the etiology and prevention of substance use disorder (SUD), particularly in relation to trauma and posttraumatic stress disorder (PTSD). To achieve this career goal, the project targets predoctoral training in four key areas over a 2-year award period: preventative intervention development and evaluation, SUD etiology and risk conferred by trauma-related pathology, knowledge and assessment of trauma-related biological processes in SUD (i.e., sleep and stress responding), and professional development. This training will be conducted under the mentorship of experts in each of these specific areas. The proposed research training plan is the ideal avenue for the applicant to gain these essential skills. Specifically, the proposed project addresses the critical need for targeted direct SUD prevention among trauma survivors by integrating empirical observations that 1) sleep disturbance is a risk factor for SUD, common among trauma survivors, and 2) sleep disturbance is malleable and potentially more amenable to change compared to directly targeting substance use, as well as 3) theoretical conceptualizations of the role of sleep in promoting key risk factors for SUD: stress, cravings and substance use to decrease negative affect. Building on this work, the current proposal will test the effects of Brief Behavioral Treatment for Insomnia (BBTI) compared to a waitlist control on SUD risk reduction. A further aim is to investigate biobehavioral mechanisms underlying improving sleep to ameliorate SUD risk (i.e., stress reactivity, associated cravings, substance use to relieve negative affect). Cannabis use was selected due to its close connection with sleep disturbance and its widespread use. To examine these aims, a sample of 60 young adults (aged 18-30) with poor sleep at risk for SUD (i.e., use cannabis at least once weekly and trauma exposed with or without PTSD) will be recruited. Participants will complete a baseline assessment including self-report, clinical interviewing, a behavioral task, and hormonal assays, then will be randomized into condition, complete their assigned intervention, and participate in follow-ups over a 3-month period. Hypotheses are: 1) BBTI will reduce SUD risk (i.e., fewer cannabis use disorder [CUD] symptoms and diagnoses, decreased coping motives, use-related problems, and PTSS) at follow-up, compared to a waitlist control; 2) that the effect of condition on SUD risk reduction will be mediated by improvements in sleep; 3) that BBTI will have high levels of treatment satisfaction in this vulnerable group; 4) that poor sleep will be associated with, and BBTI will improve: increased negative affect, cortisol secretion, and cravings following trauma imagery. The long-term goals of this research are to inform theoretical models of the development of SUD, and to guide future preventative intervention research. These goals have significant public health importance, considering the crucial need to reduce the substantial public health burden associated with SUD.