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

项目摘要/摘要 拟议的项目将使申请者为研究具有影响力的独立研究生涯做好准备 物质使用障碍的病因和预防，特别是与创伤和创伤后有关的 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进行博士前培训 超过两年的获奖期：预防性干预的发展和评估，sud病因和风险 被授予创伤相关病理学、创伤相关生物学过程的知识和评估 SUD(即睡眠和压力反应)和职业发展。该培训将在以下条件下进行 这些具体领域中每一个领域的专家指导。提出的研究性培训计划是理想的 为申请者提供获得这些基本技能的途径。具体地说，拟议的项目解决了关键的 通过整合以下经验观察，在创伤幸存者中需要有针对性的直接SUD预防1) 睡眠障碍是SUD的危险因素，在创伤幸存者中很常见，2)睡眠障碍是 与直接针对物质使用相比，可延展性和潜在更易于改变，以及 3)睡眠在促进SUD的关键风险因素中的作用的理论概念化：压力、渴望和 使用物质来减少负面影响。在这项工作的基础上，目前的提案将测试 短期行为疗法(BBTI)与等待名单对照在降低SUD风险方面的比较。再来一次 目的是研究改善睡眠以改善SUD风险(即压力)的生物行为机制 反应性、相关的渴望、缓解负面情绪的物质使用)。选择使用大麻是因为它 与睡眠障碍的密切联系及其广泛使用。为了检验这些目标，我们抽取了60个样本 睡眠不佳的青壮年(18-30岁)有患上自闭症的风险(即每周至少吸食一次大麻和精神创伤 无论是否患有创伤后应激障碍)都将被招募。参与者将完成基线评估，包括 自我报告、临床访谈、行为任务和荷尔蒙测试，然后将随机分为 完成分配给他们的干预措施，并参与为期3个月的随访。 假设是：1)BBTI将降低SUD风险(即较少的大麻使用障碍[CUD]症状和 诊断、应对动机降低、使用相关问题和创伤后应激障碍)，而不是等待名单 控制；2)条件对降低SUD风险的影响将通过改善睡眠来调节；3) BBTI将在这一弱势群体中获得高水平的治疗满意度；4)睡眠不佳将是 与BBTI相关的，BBTI将得到改善：负面影响增加，皮质醇分泌增加，以及随后的渴望 创伤影像。这项研究的长期目标是提供发展的理论模型 并指导今后的预防性干预研究。这些目标对公共卫生具有重大意义 考虑到极有必要减少与严重急性呼吸窘迫综合征相关的大量公共卫生负担，这一点非常重要。

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.