Cannabis use following trauma exposure: An observational study of the impact of acute stress and fear response on cannabis outcomes

创伤暴露后使用大麻：急性压力和恐惧反应对大麻结果影响的观察性研究

• 批准号: 10444156
• 负责人: Leslie Ann Daline Brick
• 金额: $ 73.19万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10444156
• 关键词: Accident and Emergency department; Acute; Adolescent; Arousal; Automobile Driving; Behavior; Belief; Biological Process; Cannabinoids; Cannabis; Cannabis-Related Disorder; Chronic; Clinical; Coupled; Coupling; Data; Development; Diagnosis; Disease; Distress; Drug usage; Early-life trauma; Ecological momentary assessment; Evaluation; Exhibits; Exposure to; Extinction (Psychology); Fright; Galvanic Skin Response; General Hospitals; Geographic state; Goals; Heart Rate; Hospitals; Impairment; Individual; Informal Social Control; Interview; Investigation; Laboratory Procedures; Laws; Lead; Learning; Legal; Licensing; Link; Long-Term Effects; Measures; Medical; Medical Marijuana; Memory; Modeling; Negative Reinforcements; Neurobiology; Observational Study; Outcome; Output; Participant; Patient Self-Report; Phase; Physiological; Physiology; Play; Post-Traumatic Stress Disorders; Problem behavior; Prospective Studies; Psychotropic Drugs; Public Health; Qualifying; Recreational Drugs; Reporting; Research; Retrieval; Risk; Role; Safety; Self Medication; Severities; Stress; Substance Use Disorder; Symptoms; System; Therapeutic; Time; Trauma; Trauma recovery; Traumatic injury; United States; Work; acute stress; acute symptom; aged; biological adaptation to stress; craving; critical period; emerging adult; endocannabinoid signaling; endogenous cannabinoid system; fear memory; follow-up; high risk; high risk population; in vivo; indexing; insight; marijuana legalization; marijuana use; marijuana use disorder; marijuana user; neural circuit; neurophysiology; physical assault; post-trauma; post-traumatic symptoms; pre-clinical research; prospective; recruit; response; smart watch; substance use; trauma exposure; traumatic event; vehicular accident; wearable sensor technology; young adult

PROJECT SUMMARY Exposure to trauma is associated with a range of negative outcomes such as posttraumatic stress disorder (PTSD) and substance use disorder, particularly cannabis. The early posttrauma period (i.e., the days, weeks, and months following exposure) represents a critical period of risk for long term problem behaviors, especially among emerging adults (aged 18-25), which constitutes continued development accompanied by a peak in substance use and increased risk for trauma exposure. As regional laws, cultures, and beliefs about cannabis use (CU) continue to shift, there is concern that trauma exposure may exacerbate use (via self-regulation) and lead to greater cannabis-related problems, as many individuals report using cannabis to relieve distress, hyperarousal, and other posttrauma symptoms. Furthermore, while the majority of US states that have legalized cannabis for medical use include outcomes of stress and trauma, such as PTSD, as qualifying conditions for a state-issued medical marijuana license, little is known about how cannabis may impact the early post-trauma course. Given that the endocannabinoid system plays an essential role in regulating stress response and learned fear, CU in the acute post-trauma period may alter mechanisms contributing to alterations in fear neurocircuitry (e.g., alterations in consolidation/ reconsolidation, retrieval, extinction) and physiological reactivity. Limited (and contradicting) evidence, however, regarding safety and efficacy of cannabis preclude strong conclusions about its potential therapeutic role, with some prospective studies demonstrating detrimental or no long-term effects of CU on PTSD symptoms. The overall goal of our study is to examine the interplay between posttraumatic stress symptoms and cannabis use behavior during the period immediately following trauma exposure. We will recruit and prospectively follow N=200 trauma-exposed regular cannabis users admitted to the general hospital emergency department after medical evaluation for traumatic injury. Upon discharge, participants will complete ecological momentary assessment (EMA) paired with wearable biosensors (smartwatch) to record CU behavior, symptom development, and physiological output (i.e., heart rate) during early trauma recovery. Participants will return for completion of clinical interview and self-report, as well as laboratory procedures to characterize fear extinction and physiological reactivity. The main goals of this research are to: (a) assess alterations in fear response and physiological reactivity associated with CU, (b) characterize the impact of posttraumatic stress symptoms on cannabis use behaviors, and (c) determine whether early markers of altered physiology and posttraumatic stress symptoms are makers for trajectories of long-term adverse cannabis-related outcomes (i.e., use disorder, problems, chronic/heavy use).

项目摘要 暴露于创伤与一系列负面结果（例如创伤后应激障碍）有关 （PTSD）和药物使用障碍，尤其是大麻。创伤后早期（即，几天，几周， 暴露后的几个月）代表了长期问题行为的关键风险时期，尤其是 在新兴成年人（18-25岁）中，构成持续发展的成年人 药物使用和增加创伤的风险增加。作为大麻的区域法律，文化和信念 使用（CU）继续转移，担心创伤暴露可能会加剧使用（通过自我调节）和 导致与大麻有关的问题更大，因为许多人报告使用大麻来缓解困扰， 高音和其他创伤后症状。此外，尽管我们大多数州 医疗用途的合法大麻包括压力和创伤的结果，例如PTSD，作为合格 国家发行的医用大麻许可证的条件，对大麻可能如何影响大麻的情况知之甚少 创伤后课程。鉴于内源性大麻素系统在调节压力中起着至关重要的作用 反应和学会的恐惧，急性创伤后时期的CU可能会改变有助于 恐惧神经记录的改变（例如，巩固/重新溶解，检索，灭绝的改变）和 生理反应性。但是，关于安全性和功效的有限（和矛盾）证据 大麻排除了有关其潜在治疗作用的强有力的结论，并进行了一些前瞻性研究 证明CU对PTSD症状的有害或没有长期影响。我们研究的总体目标是 在此期间检查创伤后应激症状与大麻使用行为之间的相互作用 创伤暴露后立即。我们将招募并前瞻性地遵循n = 200个创伤 医疗评估后，常规大麻使用者被接纳为急诊室 创伤性伤害。出院后，参与者将完成生态瞬时评估（EMA）配对 具有可穿戴生物传感器（智能手表）以记录CU行为，症状发展和生理学 早期创伤恢复期间的输出（即心率）。参与者将返回完成临床面试 和自我报告以及实验室程序，以表征恐惧灭绝和生理反应性。 这项研究的主要目标是：（a）评估恐惧反应和生理反应性的变化 与Cu相关，（b）表征创伤后应激症状对大麻使用行为的影响， （c）确定生理学和创伤后症状改变的早期标记是制造者 对于长期不良大麻相关结果的轨迹（即使用障碍，问题，慢性/重型 使用）。