Cue Reactivity Modulation in MSM with Methamphetamine Use Disorder

项目摘要 在阿片类药物流行期间，甲基苯丙胺的使用正在成为下一个物质使用危机， 男男性行为者（MSM）的发病率不成比例地增加，复发率高， FDA批准的治疗甲基苯丙胺使用障碍（MUD）的个人。的一个主要 复发的贡献者是对药物相关线索的增强的动机性唤醒（线索反应性），即使在 长期的禁欲导致渴望和寻求毒品的增加。虽然线索反应性研究 广泛存在于其他物质使用障碍中，其在MUD中的研究很少，在患有MUD的MSM中不存在， 在对疾病严重程度和治疗进行无偏见评估所需的知识方面存在重大差距 在这个快速增长的临床人群中。因此，在这项双阶段研究中，我们建议首先 甲基苯丙胺线索反应性心理生理学标志物及其与戒断潜伏期的鉴定 从甲基苯丙胺的使用和研究组之间的差异MSM和非MSM MUD。 随后，在第二阶段，我们建议纵向评估线索反应性的孵化，其 减少认知重新评价（CR;自我调节技术），并检查CR对临床的影响 结果在MSM与MUD。根据我们小组的初步发现，我们假设LPP， 脑电图衍生的药物线索反应标记，将跟踪甲基苯丙胺的潜伏期 提示反应性及其CR介导的降低，这反过来又与改善的临床结局相关 在MSM与MUD。在R61阶段，我们将对LPP评估的线索反应性进行横断面比较 目前使用（第1组）和禁欲（1-3个月;第2组）的MUD个体（50%的MSM， 每组，HIV状态匹配），并用CR技术检查任务中线索反应性的变化。在 R33阶段，我们将MUD队列分配到CR+（认知重新评估培训）或CR-（无 认知再评价培训）组（所有男男性接触者，艾滋病毒状态匹配），并将评估线索反应性 在开始禁欲后<2周、2个月至3个月纵向观察。成功完成这些 目的是确定一个基于脑电图的，客观的，临床上有用的甲基苯丙胺线索反应性标记， 并将描述CR对甲基苯丙胺线索反应性的影响， MSM与MUD这项工作将是对孵化作用机理研究的开始。 甲基苯丙胺线索反应性及其减少作为一个可靠的和临床上有意义的结果措施， 建立一个经验基础，以开发一种干预MUD和可能在其他成瘾。

PROJECT SUMMARY In the midst of the opioid epidemic, methamphetamine use is emerging as the next substance use crisis with disproportionately increasing prevalence in men who have sex with men (MSM), high relapse rates and no FDA-approved treatments for individuals with methamphetamine use disorder (MUD). One of the major contributors to relapse is the enhanced motivated arousal (cue-reactivity) to drug-related cues, even after protracted abstinence that leads to an increase in craving and drug-seeking. Although cue-reactivity is studied widely in other substance use disorders, its study is scarce in MUD and non-existent in MSM with MUD, creating a critical gap in knowledge needed for unbiased assessment of disease severity and treatment outcomes in this rapidly growing clinical population. Therefore, in this bi-phased study, we propose to first identify a psychophysiological marker of methamphetamine cue-reactivity and its incubation with abstinence from methamphetamine use and examine group-differences between MSM and non-MSM MUD. Subsequently, in the second phase we propose to longitudinally assess incubation of cue-reactivity, its reduction with cognitive reappraisal (CR; a self-regulation technique) and examine the impact of CR on clinical outcomes in MSM with MUD. In light of preliminary findings from our group, we hypothesize that LPP, an electroencephalography-derived marker of drug cue-reactivity, will track the incubation of methamphetamine cue-reactivity and its CR-mediated reduction, which in turn will be associated with improved clinical outcomes in MSM with MUD. In the R61 phase, we will cross-sectionally compare the LPP-assessed cue-reactivity between currently using (Group 1) and abstinent (1-3 months; Group 2) individuals with MUD (50% MSM in each group, matched on HIV status), and examine in-task changes in cue-reactivity with CR technique. In the R33 phase, we will assign a cohort of MUD to either the CR+ (Cognitive Reappraisal training) or the CR- (no Cognitive Reappraisal training) group (all MSM, matched on HIV status), and cue-reactivity will be assessed longitudinally at <2 weeks, 2 months, to 3 months after abstinence initiation. Successful completion of these aims will identify an EEG-based, objective, and clinically useful marker of methamphetamine cue-reactivity, and will delineate the impact of CR on methamphetamine cue-reactivity in relation to treatment response in MSM with MUD. This work will be the beginning of mechanistic research into the role of incubation of methamphetamine cue-reactivity and its reduction as a reliable and clinically meaningful outcome measure, establishing an empirical foundation to develop an intervention for MUD and possibly in other addictions.