Cognitive Predictors of Alcoholism Pharmacotherapy

描述（由申请人提供）：认知功能，已知在酗酒者中是可变的，在许多关于酒精依赖的社会心理和认知行为治疗的研究中已被证明可以预测酒精治疗的结果。药物治疗是治疗酒精依赖的一种相对较新的选择，它代表了酒精使用障碍患者的另一种治疗选择，但并不是所有人都对这种治疗有反应。因此，旨在预测哪些个体将从药物治疗中受益的研究对于告知治疗决策是有价值的。然而，认知功能是否可以预测药物治疗的结果尚未确定。一种用于治疗酒精依赖的药物是一种叫做纳曲酮的阿片类镇静剂。作为一项为期12周的纳曲酮临床试验的辅助研究，拟议的研究将在现有的方案中增加神经心理学评估，以确定认知功能是否可以预测药物治疗的结果。此外，正在进行两项单独资助的正在进行的研究，以调查参与临床药物试验的同一受试者中阿片系统活性的个体差异。这些研究将通过PET成像测量对纳曲酮挑战和mu阿片受体结合的反应来研究阿片系统活性。由于这些调查将在相同的受试者池中进行，因此拟议的研究还将检查认知功能和阿片系统活动之间的关系作为次要目的。本研究通过解决先前关于酒精治疗结果的认知预测因素研究的方法和概念上的缺陷，代表了先前工作的延伸。本研究的主要目的是确定认知测试表现与纳曲酮治疗结果之间的关系，并检查与认知功能不同模式相关的因素。次要目的是表征整个戒断期的认知功能，并检查认知功能和阿片系统活动之间的关系。

DESCRIPTION (provided by applicant): Cognitive functioning, known to be variable among alcoholic individuals, has been shown to predict alcohol treatment outcomes in a number of studies regarding psychosocial and cognitive-behavioral treatment for alcohol dependence. A relatively newer option for the treatment of alcohol dependence, pharmacotherapy, represents an alternative treatment option for patients with alcohol use disorders, but not all individuals respond to this type of treatment. Accordingly, studies aimed at predicting which individuals will benefit from pharmaceutical treatment are valuable in informing treatment decisions. Whether cognitive functioning can predict outcomes for pharmacotherapy, however, has not been established. One type of drug used in the treatment of alcohol dependence is an opioid antogonist called naltrexone. As an adjunct to a 12-week naltrexone clinical trial, the proposed study will add neuropsychological assessment to an existing protocol to determine whether cognitive functioning can predict pharmacotherapy treatment outcomes. Additionally, two separately funded ongoing investigations are being conducted to investigate individual differences in opioid system activity in the same subjects who are part of the clinical drug trial. These investigations will employ responses to a naltrexone challenge and mu opioid receptor binding as measured through PET imaging in investigating opioid system activity. Because these investigations will be conducted with the same pool of subjects, the proposed study will also examine the relation between cognitive functioning and opioid system activity as a secondary aim. This investigation represents an extention of prior work by addressing methodological and conceptual shortcomings of previous studies of cognitive predictors of alcohol treatment outcomes. The primary aims of this investigation are to determine the relation between cognitive test performance and naltrexone treatment outcomes and to examine factors associated with differential patterns of cognitive functioning over time. Secondary aims are to characterize cognitive functioning throughout the withdrawal period, and to examine the relation between cognitive functioning and opioid system activity.