Brain-to-brain neurofeedback during naturalistic dynamic stimuli to reduce craving in heroin addiction

自然动态刺激期间的脑对脑神经反馈可减少海洛因成瘾的渴望

• 批准号: 10725836
• 负责人: Rita Z Goldstein
• 金额: $ 25.35万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10725836
• 关键词: Abstinence; Alcohols; Attention; Brain; Brain region; COVID-19 pandemic; Cannabis; Characteristics; Chronic; Complex; Coupling; Cues; Data; Development; Disease; Drug Addiction; Drug usage; Early treatment; Environment; Feedback; Functional Magnetic Resonance Imaging; Goals; Habits; Heroin; Heroin Dependence; Human; Individual; Inpatients; Intervention; Knowledge; Learning; Longitudinal Studies; Measures; Memory; Morbidity - disease rate; Neurobiology; Neurocognitive; Neurons; Neurosciences; Opioid; Overdose; Participant; Pattern; Permeability; Persons; Pharmaceutical Preparations; Process; Protocols documentation; Public Health; Recovery; Relapse; Rewards; Sampling; Self Direction; Signal Induction; Signal Transduction; Smoker; Stimulant; Stimulus; Substance Use Disorder; Synaptic Transmission; Testing; Time; Training; Work; addiction; alcohol use disorder; behavioral study; brain based; brain behavior; craving; cue reactivity; drug craving; drug of abuse; executive function; experience; heroin use; imaging study; improved; improved outcome; innovation; interest; medication-assisted treatment; mortality; movie; neural; neural circuit; neural patterning; neurofeedback; non-drug; novel; opioid epidemic; opioid overdose; opioid use disorder; overdose death; recruit; reinforcer; response; scaffold; successful intervention

The opioid epidemic remains a major public health crisis in the US, with relapse rates and overdose-related fatalities continuing to rise. However, the mechanistic explorations of viable interventions in individuals with opioid use disorder have been particularly scarce. Here we will explore a novel brain-based intervention to decrease craving in individuals with heroin use disorder (iHUD) in early treatment. A core characteristic of drug addiction is an enhanced reactivity to drug related cues and reduced processing of other reinforcers in the natural environment, as reliably observed across numerous brain networks and associated with enhanced craving (a predictor of drug use outside the lab). Our recent studies in iHUD suggest that this brain-behavior cue-induced biased pattern improves with abstinence/treatment. Therefore, we will test whether preemptively changing such neural cue reactivity could expedite the recovery process as measured with reduced drug craving. Specifically, we hypothesize that training can help iHUD achieve an intentional modulation of their cue reactivity signal. Using one’s own brain signal, real-time fMRI neurofeedback (rt-fMRI NF) allows participants to volitionally modulate brain activity in targeted brain regions shown in smokers and heavy alcohol drinkers to be effective in reducing drug cue neural reactivity, as associated with abstinence/decreases in craving. However, the permeability of this approach is not uniform. Here for the first time, we will test whether the NF effect can be enhanced by using the signal derived from the brains of others (i.e., brain-to-brain neural transmission). Specifically, our first aim in this cutting-edge exploratory application is to identify the brain regions that distinguish between early (abstinent for <1 month) as compared to later (abstinent for >3 months) time-in-treatment in iHUD. Our second aim is to use the unique multivariate neural patterns derived later in treatment as NF provided to a newly recruited sample of iHUD in early treatment, with the goal of increasing neuronal coupling between both groups. To increase ecological validity and better approximate actual real-world experiences in iHUD, the stimulus is a dynamic, narrative-based, and context-rich movie. Our working hypothesis is that, as compared to iHUD in early treatment where drug cue reactivity is more automatic and harder to control (impacting non drug processing), recovering individuals are better able to regulate it allowing them to reduce craving (and curtail, or entirely eliminate, drug- seeking) even in potent drug-related situations. Therefore, during rt-fMRI NF, we expect greater recovery (and lower cue-induced craving) in the new sample of iHUD early in treatment who show the most neural coupling/alignment with the neural patterns of those in later recovery. In short, in this innovative R21 proposal we will answer the following question: Can the neural patterns of addicted individuals in later recovery be used to provide scaffolding for the nascent recovery process early in treatment, helping to reduce craving? Results of this proof-of-concept study can be used in later longitudinal studies to develop real-time NF-based training to improve outcomes in iHUD as generalizable to other substance use disorders.

阿片类药物流行仍然是美国的一大公共卫生危机，与复发率和过量用药有关 死亡人数继续上升。然而，对患有糖尿病的个体进行可行干预的机械性探索 阿片类药物使用障碍尤其罕见。在这里，我们将探索一种新的基于大脑的干预方法，以 在早期治疗中减少海洛因使用障碍(IHUD)患者的渴求。毒品的核心特征 成瘾是一种对与药物有关的线索的反应增强，以及对自然界中其他增强剂的处理减少。 环境，正如在许多大脑网络中可靠地观察到的，并与增强的渴望(a 实验室外药物使用的预测指标)。我们最近在伊胡德的研究表明，这种大脑行为线索诱导 有偏见的模式随着禁欲/治疗的改善而改善。因此，我们将测试是否先发制人地改变这种 神经线索的反应性可以加快恢复过程，这是通过减少对药物的渴望来衡量的。具体来说， 我们假设训练可以帮助Ihud实现对其线索反应信号的有意调制。vbl.使用 一个人自己的大脑信号，实时功能磁共振神经反馈(RT-fMRI NF)允许参与者自愿调节 吸烟者和大量饮酒者靶向大脑区域的大脑活动显示对减少 药物提示神经反应性，与禁欲/减少渴望有关。然而，这一渗透性 方法并不统一。在这里，我们将首次测试是否可以通过使用 来自他人大脑的信号(即脑与脑之间的神经传递)。具体地说，我们的首要目标是 最前沿的探索性应用是识别大脑中区分早期(禁欲)的区域 &lt；1个月)，而在伊胡德的治疗时间较晚(戒酒3个月)。我们的第二个目标是使用 在后来的治疗中作为神经营养因子提供给新招募的样本的独特的多变量神经模式 Ihud早期治疗，目标是增加两组之间的神经元耦合。增加 生态有效性和更接近伊胡德实际世界的经验，刺激是动态的， 以叙事为基础，背景丰富的电影。我们的工作假设是，与早期治疗的伊胡德相比 药物线索反应性更自动且更难控制(影响非药物处理)，恢复 个体能够更好地调节它，允许他们减少对毒品的渴望(并减少或完全消除毒品-- 寻求)，即使在与毒品有关的强烈情况下也是如此。因此，在RT-fMRI NF期间，我们预计会有更大的恢复(和 在治疗早期的Ihud新样本中，谁表现出最多的神经质 与恢复后期的神经模式相结合/对齐。简而言之，在这个创新的R21提案中 我们将回答以下问题：在后来的康复中，成瘾个体的神经模式是否可以使用 在治疗的早期为新生的康复过程提供脚手架，帮助减少渴望？结果： 这项概念验证研究可用于以后的纵向研究，以开发基于神经营养的实时培训，以 改善Ihud的结果，可推广到其他物质使用障碍。