Autonomous Digital CBT Intervention for Opioid Use Disorder in Individuals with Co-Occurring Internalizing Disorders

项目摘要 成瘾的流行神经科学特征是， 慢性药物使用最初是由增加快乐（冲动性药物使用），随着时间的推移， 神经适应性，如药物使用越来越多的动机是从负面影响（强迫使用）的救济。 成瘾的强迫阶段可以看作是一个“恶性循环”，因为短期内的负面缓解 通过药物使用产生的影响最终会通过对长期使用的神经适应而加剧负面影响。我们 早期的研究表明，这种恶性循环是维持酒精与 使用障碍（AUD）和内化障碍（焦虑和抑郁）。这为我们的工作提供了基础。 开发并验证了一种针对AUD合并症的认知行为治疗方案， 成瘾的恶性循环（VC-CBT）。此外，我们还开发了一种完全自主且易于扩展的 数字平台提供VC-CBT，已被证明与治疗师提供的版本一样有效。的 干预的重点是教育个人认识到恶性循环的可逆性，并对他们进行培训。 使用已被证明的应对技巧来管理负面影响，而不使用药物，可以显着帮助他们实现 理想的治疗目标。在这个项目中，我们利用神经科学的跨成瘾状态， VC-CBT干预的基础及其作为数字治疗的灵活性， 治疗阿片类药物使用障碍（OUD）中的合并症。与其他药物滥用相比， 从最初的冲动性使用到负强化的强迫性使用，已知是被截断的，并且几乎是普遍的 在那些经常使用阿片类药物的人中，以及那些同时发生内化障碍的人， 易受影响沿着OUD相对较高的致死率，使其成为理想的近期目标 反成瘾治疗为了实现这一目标，我们建议测试数字化交付的VC-CBT的临床疗效 在UG 3/UH 3项目中进行OUD-INTD协作，包括两个阶段。第一阶段的总体目标 是对已建立的数字化负面影响VC-CBT进行修改和试点测试，以供应用 在OUD中。第二阶段的首要目标是对改良的VC进行科学严谨的临床试验， CBT为OUD。这项工作的影响将是提供一个可扩展的和廉价的手段，以改善 在合并焦虑或抑郁的患者中，OUD治疗效果较差。而且 该项目将支持跨成瘾干预措施的可行性，这些干预措施的目标是多种成瘾者共同的过程。 成瘾类型

Project Summary The prevailing neuroscientific characterization of addiction is that of evolving neuro-behavioral responses to chronic drug use that are initially motivated by increasing pleasure (impulsive drug use) that over time causes neuro-adaptations such that drug use is increasingly motivated by relief from negative affect (compulsive use). The compulsive stage of addiction can be seen as a “vicious cycle” since the short-term relief from negative affect through drug use ultimately exacerbates negative affect through neuroadaptations to chronic use. Our early work demonstrated that the vicious cycle was a primary factor in maintaining comorbidity between alcohol use disorder (AUD) and internalizing disorders (anxiety and depression). This provided the ground work for the development and validation of a cognitive-behavioral therapy program for AUD comorbidity that directly targeted the vicious cycle of addiction (VC-CBT). Further, we developed a fully autonomous and easily scaled digital platform to deliver VC-CBT that has proved to be as effective as the therapist-delivered version. The intervention is premised on educating individuals about the reversibility of the vicious cycle, and training them to use proven coping skills to manage negative affect without drugs can significantly aid them in achieving desired treatment goals. In this project, we leverage the trans-addiction status of the neuroscientific underpinnings of the VC-CBT intervention and its flexibility as a digital therapeutic to develop and test a digital treatment for comorbidity in opioid use disorder (OUD). Relative to other drugs of abuse, the progression from initial impulsive use to negatively reinforced compulsive use is known to be truncated and nearly universal among those who routinely use opioids, and those with co-occurring internalizing disorders are especially susceptible. This, along with the relatively high lethality of OUD, makes it an ideal near-term target for this trans-addiction therapy. To achieve this, we propose to test the clinical efficacy of digitally-delivered VC-CBT for OUD-INTD comorbidity in a UG3/UH3 program consisting of two phases. The overarching aim of Phase 1 is the modification and pilot testing of the established digitally-delivered negative affect VC-CBT for application in OUD. The overarching aim of Phase 2 is to conduct a scientifically rigorous clinical trial of the modified VC- CBT for OUD. The impact of this work would be to provide a scalable and inexpensive means of improving the otherwise poor OUD treatment outcomes among those with co-occurring anxiety or depression. Moreover, the project would support the viability of trans-addiction interventions that target processes common to multiple addiction types.