Prevention of Relapse in Addiction

我们这一部分的一个主要举措是通过使用生态瞬时评估(EMA)来检查暴露于假定的复发触发因素(如环境线索和压力)中的作用。我们正在使用美沙酮维持的门诊患者和参加体重维持计划的肥胖者进行海洛因/可卡因的研究。参与者携带电子日记，以记录可能的复发诱因的基本暴露比率，以及在复发期间这些诱因的存在。我们还在探索在患者的日常环境中使用手持电子设备进行治疗。我们目前研究的另一个重点来自实验室动物数据，该数据表明，阿尔法肾上腺素能激动剂可乐定可以防止应激诱导的可卡因和/或海洛因寻找的恢复，而CB1拮抗剂利莫那班可以防止提示诱导的这种药物寻找的恢复。我们正在进行两项可乐定试验，一项是评估其对压力和药物提示的反应的效果，另一项是评估其预防复发的效果。我们目前正在进行一项研究，在这项研究中，服用美沙酮的门诊患者全天携带手持计算机，以提供有关海洛因和可卡因的渴望、吸毒失误和假定失误沉淀剂的基本比率的实时数据。我们已经证明了这种形式的数据收集在我们的人群中的可行性，并将它们用于可乐定试验，以确定其预防复发的效果是否针对复发亚型。最后，我们正在与芝加哥大学的研究人员合作进行一项两点研究，以调查戒烟者渴望的时间过程，特别关注潜伏期的可能性，这是临床前研究中看到的一种现象，即渴望随着戒烟时间的延长而增加。潜伏的渴望可能有助于解释以前依赖尼古丁、酒精或非法药物的人长期易复发的原因。

A major initiative for our section is to examine the role of exposure to putative relapse triggers (such as environmental cues and stress) through the use of ecological momentary assessment (EMA). We are conducting studies in heroin/cocaineusing methadone-maintained outpatients and in obese individuals who are in a weight-maintenance program. Participants carry electronic diaries to record the base rates of exposure to putative relapse triggers as well as the presence of these triggers during relapse. We are also exploring the use of handheld electronic devices for treatment delivery in patients daily environment. Another current focus of our research derives from laboratory-animal data showing that stress-induced reinstatement of cocaine seeking and/or heroin seeking can be prevented with the alpha-adrenergic agonist clonidine, while cue-induced reinstatement of such drug seeking can be prevented with the CB1 antagonist rimonabant. We are conducting two trials of clonidine, one to evaluate its effect on response to stress and drug cues, and the second to evaluate its efficacy in relapse prevention. We are currently conducting a study in which methadone-maintained outpatients carry handheld computers throughout the day to provide real-time data on cravings for heroin and cocaine, lapses to drug use, and base rates of putative lapse precipitants. We have demonstrated the feasibility of this form of data collection in our population and are using them in the clonidine trial to determine whether its relapse- prevention effect is specific to subtypes of relapse. Finally, we are collaborating with investigators at the University of Chicago on a two-site study to investigate the time course of craving in abstinent smokers, with particular attention to the possibility of incubation, a phenomenon seen in preclinical studies, in which craving increases with duration of abstinence. Incubation of craving may help explain the long-lasting vulnerability to relapse in individuals formerly dependent on nicotine, alcohol, or illicit drugs.