Prevention of Relapse in Addiction

预防成瘾复吸

• 批准号: 7593304
• 负责人: Kenzie Preston
• 金额: $ 128.43万
• 依托单位: NATIONAL INSTITUTE ON DRUG ABUSE
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/7593304
• 关键词: Abstinence; Adrenergic alpha-Agonists; Alcohols; Attention; Chicago; Clonidine; Cocaine; Cues; Daily; Data; Data Collection; Devices; Drug usage; Electronics; Environment; Exposure to; Goals; Handheld Computers; Heroin; Human; Illicit Drugs; Individual; Intervention; Laboratories; Methadone; Modeling; Nicotine; Obesity; Outpatients; Participant; Patients; Pharmaceutical Preparations; Population; Rate; Relapse; Research; Research Personnel; Role; Site; Smoker; Stress; Testing; Time; Universities; addiction; animal data; base; craving; day; diaries; disorder later incidence prevention; pre-clinical; preclinical study; prevent; programs; response; rimonabant; weight maintenance

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.

本节的一个主要举措是通过使用生态瞬时评估（EMA）来研究暴露于假定的复发触发因素（如环境线索和压力）的作用。 我们正在对使用美沙酮维持治疗的门诊患者和正在进行体重维持治疗的肥胖患者进行研究。 参与者携带电子日记，记录暴露于假定复发触发因素的基本比率以及复发期间这些触发因素的存在。 我们也在探索在患者的日常环境中使用手持电子设备进行治疗。 我们研究的另一个当前焦点来自实验室动物数据，这些数据显示，压力诱导的可卡因寻求和/或海洛因寻求的恢复可以用α-肾上腺素能激动剂可乐定预防，而线索诱导的这种药物寻求的恢复可以用CB 1拮抗剂利莫那班预防。 我们正在进行两项可乐定的试验，一项是评估它对压力和药物线索的反应，另一项是评估它在预防复发方面的疗效。 我们目前正在进行一项研究，在这项研究中，美沙酮维持门诊患者全天携带手持电脑，以提供对海洛因和可卡因的渴望，药物使用的失误以及推定的失误率的实时数据。 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，并正在可乐定试验中使用它们来确定其复发预防效果是否特异于复发的亚型。 最后，我们正在与芝加哥大学的研究人员合作进行一项两地研究，以调查戒烟者的渴望时间进程，特别关注潜伏期的可能性，这是一种在临床前研究中发现的现象，即渴望随着戒烟时间的延长而增加。 渴望的潜伏期可能有助于解释以前依赖尼古丁、酒精或非法药物的个体长期易复发的原因。