Prevention of Relapse in Addiction

本节的一个主要倡议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）的作用。我们正在对使用美沙酮维持的海洛因/可卡因门诊患者和正在进行体重维持计划的肥胖个体进行研究。参与者携带电子日记，记录可能的复发诱因的基本暴露率，以及这些诱因在复发期间的存在。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。我们目前研究的另一个重点来自实验动物数据，这些数据表明，应激诱导的可卡因和/或海洛因寻求的恢复可以用α -肾上腺素能激动剂可乐定来预防，而提示诱导的这种药物寻求的恢复可以用CB1拮抗剂利莫那班来预防。我们正在进行两项可乐定试验，一项是评估其对应激反应和药物提示的影响，另一项是评估其预防复发的功效。我们目前正在进行一项研究，在这项研究中，使用美沙酮的门诊病人全天携带掌上电脑，以提供对海洛因和可卡因的渴望、药物使用的缺失以及假定的缺失沉淀物的基本比率的实时数据。我们已经在我们的人群中证明了这种形式的数据收集的可行性，并在可乐定试验中使用它们来确定其预防复发的效果是否特定于复发亚型。最后，我们正在与芝加哥大学的研究人员合作进行一项两地研究，调查戒烟者渴望的时间过程，特别注意潜伏期的可能性，这是临床前研究中看到的一种现象，在这种现象中，渴望随着戒烟的持续时间而增加。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.