Sexual HIV Risk Behavior and Impulsive Decision Making in Cocaine Dependence

描述（由申请人提供）：除了共用静脉注射设备外，药物依赖对HIV风险的另一个主要贡献涉及可卡因依赖与增加的性HIV风险行为的关联。人们对导致性风险行为的决策过程知之甚少，特别是在可卡因依赖中。与性风险行为潜在相关的决策过程是延迟折扣，这被认为是冲动的一个方面。延迟折扣是指观察到延迟奖励会降低其主观价值，延迟折扣任务使用选择程序来量化未来奖励价值随时间减少的速率。延迟折扣已被证明与药物依赖性广泛相关;主要是通过研究表明依赖性个体具有较高的折扣率（即，比不依赖他人的人更冲动，或更不重视未来的后果。最近的证据还表明，延迟折扣任务可以预测谁将成功地实现戒毒治疗。这项拟议的研究将检查可卡因依赖者中延迟折扣和性艾滋病毒风险行为之间的关系。两组各57名可卡因依赖者，在相关人口统计学上相匹配，将在一次研究中进行检查：1）那些在艾滋病毒性风险行为上得分高的人，2）那些在艾滋病毒性风险行为上得分低的人。将使用主要研究者之前使用的程序，在各种结局条件下（收益与损失、多个量级以及使用假设和潜在的真实的奖励）广泛检查延迟折扣。由于冲动被认为是一个多方面的结构，为了提供对可卡因依赖性风险行为中冲动的全面评估，该研究还将包括评估与延迟折扣不同的冲动形式的任务，特别是概率折扣（程序上类似于延迟贴现，但评估对不确定结果的敏感性，而不是延迟结果），以及Barratt冲动量表-11，一份测量冲动的问卷。如果延迟折扣被发现与性风险行为有关，那么它将提供一个丰富的理论框架，由人类和非人类动物研究提供信息，从中了解和预防性风险行为。本研究的成功完成将通过识别导致性风险行为的决策过程，为可卡因依赖人群的HIV预防工作提供临床相关信息。例如，性风险行为包括评估延迟和不确定的后果，积极和消极的后果，以及小的和大的后果。了解这些决策过程有助于性风险行为可能有助于告知艾滋病毒预防工作，指出最有效的语言用于媒体宣传，提高决策技能，在最相关的领域，并指出自我控制技术，以避免性风险行为。公共卫生相关性：将在可卡因依赖者中进行行为研究，比较性HIV风险行为得分高的人与性HIV风险行为得分低的人，以评估与性HIV风险行为相关的基本决策过程。将评估各种冲动和决策措施，以确定哪些决策过程与从事性艾滋病毒风险行为最相关。由于与可卡因依赖相关的冲动性已知会通过性HIV风险行为导致公共卫生危害，因此本研究将通过确定哪些决策过程与HIV预防工作中的目标最相关来改善可卡因依赖者中的HIV预防工作。

DESCRIPTION (provided by applicant): In addition to the sharing of intravenous injection equipment, another major contribution of drug dependence to HIV risk involves the association of cocaine dependence with increased sexual HIV risk behavior. Little is known about decision-making processes contributing to sexual risk behavior, particularly in cocaine dependence. A decision-making process of potential relevance to sexual risk behavior is delay discounting, which is considered an aspect of impulsivity. Delay discounting refers to the observation that delaying a reward reduces its subjective value, and delay discounting tasks use choice procedures to quantify the rate at which the value of a future reward decreases over time. Delay discounting has been shown to be widely relevant to drug dependence; primarily by studies showing that dependent individuals have higher discounting rates (i.e., are more impulsive, or value future consequences less) than non-dependent individuals. Recent evidence also suggests that delay-discounting tasks can predict who will be successful in achieving abstinence in drug treatment. The proposed research will examine the relationship between delay discounting and sexual HIV risk behaviors among cocaine-dependent individuals. Two groups of 57 cocaine-dependent individuals each, matched on relevant demographics, will be examined in a single research session: 1) those scoring high on HIV sexual risk behaviors, and 2) those scoring low on HIV sexual risk behaviors. Delay discounting will be extensively examined in a variety of outcome conditions (gains versus losses, multiple magnitudes, and using hypothetical and potentially real rewards) using procedures previously employed by the principal investigator. Because impulsivity is recognized to be a multifaceted construct, and in order to provide a comprehensive assessment of impulsivity in sexual risk behavior in cocaine dependence, the study will also include tasks thought to assess forms of impulsivity distinct from delay discounting, specifically, probability discounting (procedurally similar to delay discounting, but assessing sensitivity to uncertain rather than delayed outcomes), and the Barratt Impulsivity Scale-11, a questionnaire measure of impulsivity. If delay discounting were found to be relevant to sexual risk behavior, then it would provide a rich theoretical framework, informed by both human and nonhuman animal studies, from which to understand and prevent sexual risk behavior. Successful completion of this study will provide information of clinical relevance for HIV prevention efforts in cocaine dependent populations by identifying the decision-making processes contributing to sexual risk behavior. For example, sexual risk behavior involves evaluating both delayed and uncertain consequences, both positive and negative consequences, and both small and large consequences. Knowing which of these decision-making processes contributes to sexual risk behavior may help to inform HIV prevention efforts by indicating the most effective language for use in media campaigns, improving decision-making skills in the most relevant domain, and indicating self-control techniques for avoiding sexual risk behavior. PUBLIC HEALTH RELEVANCE: A behavioral study in cocaine dependent individuals will be conducted comparing those scoring high in sexual HIV risk behavior versus those scoring low in sexual HIV risk behavior in order to evaluate the basic decision-making processes related to sexual HIV risk behavior. A variety of impulsivity and decision-making measures will be assessed in order to determine which decision-making process are most relevant to engaging in sexual HIV risk behavior. Because impulsivity associated with cocaine dependence is known to result in public health harms through sexual HIV risk behavior, this study will improve HIV prevention efforts within cocaine dependent individuals by determining which decision-making processes are most relevant to target in HIV prevention efforts.