Role of delay discounting in driving HIV sexual risk behavior in cocaine abuse

延迟贴现在驱动可卡因滥用中艾滋病毒性危险行为中的作用

• 批准号: 8328746
• 负责人: Matthew Wayne Johnson
• 金额: $ 32.4万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8328746
• 关键词: AIDS prevention; AIDS/HIV problem; Abstinence; Acute; Address; Animals; Automobile Driving; Behavior; Behavior assessment; Behavioral; Characteristics; Chronic; Cocaine; Cocaine Abuse; Data; Decision Making; Dose; Drug abuse; Epidemiology; Equipment; Food; Future; General Population; Goals; Grant; HIV; HIV Infections; Human; Impulsivity; Incidence; Individual; Infection; Intoxication; Laboratory Study; Measures; Methods; Neurosciences; Oral; Outcome; Participant; Patient Self-Report; Personality; Pharmaceutical Preparations; Placebos; Play; Prevention education; Principal Investigator; Process; Psychology; Public Health; Qualitative Research; Questionnaires; Relative (related person); Research; Research Methodology; Rewards; Risk; Risk Behaviors; Role; Sexual Partners; Sexually Transmitted Diseases; Testing; Unsafe Sex; clinically relevant; cocaine exposure; condoms; delay sex; discount; discounting; improved; indexing; intravenous injection; non-drug; novel; preference; reinforcer; response; sex; sex risk; tool; treatment effect

DESCRIPTION (provided by applicant): In addition to the sharing of intravenous injection equipment, a major contribution of drug abuse to HIV risk involves the association of cocaine abuse with increased HIV sexual risk behavior and HIV infection. Little is known about decision-making processes contributing to sexual risk behavior, particularly in cocaine abuse. 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 is typically indexed in laboratory studies by preference for smaller sooner over larger later rewards. Delay discounting has been shown to be widely relevant to drug abuse, primarily by studies showing that drug-abusing individuals have higher discounting rates (i.e., are more impulsive, or value future consequences less) than non-abusing individuals. Several animal studies show that chronic exposure to cocaine causes long lasting increases in delay discounting for food reinforcers (i.e. preference for smaller sooner over larger later food), even after prolonged abstinence from cocaine. Under an R21 grant the principal investigator developed a novel task assessing the discounting of delayed sexual rewards (i.e., sexual discounting). The task uses clinically relevant hypothetical choices between unprotected sex now vs. waiting for sex with a condom, in reference to the photograph of an individual judged as sexually desirable by the participant. Preliminary data in cocaine-abusing individuals suggest that the discounting of sexual rewards correlates with self-report sexual risk behavior, and follows the same mathematical form characteristic of the discounting of other rewards in humans and animals. Furthermore, discounting of sexual rewards was sensitive to two manipulations. That is, participants were more likely to prefer immediate unprotected sex in response to more desirable partners, and in response to partners judged least likely to have a sexually transmitted disease. Two studies are proposed that will systematically extend this line of research to determine the relationship between sexual discounting and HIV sexual risk behavior among cocaine-abusing individuals. One study will test whether cocaine-abusing individuals show greater sexual discounting than matched control non-drug users to determine if sexual discounting relates to cocaine abuse status. The second study will administer placebo and 2 doses of oral cocaine to non-treatment seeking cocaine-abusing individuals to determine the causal role of cocaine intoxication on sexual discounting. Collectively, these studies will develop and provide clinically meaningful data on a new and empirically supported tool for examining sexual risk behavior. Ultimately, completion of this project will increase our understanding of sexual HIV risk behavior and therefore inform HIV prevention and education efforts. PUBLIC HEALTH RELEVANCE: Two studies will be conducted in order to understand the basic-decision making mechanisms that drive the high rates of HIV sexual risk behavior and HIV infection rates in cocaine-abusing individuals. More specifically, the studies will explore whether the devaluation of future consequences (called delay discounting) is a factor that underlies HIV sexual risk behavior. Because risk behavior associated with cocaine abuse is known to result in public health harms through sexual HIV risk behavior, these studies will improve HIV prevention and education efforts within cocaine-abusing individuals by determining which decision-making processes are most relevant to risk behavior.

描述（由申请人提供）：除了共用静脉注射设备外，药物滥用对艾滋病毒风险的一个主要贡献涉及可卡因滥用与艾滋病毒性风险行为和艾滋病毒感染增加的关联。人们对导致性危险行为的决策过程知之甚少，特别是在可卡因滥用方面。一个与性风险行为潜在相关的决策过程是延迟折扣，这被认为是冲动性的一个方面。延迟折扣指的是延迟奖励会降低其主观价值的观察结果，在实验室研究中通常是通过偏好较小的较早奖励而不是较大的较晚奖励来索引的。延迟折扣已被证明与药物滥用广泛相关，主要是研究表明，滥用药物的人比不滥用药物的人有更高的贴现率（即，更冲动，或更不重视未来的后果）。几项动物研究表明，即使在长期戒断可卡因之后，长期接触可卡因也会导致对食物强化物的延迟折扣长期增加（即对较小的食物的偏好，而不是较大的食物）。在R21资助下，首席研究员开发了一项新任务，评估延迟性奖励的折扣（即性折扣）。这项任务使用了临床相关的假设选择，在现在无保护的性行为和等待带避孕套的性行为之间，参考被参与者认为具有性吸引力的个体的照片。可卡因滥用者的初步数据表明，对性奖励的折扣与自我报告的性风险行为有关，并且遵循与人类和动物对其他奖励的折扣相同的数学形式。此外，性奖励折扣对两种操作都很敏感。也就是说，参与者更倾向于立即发生无保护措施的性行为，以回应更理想的伴侣，以及被认为最不可能患有性传播疾病的伴侣。提出了两项研究，将系统地扩展这一研究路线，以确定可卡因滥用者的性折扣与艾滋病毒性风险行为之间的关系。一项研究将测试可卡因滥用者是否比对照组非吸毒者表现出更大的性折扣，以确定性折扣是否与可卡因滥用状况有关。第二项研究将给未接受治疗的寻求可卡因滥用者服用安慰剂和2剂口服可卡因，以确定可卡因中毒对性折扣的因果作用。总的来说，这些研究将开发并提供临床有意义的数据，为检查性风险行为提供新的经验支持工具。最终，该项目的完成将增加我们对性艾滋病毒风险行为的了解，从而为艾滋病毒预防和教育工作提供信息。