Cognitive Reappraisal for Mitigating Incubation of Cocaine Cue-Reactivity

减轻可卡因线索反应潜伏期的认知重新评估

• 批准号: 10812738
• 负责人: Muhammad Adeel Parvaz
• 金额: $ 81.59万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10812738
• 关键词: Abstinence; Accounting; Affect; Affective; Aftercare; Alcohols; Arousal; Attention; Attenuated; Back; Behavior Therapy; Behavioral; COVID-19 pandemic; Cessation of life; Chronic; Clinic; Clinical; Clinical Research; Cocaine; Cocaine Users; Cocaine use disorder; Cognitive; Control Groups; Cross-Sectional Studies; Cues; Data; Down-Regulation; Drug Addiction; Drug usage; Electroencephalography; Enrollment; Evidence based intervention; Exposure to; Foundations; Incubated; Individual; Intervention; Longitudinal Studies; Measures; Mediating; Minority; Neurocognitive; Outcome; Outcome Measure; Participant; Patient Self-Report; Pharmaceutical Preparations; Population; Prediction of Response to Therapy; Procedures; Process; Randomized; Regulation; Relapse; Reporting; Research; Research Personnel; Smoker; Substance Use Disorder; Surveys; Techniques; Testing; Time; Training; United States; addiction; attentional bias; clinical effect; clinical outcome assessment; clinically significant; cocaine cue; cocaine overdose; cocaine relapse prevention; cocaine use; cognitive process; cognitive reappraisal; comparison control; craving; cue reactivity; drug seeking behavior; emotion regulation; follow-up; gaze; human study; improved; innovation; novel; outcome prediction; predict clinical outcome; prolonged abstinence; public health emergency; randomized, controlled study; reduced substance use; relapse prediction; relapse prevention; substance use; treatment research; treatment response; visual tracking

SUMMARY Cocaine use is endemic nationwide. According to a national survey, over 2.5% of the population of individuals 12 years and older reported crack or cocaine use in the past year, accounting for over 10,000 deaths related to cocaine overdose. Recent data suggests that the COVID-19 pandemic has exacerbated substance use in the United States. Only a small minority of cocaine users seek formal treatment for their addiction, and even in those who do, the relapse rate remains disturbingly high with some studies reporting rates as high as 90%, 12 months after treatment. Relapse in addicted individuals is presumed to precipitate from the re-exposure to cues that were previously associated with drug use. Over the course of chronic drug use, these cues are afforded enhanced attention (or attention-bias), which has shown to promote motivated arousal, culminating in compulsive drug-seeking or relapse. We have used the late positive potential (LPP), an EEG-derived marker of motivated arousal to show that, unlike commonly believed, arousal to drug cues (or cue-reactivity) increases (or incubates) during the first six months of abstinence. Such incubation of cue-reactivity is posited to confer disproportionately high relapse vulnerability in addicted individuals. Our recently acquired follow-up data show that addicted individuals are able to down-regulate drug cue-reactivity (as evident via a decrease in LPP amplitude) via cognitive reappraisal (an emotion-regulation technique) training, which then leads to a reduction in spontaneous attention-bias to drug cues (quantified using eye-tracking). Here, we propose to integrate the two pieces of evidence to test whether cognitive reappraisal training can reduce the incubation of drug cue-reactivity (Aim 1) and improve clinical outcomes (e.g., reduce craving and prolong cocaine abstinence duration; Aim 2) during the first 6 months of abstinence in individuals with cocaine use disorder (iCUD). We will further explore whether changes in attention-bias to drug cues and/or blunting of incubation of cue-reactivity tracks treatment response and predicts clinical outcomes at 6 months follow-up (exploratory aim). For this purpose, we propose to enroll 126 iCUD, half of whom will be randomized to undergo cognitive reappraisal training and the other half will instead complete a control task. In this longitudinal study, participants will complete these procedures at 1-week, 1-, 3-, and 5-months post abstinence initiation, and will then come back one month after (at 6 months post abstinence initiation) for the assessment of clinical outcomes. Thus, this novel study aims to bridge between the lab and the clinic by advancing basic mechanistic understanding of a novel evidence-based intervention to provide cognitive markers for tracking treatment response and predicting outcomes in addiction. Successful completion of this study would lay the foundation for further basic and clinical studies that will examine other putative mechanisms and potentially also use the same framework for the neurocognitive examination of similar cognitive interventions in other substance use disorders as well as in other behavioral addictions.

总结 可卡因是全国性的地方病。根据一项全国性的调查，超过2.5%的人口 12岁及以上的人在过去一年中报告了快克或可卡因的使用，造成了10，000多人死亡， 可卡因过量最近的数据表明，COVID-19大流行加剧了 美国的只有一小部分可卡因使用者寻求正式治疗，即使在那些 但复发率仍然高得令人不安，一些研究报告的复发率高达90%， 治疗后成瘾者的复发被认为是由于再次暴露于线索， 以前与吸毒有关。在长期使用毒品的过程中， 增强注意力（或注意力偏差），这表明可以促进动机性唤醒，最终导致强迫性 吸毒或复吸我们使用了晚正电位（LPP），一种脑电图衍生的动机性标记物， 唤醒表明，与通常认为的不同，对药物线索（或线索反应性）的唤醒增加（或潜伏） 在禁欲的头六个月里这种暗示反应的孵化被假定为不成比例地赋予 成瘾者的复发风险较高。我们最近获得的后续数据显示， 个体能够下调药物线索反应性（如通过LPP幅度的降低所证明的）， 认知重新评价（一种情绪调节技术）训练，然后导致自发性的减少。 对药物线索的注意力偏差（使用眼动追踪进行量化）。在这里，我们建议将这两个部分结合起来， 测试认知再评价训练是否可以减少药物线索反应的潜伏期的证据（目标1） 并改善临床结果（例如，减少渴望和延长可卡因戒断持续时间;目标2）在 可卡因使用障碍（iCUD）患者戒断的前6个月。我们将进一步探讨 对药物线索的注意力偏差的变化和/或线索反应性跟踪治疗反应的潜伏期的钝化 并预测6个月随访时的临床结果（探索性目标）。为此，我们建议 126名iCUD患者，其中一半将随机接受认知再评估培训，另一半将 而是完成控制任务。在这项纵向研究中，参与者将在1周内完成这些程序， 开始禁欲后1个月、3个月和5个月，然后将在1个月后（6个月后）返回 禁欲开始）用于临床结果的评估。因此，这项新的研究旨在弥合 通过推进对一种新的循证干预的基本机制理解， 为追踪治疗反应和预测成瘾结果提供认知标记。成功 这项研究的完成将为进一步的基础和临床研究奠定基础， 假定的机制，并可能也使用相同的框架，神经认知检查类似的 对其他物质使用障碍以及其他行为成瘾的认知干预。