The Neuroeconomics of Behavioral Therapies for Adolescent Substance Abuse

青少年药物滥用行为疗法的神经经济学

• 批准号: 7925140
• 负责人: Clinton D Kilts
• 金额: $ 21.75万
• 依托单位: UNIV OF ARKANSAS FOR MED SCIS
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-04-01 至 2013-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7925140
• 关键词: Abstinence; Address; Adolescent; Alcohol consumption; Alcohols; Amygdaloid structure; Arts; Behavior Therapy; Behavioral; Biological Models; Brain; Cognitive; Cognitive Therapy; Controlled Clinical Trials; Corpus striatum structure; Data; Decision Making; Development; Evaluation; Exhibits; Family; Future; Globus Pallidus; Image; Incentives; Individual; Intake; Intervention; Investigation; Laboratories; Marijuana; Marijuana Abuse; Marijuana Smoking; Measures; Mediating; Neurobiology; Neurosciences; Outcome; Outpatients; Pattern; Performance; Prefrontal Cortex; Prevention Research; Preventive Intervention; Process; Psychological reinforcement; Public Health; Randomized Clinical Trials; Recruitment Activity; Research; Rewards; Role; Sampling; Specificity; Structure; System; Testing; Treatment outcome; Variant; addiction; adolescent alcohol abuse; adolescent substance abuse; arm; base; contingency management; discount; discounting; drug abstinence; effective therapy; improved; neural patterning; neurodevelopment; neuroeconomics; neuroimaging; novel; preference; programs; public health relevance; relating to nervous system; response; substance abuse treatment; substance abuser; treatment effect; treatment response; trial comparing

DESCRIPTION (provided by applicant): Little is known about the role of adolescent neurodevelopment in adolescent substance abuse treatment outcomes. The development and evaluation of adolescent substance abuse treatments rarely includes consideration of varying cognitive capacities and their neural representations as determinants of individual variation in treatment response. This proposed R21 project would address this gap by identifying associations among decision making, task-related neural processing, and treatment outcome among adolescents participating in two ongoing randomized clinical trials for adolescent substance abuse. Increasing our understanding of neural processes that underlie decision making in adolescent marijuana and alcohol users would inform the development of future intervention and prevention efforts. This complementary project would draw subjects from two ongoing studies investigating contingency- management (CM) based treatments "Behavioral Treatment of Adolescent Marijuana Abuse" (DA015186), and "Family Based Contingency Management for Adolescent Alcohol Abuse" (AA016917). Both trials compare a unique CM intervention that involves an abstinence-based reinforcement program to a standard, state of the art cognitive behavioral intervention. Analyses would be performed separately for the two samples, with hypotheses tested first using the Marijuana sample, and assessed for replication/specificity using the Alcohol sample. The proposed project would explore novel neurobiological predictors of response to CM interventions. Adolescents recruited into the Marijuana Trial (n=69; 23 per treatment arm) and the Alcohol Trial (n=54; 27 per treatment arm) during the period of this R21 project would participate in a neuroimaging session. During the neuroimaging session, adolescents would make intertemporal choice decisions in a Delay Discounting task. Preliminary data from the Marijuana trial demonstrates significant association between performance on this behavioral delay discounting task and abstinence achieved during treatment over and above the significant effect of treatment condition. We seek to understand the neural processes that underlie performance on this laboratory task, and the degree to which variation in these neural processes relate to and predict adolescent substance abuse treatment outcomes. The conceptual framework for the proposed project is a competing neural systems model which hypothesizes a biased competition between an "impulsive" (or ''reflexive") neural system and the "executive" (or "reflective") neural system in understanding patterns of suboptimal decision making among substance-dependent individuals. An overarching hypothesis is that differing responses to distinct treatment approaches (CM vs. CBT) depend on the pattern of activation or functional connectivity within and across these competing neural systems. Specifically, we will determine the degree to which performance on a laboratory delay discounting task correlates with activity in impulsive and/or executive neural systems. We will also determine the degree to which performance on a laboratory delay discounting task and neural processing predict adolescent substance abuse treatment outcome over and above the effects of treatment condition. Finally, we will explore interactions between response to CM and delay discounting-related neural processing. This neuroimaging project will provide a springboard for the development of future projects with this newly formed interdisciplinary team. Conducting the proposed imaging study in the context of a controlled clinical trial has potential to guide the development/refinement of more efficacious treatments tailored to the individual, and may have strong implications for prevention research and intervention as well. The significance of this specific proposal is enhanced by our proposed investigation of neural predictors of response to one of the most common outpatient interventions (i.e., MET/CBT) and one of the most promising interventions for improving outcomes of MET/CBT (i.e., CM). Last, the focus on temporal discounting of rewards represents a significant test of a major theoretical construct thought to drive the addiction process. Decision making and incentive valuation represent novel targets of future treatment interventions. PUBLIC HEALTH RELEVANCE: This study will measure the brain activity of adolescent substance abusers while they make decisions about their preferences to receive smaller, immediate rewards vs. larger delayed rewards. We expect that patterns of brain activity while engaged in this decision making task will predict response to treatment among adolescent substance users. We expect to use the results of this study to develop more effective treatments for adolescent substance abuse.

描述（由申请人提供）：人们对青少年神经发育在青少年药物滥用治疗结果中的作用知之甚少。青少年药物滥用治疗的开发和评估很少考虑不同的认知能力及其神经表征作为治疗反应个体差异的决定因素。拟议的 R21 项目将通过确定参与两项正在进行的青少年药物滥用随机临床试验的青少年的决策、任务相关神经处理和治疗结果之间的关联来解决这一差距。增加我们对青少年大麻和酗酒者决策背后的神经过程的了解，将为未来干预和预防工作的发展提供信息。 这个补充项目将从两项正在进行的研究中抽取主题，调查基于应急管理（CM）的治疗“青少年大麻滥用的行为治疗”（DA015186）和“青少年酒精滥用的家庭应急管理”（AA016917）。这两项试验都将一种独特的 CM 干预措施（涉及基于禁欲的强化计划）与标准的、最先进的认知行为干预措施进行了比较。将分别对两个样本进行分析，首先使用大麻样本测试假设，并使用酒精样本评估重复性/特异性。拟议的项目将探索对 CM 干预反应的新型神经生物学预测因子。在 R21 项目期间招募参加大麻试验（n = 69；每个治疗组 23 名）和酒精试验（n = 54；每个治疗组 27 名）的青少年将参加神经影像学会议。在神经影像学会议期间，青少年将在延迟贴现任务中做出跨期选择决策。大麻试验的初步数据表明，除了治疗条件的显着影响之外，这种行为延迟贴现任务的表现与治疗期间实现的戒断之间存在显着相关性。我们试图了解这项实验室任务表现背后的神经过程，以及这些神经过程的变化与青少年药物滥用治疗结果相关并预测的程度。拟议项目的概念框架是一个竞争性神经系统模型，该模型假设“冲动”（或“反射”）神经系统和“执行”（或“反射”）神经系统之间在理解物质依赖个体的次优决策模式方面存在偏见竞争。一个总体假设是，对不同治疗方法（CM 与 CBT）的不同反应取决于激活或认知模式。 这些竞争性神经系统内部和之间的功能连接。具体来说，我们将确定实验室延迟贴现任务的表现与冲动和/或执行神经系统活动的相关程度。我们还将确定实验室延迟贴现任务和神经处理的表现在多大程度上预测青少年药物滥用治疗结果，而不是治疗条件的影响。最后，我们将探讨对 CM 的反应与延迟贴现相关的神经处理之间的相互作用。 这个 神经影像项目将为这个新组建的跨学科团队未来项目的开发提供跳板。在对照临床试验的背景下进行拟议的影像学研究有可能指导开发/完善针对个人的更有效的治疗方法，并且也可能对预防研究和干预产生重大影响。我们提议对最常见的一种反应的神经预测因子进行研究，增强了这一具体提议的重要性。 门诊干预（即 MET/CBT）和改善 MET/CBT 结局（即 CM）最有希望的干预措施之一。最后，对奖励的时间贴现的关注代表了对驱动成瘾过程的主要理论构建的重大考验。决策和激励评估代表了未来治疗干预的新目标。 公共健康相关性：这项研究将测量青少年药物滥用者在决定自己是否愿意接受较小的即时奖励与较大的延迟奖励时的大脑活动。我们预计，参与这项决策任务时的大脑活动模式将预测青少年药物使用者对治疗的反应。我们希望利用这项研究的结果来开发针对青少年药物滥用的更有效的治疗方法。