Exercise as a Behavioral Treatment for Cocaine Dependence

描述（由申请人提供）：可卡因依赖问题仍然是一个主要的医疗、社会和法律问题，迫切需要一种广泛有效的治疗方法。数十种药物已经在临床试验中进行了评估，尽管做出了这些努力，但没有一种药物获得美国食品和药物管理局的批准，可以用于治疗可卡因依赖。行为干预，如认知行为疗法，已经有了适度的效果，这表明非药物治疗方法值得额外考虑。最近的数据表明，适度的体育锻炼可以减少人们对香烟的渴望，改善人类的认知功能。这些数据与一些啮齿类动物的报告相吻合，这些报告显示，运动（即轮转）减少了可卡因的自我施用，尽管运动对人类可卡因使用的影响尚未得到调查。有趣的是，运动已被证明对人类有强化作用，这可能解释了它作为一种成瘾治疗的潜在功效。我们建议采用安慰剂对照、受试者间设计来评估运动对改善健康、可卡因使用和对可卡因渴望的影响。鉴于现有数据显示运动对吸烟有有益影响，我们还将监测吸烟和对尼古丁渴望的变化，作为积极控制。具体目标包括：1)评估运动（跑步vs步行，每次30分钟，每周3次，连续4周）与安慰剂（坐同样的时间和持续时间）对基本健身指标的影响；2)评价运动对可卡因和尼古丁使用和渴望的客观和主观测量的影响。所有参与者都是符合DSM标准的目前可卡因和尼古丁依赖的成年人，他们正在寻求治疗可卡因成瘾。计算机认知行为疗法（CBT）将成为所有参与者的标准治疗。一个应急管理平台也将用于鼓励出席（而不是禁欲）。运动课程将在NordicTrack Elite 9500 PRO跑步机上进行，并在所有体育活动期间有医生或执业护士在场。这项申请代表了一项重要的研究成果，具有相当大的公共卫生意义，因为它将建立一个评估运动对可卡因依赖者渴望和使用可卡因和尼古丁的影响的计划。

DESCRIPTION (provided by applicant): The problem of cocaine dependence remains a major medical, social, and legal concern, and there is a pressing need for a broadly effective treatment approach. Dozens of medications have been evaluated in clinical trials and, despite these efforts, not one has gained FDA approval as a treatment for cocaine dependence. Behavioral interventions, such as cognitive behavioral therapy, have been moderately effective, indicating that non-pharmacological treatment approaches warrant additional consideration. Recent data suggest that moderate physical exercise attenuates cravings for cigarettes and improves cognitive functioning in humans. These data coincide with several reports in rodents showing that exercise (i.e., wheel running) reduced cocaine self-administration, though the effects of exercise on cocaine use in humans has not been investigated. Of interest, exercise has been shown to be reinforcing in humans, and this may account for its potential efficacy as an addiction treatment. We propose a placebo-controlled, between-subjects design to evaluate the effects of exercise on improved fitness, cocaine use, and craving for cocaine. Given existing data showing beneficial effects of exercise on cigarette smoking, we will also monitor changes in smoking and craving for nicotine as a positive control. The Specific Aims include: 1) To evaluate the effects of exercise (running vs. walking 30 min per session, 3 times per week, over 4 consecutive weeks) versus placebo (sitting for the same period of time and duration) on basic fitness measures; 2) To evaluate the effects of exercise on objective and subjective measures of cocaine and nicotine use and craving. All participants will be adults who meet DSM criteria for current cocaine- and nicotine-dependence, who are seeking treatment for their cocaine addiction. Computerized cognitive behavioral therapy (CBT) will be the standard treatment provided to all participants. A platform of contingency management will also be used to encourage attendance (not abstinence). Exercise sessions will be performed on a NordicTrack Elite 9500 PRO Treadmill, and a physician or nurse practitioner will be present during all physical activity sessions. This application represents an important research effort with considerable public health significance in that it will establish a program for evaluating the effects of exercise on craving and use of cocaine and nicotine in cocaine-dependent individuals. PUBLIC HEALTH RELEVANCE: This application describes a placebo-controlled, between-subjects study to evaluate the effects of exercise on improved fitness, cocaine use, and craving for cocaine in cocaine-dependent individuals.