Risk-Taking Following Trauma Cue Exposure in Substance Users with PTSD

描述（由申请人提供）：创伤后应激障碍（PTSD）与物质使用障碍（SUDs）共发病频率高（Brady et al., 2004; Cottler et al., 1992; Jacobson et al., 2001），这种诊断共发病具有重要的临床和公共卫生意义。特别是，研究表明，在患有SUD的个体中同时发生PTSD与各种冒险和冲动行为的风险增加以及相关的负面临床结果相关，包括更严重的物质使用模式（Back等人，2000；Cottler等人，1992；Najavits等人，2007；Salgado等人，2007），更大的法律问题(Najavits等人，1999,2007；Ouimette et al., 1999)，更危险的性行为和药物使用行为（Plotzker et al., 2007），更大的艾滋病毒感染风险（Hoff et al., 1997），并且在SUD治疗出院后更快地重新使用药物（Hien et al., 2000; Ouimette et al., 1999, 2007）。此外，研究发现，在合并PTSD（与未合并PTSD）的SUD患者中观察到的较差的治疗结果并不仅仅是一般情况下更大的合并症（Ouimette et al., 1999）或创伤暴露史（Hien et al., 2000）的结果，这表明，在物质使用者中，PTSD的存在存在一些独特的因素，使他们面临更大的负面临床结果风险。尽管有这些发现，以及初步发现可卡因依赖的创伤后应激障碍住院患者（与非创伤后应激障碍患者相比；Tull, Trotman, et al., 2009）普遍具有更高水平的冒险行为，但没有研究调查PTSD- sud人群中促成危险行为的因素或背景，也没有研究调查选择的物质在多大程度上影响PTSD- sud患者的危险行为。因此，本实验研究旨在通过研究210名创伤暴露的SUD患者（仅依赖可卡因，仅依赖酒精或可卡因和酒精）的想象创伤线索暴露对冒险行为的影响来扩展该领域的现有研究，这些患者有或没有PTSD。在不同的日子里，有标准a创伤暴露史的SUD患者将暴露于中性线索或个性化的想象创伤线索。在提示暴露之后，参与者将完成两个既定的冒险行为测量，气球模拟风险任务（Lejuez et al., 2002）和爱荷华赌博任务（Bechara et al., 1994）。我们将研究创伤线索暴露（与中性线索暴露相比）、物质选择（可卡因、酒精、可卡因酒精依赖）和创伤后应激障碍状态（当前创伤后应激障碍与无创伤后应激障碍病史）对冒险行为的影响。我们期望发现可卡因依赖和创伤后应激障碍对冒险行为的主要影响，以及线索暴露、物质选择和创伤后应激障碍状态之间的三方相互作用。具体来说，我们预计可卡因依赖的PTSD患者在创伤提示暴露后会比其他所有组表现出最高的冒险水平。生物学（唾液皮质醇）、生理学（心率、皮肤电反应）和自我报告的对线索的反应性也将被检查，以更好地了解可能导致PTSD-SUD患者冒险的因素，从而说明其功能。

DESCRIPTION (provided by applicant): Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) co-occur with high frequency (Brady et al., 2004; Cottler et al., 1992; Jacobson et al., 2001), and this diagnostic co-occurrence has great clinical and public health significance. In particular, research indicates that the presence of co-occurring PTSD among individuals with a SUD is associated with heightened risk for a variety of risky and impulsive behaviors and associated negative clinical outcomes, including more severe substance use patterns (Back et al., 2000; Cottler et al., 1992; Najavits et al., 2007; Salgado et al., 2007), greater legal problems (Najavits et al., 1999, 2007; Ouimette et al., 1999), greater risky sexual and drug use behavior (Plotzker et al., 2007), greater risk for HIV infection (Hoff et al., 1997), and quicker relapse to substance use following discharge from SUD treatment (Hien et al., 2000; Ouimette et al., 1999, 2007). Further, findings that the worse treatment outcomes observed among SUD patients with (vs. without) PTSD are not the result of simply greater comorbidity in general (Ouimette et al., 1999) or a history of traumatic exposure (Hien et al., 2000) suggest that there is something unique to the presence of PTSD among substance users that places them at greater risk for negative clinical outcomes. Despite these findings, as well as preliminary findings of higher levels of risk-taking (as assessed through a laboratory-based task) in general among cocaine dependent inpatients with PTSD (vs. those without PTSD; Tull, Trotman, et al., 2009), no studies have examined the factors or contexts that precipitate risky behavior within a PTSD-SUD population, or the extent to which substance of choice influences risky behavior among PTSD-SUD patients. Thus, the proposed experimental study seeks to extend extant research in this area by examining the effect of imaginal trauma cue exposure on risk-taking among 210 trauma-exposed SUD patients (dependent on cocaine only, alcohol only, or cocaine and alcohol) with or without PTSD. On separate days, SUD patients with a history of Criterion A traumatic exposure will be exposed to a neutral cue or a personalized imaginal trauma cue. Following cue exposure, participants will complete two established behavioral measures of risk-taking, the Balloon Analogue Risk Task (Lejuez et al., 2002) and the Iowa Gambling Task (Bechara et al., 1994). We will examine the effect of trauma cue exposure (vs. neutral cue exposure), substance of choice (cocaine vs. alcohol vs. cocaine-alcohol dependence), and PTSD status (current PTSD vs. no history of PTSD) on risk-taking. We expect to find main effects of cocaine dependence and PTSD on risk-taking, as well as a three-way interaction between cue exposure, substance of choice, and PTSD status. Specifically, we expect that cocaine dependent patients with PTSD will exhibit the highest levels of risk-taking following trauma cue exposure than all other groups. Biological (salivary cortisol), physiological (heart rate, electrodermal response), and self-reported reactivity to cues will also be examined to better understand the factors that may lead to risk-taking among PTSD-SUD patients, thus speaking to its function. PUBLIC HEALTH RELEVANCE: By examining the effects of trauma cue exposure, substance of choice, and PTSD status on risk-taking among low SES minority substance users in rural Mississippi, the proposed study will play an important role in reducing disparities in research on the effects of PTSD among SUD patients. In addition, by improving our understanding of the pathways through which PTSD and SUDs may contribute to risky behavior in this population, results from this study will facilitate the development of targeted prevention and intervention programs - a particularly relevant consideration for treatment centers in areas with limited mental health resources.