Longitudinal study of functional connectivity among cocaine users in treatment

描述(申请人提供)：慢性可卡因使用是最难治疗的物质使用障碍之一。高复发率可能是边缘和认知因素的组合，包括对显著边缘提示的脆弱性和执行控制的丧失。这可能是由于边缘神经回路(例如，内侧前额叶(MPFC)和腹侧纹状体之间)的功能连接增强和/或执行控制电路(例如，背外侧前额叶(DLPFC)和背侧纹状体之间)的功能连接降低所致。这项纵向成像研究的主要目标是使用新的TMS/fMRI探头来确定执行电路和边缘电路完整性之间的关系，因为它与 强化门诊治疗计划后的即时和延长结果。这将通过评估寻求治疗的可卡因使用者和非药物使用对照的基线功能连接性(Aim1)以及在28天认知-行为治疗计划(仅限使用者)(Aim 2)后功能连接性的变化来实现。我们还将确定这些回路的完整性与基线后60天和90天的临床有意义的结果测量之间的关系(目标3)。由这些目的产生的基础神经科学知识涉及执行(例如DLPFC)和边缘(例如MPFC)回路连接对成瘾治疗结果的重要性。这些数据将提供关键的基础 在此基础上，该领域可以开发基于证据的脑刺激治疗策略(例如重复TMS)，以扩大寻求治疗的个人之间的DLPFC连接。

DESCRIPTION (provided by applicant): Chronic cocaine use is among the most difficult substance-use disorders to treat. High relapse rates are likely due to a combination of limbic and cognitive factors, including vulnerability to salient limbic cues and loss of executive control This may be due to elevated functional connectivity in limbic neural circuitry (e.g. between the medial prefrontal cortex (MPFC) and ventral striatum) and/or lower functional connectivity in executive control circuitry (e.g. between the dorsolateral prefrontal cortex (DLPFC) and dorsal striatum). The overarching goal of this longitudinal imaging study is to use the novel TMS/fMRI probe to determine the relationship between executive and limbic circuit integrity as it relates to immediate and extended outcomes after an intensive outpatient treatment program. This will be achieved by assessing functional connectivity in treatment-seeking cocaine users and non-drug using controls at baseline (Aim1) and the change in functional connectivity after a 28-day cognitive- behavioral treatment program (users only)(Aim 2). We will also determine the relationship between the integrity of these circuits and clinically meaningful outcome measures 60 days and 90 days after baseline (Aim 3). The fundamental neuroscience knowledge resulting from these aims regarding the importance of executive (e.g. DLPFC) and limbic (e.g. MPFC) circuit connectivity to addiction treatment outcomes. These data will provide a critical foundation from which the field can develop evidence-based brain stimulation treatment strategies (such as repetitive TMS) to amplify DLPFC connectivity among treatment-seeking individuals.