Enhancing treatment outcomes among veterans with alcohol use disorder: Clinical and neural markers of adjunctive approach-avoidance training

患有酒精使用障碍（AUD）的退伍军人将通过制定有效的干预措施得到极大的服务， 解决高复发率和恢复最佳功能恢复的困难（即，重新参与 职业、社会和日常生活中的角色对保持酒精消费目标至关重要）。接近偏差 对酒精的态度，对酒精线索的内隐动机反应，在行为和神经上都可以观察到。 指标，是AUD的核心特征，阻碍恢复，但不是常规治疗的标准护理。治疗 以接近偏差为目标的选择可能会通过减少酒精的食欲来改善结果， 个人能够更好地脱离习惯性饮酒行为，以服务于他们的功能目标 和目标。避免接近训练（AAT）是一种计算机提供的治疗计划， 行为和神经指标的接近偏见的酒精，并已被证明可以改善饮酒相关的 与标准治疗联合使用时的结局（以AUD表示）。鉴于此次干预澳元的承诺， 有一个关键的需要，以确定这种治疗是否可以成功地用于退伍军人谁通常 存在复杂的合并症，并查明认知和神经生物学过程的变化。的 本提案的总体目标是确定酒精接近避免培训（AAT） 改善接受AUD标准治疗的退伍军人的康复结果， 以确定潜在的认知和神经基板修改。核心假设是AAT训练 将改善退伍军人的关键恢复结果，并改善行为和神经指标的方法 bias.我们将探讨AAT的影响是否适用于相关的自上而下和自下而上的神经认知 流程.我们还将探索治疗反应的潜在预测因素。总体目标是 在一项随机对照试验中，136名退伍军人在我们当地的VA环境中完成标准治疗， AAT或控制条件。目标1将确定是否通过反复练习避免酒精暗示， AAT可以改善恢复结果和危险饮酒。目标2将确定AAT是否修改进近 通过用多种评估方法测量该构造的偏差（即，行为，功能磁共振成像）。探索性目标将 检查AAT是否改变抑制（自上而下）和线索反应性（自下而上）处理，以及在多大程度上 基线合并症严重程度、治疗参与特征或基线方法偏倚（行为任务 反应时间，功能性磁共振成像期间的大脑反应）与临床结果相关。该项目预计将 确定AAT是否显示出临床潜力，这将保证扩展到其他滥用物质和更大的 在AUD退伍军人中进行的多中心确证性疗效试验。研究结果将告知AAT作为一种 为退伍军人提供了一种新的、低成本的、便携式的替代选择， 改善这些人的恢复。与RR&D的使命一致，以最大限度地发挥“功能 独立、生活质量和参与生活和社区，”该项目将提供一个 基金会为神经科学为基础的替代治疗方案，以改善恢复退伍军人与AUD。

Veterans with alcohol use disorders (AUD) would be greatly served by development of effective interventions to address high relapse rates and difficulty with resuming optimal functional recovery (i.e., re-engaging in vocational, social, and daily life roles that are critical to maintaining alcohol consumption goals). Approach bias toward alcohol, an implicit motivational response to alcohol cues observable across behavioral and neural indicators, is a core feature of AUD that impedes recovery but is not routinely treated in standard care. Treatment options that target approach bias may improve outcomes by decreasing the appetitive pull of alcohol, so that individuals are better able to disengage from habitual drinking behaviors in the service of their functional goals and objectives. Approach Avoidance Training (AAT) is a computer-delivered treatment program that shifts behavioral and neural indicators of approach bias for alcohol and has been shown to improve drinking-related outcomes in AUD when used in conjunction with standard care. Given the promise of this intervention for AUD, there is a critical need to determine if this treatment can be successfully used for Veterans who commonly present with complex comorbidities, and to pinpoint cognitive and neurobiological processes of change. The overall objectives of this proposal are to determine whether Alcohol Approach Avoidance Training (AAT) improves recovery outcomes in Veterans undergoing standard care for AUD with co-occurring conditions, and to identify the underlying cognitive and neural substrates modified. The central hypothesis is that AAT training will improve critical recovery outcomes for Veterans and improve behavioral and neural indicators of approach bias. We will explore whether effects of AAT generalize to related top-down and bottom-up neurocognitive processes. We will also explore potential predictors of treatment response. The overall objectives will be addressed in a randomized controlled trial of 136 Veterans completing standard care in our local VA setting with either AAT or a control condition. Aim 1 will determine if repeatedly practicing avoidance of alcohol cues through AAT can improve recovery outcomes and hazardous drinking. Aim 2 will determine if AAT modifies approach bias by measuring this construct with multiple assessment methods (i.e., behavioral, fMRI). Exploratory aims will examine if AAT modifies inhibition (top-down) and cue reactivity (bottom up) processing, and the extent to which baseline comorbidity severity, treatment engagement characteristics, or baseline approach bias (behavioral task reaction times, brain response during fMRI) are associated with clinical outcomes. The project is expected to determine if AAT shows clinical potential that would warrant expansion to other substances of abuse and a larger multisite confirmatory efficacy trial in Veterans with AUD. Results of the study will inform the utility of AAT as an adjunctive AUD treatment for Veterans, potentially offering a novel, low-cost, and portable alternative option to improve recovery in these individuals. Consistent with the RR&D mission to maximize “functional independence, quality of life and participation in their lives and community,” the project will provide a foundation for neuroscience-based alternative therapeutic options to improve recovery in Veterans with AUD.