REINFORCING EFFECTS OF BENZODIAZEPINES IN ANXIETY

申请人摘要：拟议的研究将利用标准 双盲药物/安慰剂偏好的行为药理学方法 用于焦虑门诊患者阿普唑仑自我用药行为的研究 因为他们的精神病理学，被认为有患上 苯二氮依赖 所有患者都会有广泛性焦虑， 没有药物滥用或依赖史 患者将 允许“按需”用药和自我给药行为 将通过使用自动记录装置进行监测。 在最初暴露于颜色编码的安慰剂和阿普唑仑胶囊后， 受试者将能够在双盲条件下选择， 他们更喜欢的胶囊。 这一建议的基本假设是， 阿普唑仑的抗焦虑疗效将加强自我药疗行为 但是通常使用药物 在治疗上是适当的，并且将与焦虑症状相对应 救灾 两个实验将雇用很少或没有病史的患者 处方抗焦虑药的使用 这些研究将：1）证明 阿普唑仑对一般焦虑患者的强化作用， 无惊恐障碍; 2）确定患者用药史的影响 处方药使用;和3）确定认知能力 行为疗法，以减少焦虑症状，并尽量减少药物使用， 焦虑症 两个实验都将评估人格的能力 类型和患者对药物使用的态度来预测观察到的药物 自我管理行为。 这项研究与NIDA的研究一致。 目的研究药物强化的基本机制和风险 使人容易对处方药产生依赖的因素。 有 脆弱性的三个因素正在被实验检验。 这些措施是： 1)患者的其他药物使用史; 2）人格类型和态度 对药物使用;和3）未经治疗的焦虑心理病理学的影响 促进自我药疗。 此外，一项重大成就是， 这项研究将是门诊程序的发展， 处方药自我管理与强化研究 治疗人群。 结果将解决基本问题 关于自我药疗动机及其在病因学中的作用， 处方药依赖 此外，这些研究可能 实验性地识别患者变量，这些变量可以预测 药物使用使患者有苯二氮卓类药物依赖的风险。 最后，建议的研究将确定认知能力 行为疗法，以减少自我药疗药物使用行为，从而 最大限度地减少苯二氮卓类药物依赖的风险。

APPLICANT'S ABSTRACT: The proposed research will utilize standard behavioral-pharmacologic methods of double blind drug/placebo preference for the study of alprazolam self-medication behavior in anxious outpatients who, because of their psychopathology, are presumed to be at risk for benzodiazepine dependence. All patients will have generalized anxiety but will have no history of substance abuse or dependence. Patients will be allowed to use medication "as needed" and self-administration behaviors will be monitored through the use of automated recording devices. Following initial exposures to color-coded placebo and alprazolam capsules, subjects will be able to choose, under double-blind conditions, which capsules they prefer. The basic hypothesis of this proposal is that the anxiolytic efficacy of alprazolam will reinforce self-medication behavior in anxious patients but that medication use generally will be therapeutically appropriate and will correspond with anxiety symptom relief. Two experiments will employ patients who have little or no history of prescription anxiolytic use. These studies will: 1) demonstrate reinforcing effects of alprazolam in generally anxious patients with or without panic disorder; 2) determine the effect of patient drug use history on prescription drug use; and 3) determine the ability of cognitive behavior therapy to reduce anxiety symptoms and minimize drug use in anxiety disorders. Both experiments will assess the ability of personality type and patient attitude towards medication use to predict observed drug self-administration behaviors. This research is consistent with NIDA's goals to examine the basic mechanisms of drug reinforcement and the risk factors making one vulnerable to prescription drug dependence. There are three factors of vulnerability being experimentally examined. These are: 1) patient history of other drug use; 2) personality type and attitudes towards drug use; and 3) the effects of untreated anxiety psychopathology to promote self-medication. Furthermore, a significant accomplishment of this research will be the development of outpatient procedures for the study of prescription drug self-administration and reinforcement in therapeutic populations. The results will address fundamental questions regarding the self-medication motivation and its role in the etiology of prescription drug dependence. Furthermore, these studies may experimentally identify patient variables which can predict patterns of medication use placing patients at risk for benzodiazepine dependence. Finally, the proposed research will determine the ability of cognitive behavior therapy to reduce self-medication drug use behaviors and thereby minimize the risks of benzodiazepine dependence.