CONTEXTUAL CONTROL OF CRAVING FOR ALCOHOL

长期以来，人们都知道语境（即背景线索）在调节后天行为中起着至关重要的作用。在过去的20年里，研究者们广泛地研究了外部环境对巴甫洛夫条件反射消失的影响。这方面的最新研究进展对我们如何进行线索暴露治疗有直接的影响，但尚未纳入线索暴露研究和酗酒者的治疗。本应用程序旨在通过调查最近在实验室动物研究中得到支持的消退表现理论模型是否适用于酗酒者的酒精线索反应消退来填补这一空白。具体来说，该研究代表了一个初步的测试，即环境对寻求治疗的酗酒者的渴望和酒精线索反应的影响。210名寻求治疗的酗酒者将被随机分配到六个实验组中，这些实验组在戒酒后评估环境方面有所不同。采用平衡设计，将第1组至第4组进行比较，以测试灭绝后评估环境是否影响对酒精饮料线索的反应性更新。包括第5组和第6组，以测试与消失上下文配对的线索（即消失线索）的存在是否可以在后测试中减少渴望和酒精线索的反应性，以及旨在增加该线索的显著性的程序（即第6组）是否会进一步增强这种效果。第5组和第6组将从四组设计中与第2组进行比较。该项目的短期目标是将当代学习理论的最新发现应用于旨在减少酗酒者的渴望和酒精线索反应的研究。长期目标是开发线索暴露治疗的替代方法，通过进一步降低酒精线索反应性和增加重新饮酒和大量饮酒的潜伏期，提高线索暴露治疗效果的泛化，改善治疗结果。总而言之，这项研究代表了程序化研究的第一步。在程序化研究中，从基础实验室研究中发展出来的理论首先在人类临床样本中进行测试，然后用于开发新的行为干预。

Context (i.e., background cues) has long been known to play a vital role in modulating acquired behavior. During the past 20 years, researchers have extensively studied the effects of external context upon the extinction of Pavlovian conditioning. Recent advances in this line of research, which have direct implications for how we conduct cue exposures treatment, have yet to be incorporated into cue exposure research and treatment for alcoholics. The present application is designed to fill that void by investigating whether a recent theoretical model of extinction performance, which has been supported in laboratory animal studies, will apply to the extinction of alcohol cue responses in alcoholics. Specifically, the proposed study represents an initial test of the effect of context on measures of craving and alcohol cue reactivity in treating-seeking alcoholics. Subjects will be 210 alcoholics seeking treatment and randomly assigned to one of six experimental groups that vary with regard to the post-extinction assessment context. Using a counter-balanced design, Groups 1 through 4 will be compared to test if post-extinction assessment context affects renewal of reactivity to alcohol beverage cues. Groups 5 and 6 are included to test if the presence of a cue (i.e, extinction cue) that was paired with the extinction context can reduce craving and alcohol cue reactivity during the post-test and whether a procedure designed to increase the saliency of this cue (i.e., Group 6) will further enhance this effect. Groups 5 and 6 will be compared to Group 2 from the four group design. The short-term goal of this project is to apply recent findings from contemporary learning theory to research aimed at reducing craving and alcohol cue reactivity in alcoholics. The long-term goal is to develop alternative methods of conducting cue exposure treatment that will enhance the generalization of cue exposure treatment effects and improve treatment outcomes by further reducing alcohol cue reactivity and increasing the latency of return to drinking and heavy drinking. In summary, this study represents the first step in a programmatic line of research in which a theory developed with basic laboratory research is first tested in a human clinical sample, and then used to develop a new behavioral intervention.