Stress, Distress Intolerance, and Drug Dependence

描述(由申请人提供)： 尽管人们很早就认识到内在线索(渴望感觉和情绪状态)对物质使用障碍患者复发的重要性，但针对这些线索的暴露治疗相对较少。作为NIDA第一阶段试验的一部分，我们开发并试行了一种治疗方法，强调药物使用障碍的内部(主要是情绪)线索暴露。我们的这种治疗模式是基于暴露于令人恐惧的焦虑感在治疗惊恐障碍和苯二氮卓类停药中的作用，以及在治疗与压力相关的疾病(如创伤后应激障碍)时关注这些恐惧的重要性。这一治疗模式得到了最近的研究的进一步支持，该研究通过生物激发程序和焦虑敏感指数等衡量标准评估了吸毒动机与对内部线索的不耐受之间的联系。根据这项研究，我们的治疗重点是内部线索暴露策略对使用物质作为应对负面情绪和压力的一种方式的个体的价值。具体地说，我们关注的不是“减弱压力产生的情感信号”，而是：(1)增强患者对各种形式的痛苦--悲伤、无聊、焦虑、戒断感觉等--的耐受性，这些痛苦与药物依赖者紧张的生活有关，以及(2)打破这些情感线索与与毒品有关的尝试之间的联系，以避免情感痛苦。由于它的重点是改变对内部线索的反应，我们将其命名为认知-行为疗法(CBT-IC)。 作为对RFA DA-04-001的回应，我们提议进行一项为期5年的研究，旨在进一步测试CBT-IC对长期应激和治疗耐药的阿片依赖门诊患者的干预效果。这项研究与RFA特别相关的特点包括：(1)重点关注阿片依赖患者的慢性应激反应；(2)慢性应激转化为慢性药物使用的模式；(2)重点关注应激相关症状引发药物使用的方式；(3)重点关注将为治疗配对工作提供信息的治疗的调解人和调节者；以及(4)在第二阶段治疗试验中检查治疗结果。

DESCRIPTION (provided by applicant): Despite early recognition of the importance of internal cues (craving sensations and emotional states) for relapse in substance use disorders, relatively little attention has been devoted to exposure-based treatments targeting these cues. As part of a NIDA Phase I trial, we developed and pilot tested a treatment that emphasizes internal (largely emotional) cue exposure for substance use disorders. Our model for this treatment was based on the role of exposure to feared sensations of anxiety in the treatment of panic disorder and benzodiazepine discontinuation, as well as the importance of attending to these fears in treatments of stress-related conditions such as posttraumatic stress disorder (PTSD). This model of treatment gained further support from recent research on the link between drug-use motives and intolerance to internal cues as assessed by biological provocation procedures and measures such as the Anxiety Sensitivity Index. In accordance with this research, our treatment focuses on the value of internal cue exposure strategies for individuals who use substances as a way to cope with negative affect and stress. In particular, rather than focusing on "attenuating the affective signal" arising from stress, we focus on: (1) enhancing a patient's tolerance to the myriad forms of distress--sadness, boredom, anxiety, withdrawal sensations, etc.--that are linked to the stressful lives of drug-dependent individuals, and (2) breaking the link between these emotional cues and drug-related attempts to avoid emotional distress. Because of its focus on changing responses to internal cues, we titled our treatment, Cognitive-Behavioral Therapy for Interoceptive Cues (CBT-IC). In response to RFA DA-04-001 we are proposing a 5-year study designed to test further the efficacy of CBT-IC for intervening with chronically stressed and treatment-resistant opiate-dependent outpatients. Features of this study of particular relevance to the RFA include: (1) a focus on opiate-dependent patients undergoing chronic stress; (2) a model for the way in which chronic stress translates into chronic drug use; (2) a focus on the way in which stress-related symptoms serve as trigger for drug use; (3) a focus on both mediators and moderators of treatment that will inform treatment-matching efforts, including a focus on gender differences and emotional avoidance/distress intolerance and (4) the examination of treatment outcome in a Stage II treatment trial.