Cognitive and Reward processes in risk for relapse in poly substance dependence

 描述(由申请人提供)：据估计，美国有2040万人受到药物使用障碍的影响，其中酒精和药物成瘾造成的经济损失 按每年5000亿美元计算。吸毒和酗酒现在被认为是慢性复发性疾病，大约60%的人在长期戒酒后复发。研究已经确定了复发的两个主要风险来源：1)与奖励相关的因素，与对虐待物质的渴望增加有关；以及2)与认知控制相关的因素，与故意抑制这些欲望以及减少对环境和内部触发因素的关注有关。尽管研究已经独立地研究了这些系统中的每一个，但很少有研究有效地检查与奖励和认知控制相关的因素对复发的相对贡献。更少的人结合使用有针对性的行为和神经成像手段来检查物质使用障碍复发风险的潜在神经生物学。此外，复发研究很少检查多物质滥用者滥用物质的脆弱性，而是更愿意研究一种主要物质。可以说，滥用多种物质更能代表现实世界的上瘾。这项拟议的项目将使用与临床相关的功能神经成像和行为测量，包括“纯粹的”认知控制和奖赏相关过程，以及两者之间的关系，以评估患有多物质使用障碍的个人复发的最强预测因素。此外，与许多其他关于复发的成像研究不同，我们将在受控治疗环境中招募参与者，在那里我们不仅可以更可靠地确定参与者的状态(复发与不复发)，而且还可以确定复发的天数。我们的目标是确定认知控制与奖励相关的因素，还是它们的组合，是多物质使用障碍复发的更强预测因素。这一R21产生的数据将具有临床意义，为治疗提供者提供工具，有效地针对特定的神经生物学弱点定制成瘾治疗。这项拟议研究的结果是制定一项纵向研究计划的重要第一步，该计划旨在调查多物质滥用者发展和维持药物使用障碍的神经和心理风险因素。该项目将为一个更大的RO1提案提供试点数据，以更详细地调查复发，包括更全面地调查社会、心理和临床风险因素等中介因素。这项提案的目标一致 通过研究患有多种物质使用障碍的个体，直接与美国国立卫生研究院成瘾合作研究中心(CRAN)的兴趣相联系。

 DESCRIPTION (provided by applicant): Substance use disorders are estimated to affect 20.4 million individuals in the United States with the financial cost of alcohol and substance addiction calculated at half a trillion dollars per year. Drug and alcohol addictions are now recognized as chronic, relapsing disorders, with approximately 60% of individuals relapsing following extended periods of sobriety. Research has identified two major sources of risk for relapse: 1) reward-related factors associated with increased wanting or desire for the substance of abuse; and 2) cognitive control-related factors linked to both the deliberate suppression of these desires as well as reduced attention to environmental and internal triggers. Although studies have investigated each of these systems independent of the other, few have effectively examined the relative contributions of reward- and cognitive control-related factors to relapse. Fewer still hav combined the use of targeted behavioral and neuroimaging measures to examine the underlying neurobiology of risk for relapse in substance use disorder. Furthermore, relapse studies rarely examine vulnerabilities across substances of abuse in poly-substance abusers, preferring to study one primary substance. Poly-substance abuse is arguably far more representative of real-world addiction. The proposed project will use clinically relevant functional neuroimaging and behavioral measures of "pure" cognitive control and reward-related processes, as well as the relationship between the two, to assess the strongest predictors of relapse in individuals with poly-substance use disorder. Furthermore, unlike many other imaging studies of relapse we will recruit participants in a controlled treatment setting, where we can more reliably ascertain not only the status of participants (relapse vs. no relapse) but also the number of days to relapse. Our goal is to determine whether cognitive control- versus reward-related factors, or their combination, is the stronger predictor of relapse in poly-substance use disorder. Data generated by this R21 will have clinical relevance by offering treatment providers tools to effectively tailo addiction treatments to specific neurobiological vulnerabilities. Results from this proposed study represent an important first step in the development of a longitudinal research program aimed at investigating the neural and psychological risk factors for developing and maintaining substance use disorder in poly-substance abusers. This project would provide pilot data for a larger RO1 proposal to investigate relapse in greater detail, including more comprehensively probing mediators such as social, psychological and clinical risk factors. The goals of this proposal align directly with the interests of CRAN (Collaborative Research on Addiction at NIH) by studying individuals with poly-substance use disorder.