Technology Enhanced Behavioral Activation Treatment for Substance Use

 描述(由申请人提供)：共病物质使用障碍(SUD)和抑郁症对少数民族的影响不成比例，并与治疗后药物使用复发率升高、艾滋病毒危险行为以及相关的不良心理和身体健康结果有关。尽管CBT有效，但CBT往往复杂、专门，在将其纳入物质使用治疗方案方面存在问题。此外，心理健康和药物使用治疗的预算削减减少了公共资助的治疗计划的可用性和工作人员与患者的比例。为了解决这一局限性，开发了一种行为激活(BA)疗法，即物质使用的生活增强疗法(LETS ACT)，以治疗目前正在接受住宅物质使用治疗的以非裔美国人为主的低收入非法吸毒者样本中的抑郁症状。经验证据表明，在治疗保留、治疗后禁欲、HIV性行为风险行为、抑郁症状和环境奖励等方面，LET ACT与显著优于对照条件的结果相关。尽管这些强有力的结果表明，LET ACT可能已经准备好进行III期传播试验，但除了治疗后3个月的随访外，LET ACT对禁欲的影响并不显著，而且LET ACT的作业遵从性通过环境奖励对治疗后物质使用和HIV性行为风险行为有显著的间接影响。这些发现表明，需要确定具有成本效益的递送工具，以增加临床医生会议之外的治疗参与度。最后，确定BA的关键理论方面(即奖赏敏感性)下的神经科学生物标记物(神经标记物)，以及它们与患有抑郁症的药物使用者BA治疗反应的异质性的关系，对于确定准确的靶向干预至关重要。目前的提案将扩展R01 DA026424中的发现，解决抑郁的低收入物质使用者的关键需求，以(1)确定LET ACT的智能手机强化治疗(LET ACT-SE)是否与长期治疗参与度的增加相关，进而改善长期治疗结果，以及(2)使用功能磁共振成像(FMRI)来确定LET ACT-SE对奖励敏感性神经标记物的影响。该应用跨越了多项NIDA倡议，旨在(1)利用创新技术改善行为干预措施，以提高效果并增加可实施性(PA-13-077)，(2)开发有效的干预措施，以防止新的艾滋病毒感染(PA-12-281)，(2)确定影响艾滋病毒风险的潜在机制(PA-14-061)，(3)确定物质使用与精神疾病共病的潜在神经回路(PA-14-026)，以及(4)确定药物滥用的神经生物学机制，以改进治疗(PA-13-338)。

 DESCRIPTION (provided by applicant): Comorbid substance use disorder (SUD) and depression disproportionately affect ethnic minorities, and is associated with elevated rates of post treatment relapse to substance use, HIV risk behavior, and associated poor mental and physical health outcomes. Although efficacious, the often complex, specialized nature of CBT poses problems in its integration into substance use treatment programs. Moreover, budget cuts for mental health and substance use treatment reduce availability of publically funded treatment programs and staff to patient ratios. To address this limitation, a behavioral activation (BA) treatment, the Life Enhancement Treatment for Substance Use (LETS ACT), was developed to treat depressive symptoms among a predominantly African American sample of low income illicit drug users currently receiving residential substance use treatment. Empirical evidence indicates that LETS ACT is associated with significantly better outcomes then a control condition for treatment retention, post treatment abstinence, HIV sexual risk behavior, depressive symptoms, and environmental reward. Although these strong outcomes suggest that LETS ACT may be ready for a Stage III dissemination trial, the effects of LETS ACT on abstinence were not significant beyond a 3- month post treatment follow-up, and there was a significant indirect effect of LETS ACT homework compliance on post treatment substance use and HIV sexual risk behavior via environmental reward. These findings point to the need to identify cost-effective delivery-vehicles to increase treatment engagement outside of clinician sessions. Finally, identifying neuroscience based biomarkers (neuromarkers) underlying key theoretical aspects of BA (i.e., reward sensitivity), and their relation to heterogeneity in BA treatment response among substance users with depression are critical for the identification of accurately targeted interventions. The current proposal will expand upon findings in R01 DA026424 by addressing the critical needs of depressed low income substance users to (1) determine if a smartphone enhanced treatment for LETS ACT (LETS ACT-SE) is associated with increased long term treatment engagement, and in turn, improved long term treatment outcomes, and (2) use functional magnetic resonance imaging (fMRI) to identify the effects of LETS ACT-SE on the neuromarkers of reward sensitivity. The application cuts across multiple NIDA initiatives aiming to (1) improve behavioral interventions using innovative technologies to boost effects and increase implementability (PA-13-077), (2) develop effective interventions to prevent new HIV infection (PA-12- 281), (2) identify the underlying mechanisms that impact HIV risk (PA-14-061), (3) identify neural circuits underlying substance use comorbidity with psychiatric disorders (PA-14-026), and (4) identify neurobiological mechanisms underlying drug abuse to improve treatment (PA-13-338).