Neuro-Cognitive Aspects of Opiate Abuse & Antisocial Behavior

描述(申请人提供)：海洛因成瘾率在全球范围内不断上升，伴随而来的是法律和健康成本，包括艾滋病毒和丙型肝炎病毒传播风险的增加。然而，目前很难或根本不可能研究“纯”海洛因使用的后果，因为大多数吸毒者对多种物质有依赖。此外，反社会人格障碍和精神变态等并存疾病使海洛因依赖者的临床表现和日常功能进一步复杂化。滥用药物对大脑的影响和成瘾的发展的研究尤其困难，因为很难将药物对认知的影响与与共病条件相关的功能障碍分开。我们建议开发一个长期目标的研究计划，以调查患有和不患有ASPD/精神病症的吸毒者大脑功能的神经认知方面。这项计划将在保加利亚发展，保加利亚是东南欧的一个中低收入国家，海洛因成瘾的流行率很高。保加利亚的地理位置使其成为“巴尔干毒品路线”上的关键国家，这是从西南亚到西欧的国际毒品贩运的主要路线之一，西欧目前使用的海洛因约有80%通过该路线。因此，海洛因在该国很容易获得，事实上，海洛因成瘾已成为最严重的健康和法律问题之一。保加利亚的海洛因成瘾模式是独一无二的，因为对多种物质的依赖并不常见。因此，对保加利亚吸毒者的研究为评估相对“纯粹”的海洛因使用的神经认知和精神后果提供了一个独特的机会。此外，保加利亚法律制度的性质有利于在有或没有警察局的情况下研究海洛因依赖者，因为所有因与毒品有关的指控而被捕的被拘留者在处理其案件之前都要接受强制的医疗和精神评估。我们与索非亚的医生和精神卫生专业人员合作，他们可以接触到大量审前被拘留者，其中绝大多数人因与毒品有关的罪行而被拘留。在保加利亚，关于成瘾及其神经认知后果的研究很少，尽管迫切需要解决这些问题。在拟议的项目中，她的同事、伊利诺伊大学芝加哥分校以及保加利亚索非亚州立大学神经病学和精神病学医院的法医精神病学和心理学诊所将启动开发资源，研究患有和不患有apd/精神病和不存在多物质依赖的海洛因成瘾者的神经认知功能。这项初步工作将对患有和不患有自闭症/精神病的海洛因成瘾者的神经认知进行初步研究，并根据这些初步结果和在两年中开发的其他假设进行R01应用。

DESCRIPTION (provided by applicant): Rates of heroin addiction are increasing worldwide with concomitant legal and health costs, including increased risk of HIV and hepatitis C viral transmission. However, at present it is difficult to impossible to study the consequences of "pure" heroin use since the majority of addicts are polysubstance-dependent. Further, co-morbid conditions, such as Antisocial Personality Disorder (APD) and psychopathy, additionally complicate the clinical picture and daily function of heroin-dependent persons. Study of the effect of drugs of abuse on the brain and the development of addiction are particularly difficult, due to difficulty in isolating drug effects on cognition from dysfunction associated with co-morbid conditions. We propose to develop a program of studies with the long-term goals of investigating neurocognitive aspects of brain function in drug addicts with and without a diagnosis of ASPD / psychopathy. This program will be developed in Bulgaria, a low-middle income country in Southeastern Europe with significantly high prevalence of heroin addiction. Bulgaria's geographical position make it a key country on the "Balkan Drug Route", one of the main routes for international drug traffic from South-West Asia to Western Europe, through which approximately 80% of the heroin currently used in Western Europe passes. Consequently, heroin is easily available in the country, and in fact heroin addiction has become one of the most significant health and legal problems. Patterns of heroin addiction in Bulgaria are unique in that polysubstance dependence is uncommon. Consequently study of Bulgarian addicts provides a unique opportunity to evaluate neurocognitive and psychiatric consequences of relatively "pure" heroin use. In addition, the nature of the Bulgarian legal system facilitates the opportunity to study heroin dependent subjects both with and without APD because all detainees arrested for drug-related charges undergo mandated medical and psychiatric evaluation prior to disposition of their cases. We have partnered with physicians and mental health professionals in Sofia who have access to a large population of pre-trial detainees, a large majority of whom have been detained for drug-related crimes. Research on addiction and its neuro-cognitive consequences is minimal in Bulgaria, despite a significant need to address these concerns. In the proposed project the PI, her colleagues the University of Illinois-Chicago, and at the Clinic of Forensic Psychiatry and Psychology at the State University Hospital of Neurology and Psychiatry in Sofia, Bulgaria, will initiate the development of resources for studies of neuro-cognitive function in heroin addicts with and without APD/psychopathy, and without polysubstance dependence. This preliminary work will culminate in a pilot study of neuro-cognition in heroin addicts with and without ASPD/psychopathy and an R01 application based on these pilot findings and other hypotheses developed in the course of the two years.