Autonomous Digital CBT Intervention for Opioid Use Disorder in Individuals with Co-Occurring Internalizing Disorders

项目摘要 成瘾的主要神经科学特征是进化的神经行为反应 慢性药物使用，最初的动机是随着时间的推移而导致的快感增加(冲动性药物使用) 神经适应，使药物使用越来越多地受到负面情绪(强迫性使用)缓解的推动。 上瘾的强迫阶段可以被看作是一个从负面情绪中短期解脱以来的“恶性循环” 通过药物使用产生的影响最终会通过对长期使用的神经适应而加剧负面影响。我们的 早期的研究表明，恶性循环是维持酒精共病的主要因素。 使用障碍(AUD)和内在性障碍(焦虑和抑郁)。这为 AUD共病认知行为治疗方案的开发和验证 针对成瘾的恶性循环(VC-CBT)。此外，我们还开发了一个完全自主且易于扩展的 提供VC-CBT的数字平台已被证明与治疗师提供的版本一样有效。这个 干预的前提是教育个人了解恶性循环的可逆性，并对他们进行培训 在没有药物的情况下，使用已被证实的应对技能来管理负面情绪可以显著地帮助他们实现 期望的治疗目标。在这个项目中，我们利用神经科学的跨性成瘾状态 VC-CBT干预的基础及其作为开发和测试数字治疗的灵活性 阿片使用障碍(OUD)共病的治疗。相对于其他滥用药物，从 最初的冲动使用对消极强化的强迫使用是已知的截断和几乎普遍的 在那些经常使用阿片类药物的人中，以及那些同时发生内化障碍的人中，尤其是 易受影响。这一点，再加上OUD相对较高的致命性，使其成为理想的近期目标。 转化成瘾疗法。为了实现这一点，我们建议测试数字交付的VC-CBT的临床疗效 在由两个阶段组成的UG3/UH3方案中用于OUD-INTD共病。第一阶段的总体目标 对已建立的数字传输负面影响VC-CBT的修改和中试是否适用 在声音中。第二阶段的总体目标是对改良的VC进行科学严格的临床试验- CBT FOR OUD。这项工作的影响将是提供一种可伸缩且廉价的手段来改进 否则，患有焦虑或抑郁的患者的治疗结果会很差。此外， 该项目将支持针对多个共同过程的跨成瘾干预措施的可行性 上瘾类型。

Project Summary The prevailing neuroscientific characterization of addiction is that of evolving neuro-behavioral responses to chronic drug use that are initially motivated by increasing pleasure (impulsive drug use) that over time causes neuro-adaptations such that drug use is increasingly motivated by relief from negative affect (compulsive use). The compulsive stage of addiction can be seen as a “vicious cycle” since the short-term relief from negative affect through drug use ultimately exacerbates negative affect through neuroadaptations to chronic use. Our early work demonstrated that the vicious cycle was a primary factor in maintaining comorbidity between alcohol use disorder (AUD) and internalizing disorders (anxiety and depression). This provided the ground work for the development and validation of a cognitive-behavioral therapy program for AUD comorbidity that directly targeted the vicious cycle of addiction (VC-CBT). Further, we developed a fully autonomous and easily scaled digital platform to deliver VC-CBT that has proved to be as effective as the therapist-delivered version. The intervention is premised on educating individuals about the reversibility of the vicious cycle, and training them to use proven coping skills to manage negative affect without drugs can significantly aid them in achieving desired treatment goals. In this project, we leverage the trans-addiction status of the neuroscientific underpinnings of the VC-CBT intervention and its flexibility as a digital therapeutic to develop and test a digital treatment for comorbidity in opioid use disorder (OUD). Relative to other drugs of abuse, the progression from initial impulsive use to negatively reinforced compulsive use is known to be truncated and nearly universal among those who routinely use opioids, and those with co-occurring internalizing disorders are especially susceptible. This, along with the relatively high lethality of OUD, makes it an ideal near-term target for this trans-addiction therapy. To achieve this, we propose to test the clinical efficacy of digitally-delivered VC-CBT for OUD-INTD comorbidity in a UG3/UH3 program consisting of two phases. The overarching aim of Phase 1 is the modification and pilot testing of the established digitally-delivered negative affect VC-CBT for application in OUD. The overarching aim of Phase 2 is to conduct a scientifically rigorous clinical trial of the modified VC- CBT for OUD. The impact of this work would be to provide a scalable and inexpensive means of improving the otherwise poor OUD treatment outcomes among those with co-occurring anxiety or depression. Moreover, the project would support the viability of trans-addiction interventions that target processes common to multiple addiction types.