Cardiovascular, Immune and Psychosocial Benefits of Reduced Cocaine Use

摘要 促进减少问题行为在医疗实践中很常见，在这种情况下，高危个人 建议在生活方式上做出适度、可持续的改变。减少重度饮酒的比例 酒精使用障碍患者的日子是酒精成瘾治疗中公认的干预目标， 然而，对于其他药物使用障碍，完全戒除仍然是证明治疗的标准。 功效。促进减少药物使用的干预措施应该改善生物、心理和社会结果。一点儿 然而，已经进行了研究，以证明减少药物使用的好处。展示了 减少可卡因(COC)使用的好处将通过挑战 对可能的干预结果的预期。使用COC会产生许多生物、心理和社会 有害的(例如，心血管毒性、免疫功能紊乱、精神疾病共病增加) 可以通过减少COC使用量来改善。目前还没有研究对此进行前瞻性或全面的评估。 到目前为止的可能性，尽管初步数据支持这一假设。为了填补这一关键的知识缺口，我们 建议一项为期12周的随机对照试验，在该试验中，将使用财政激励措施来减少COC的使用。 受试者将被随机分配到三组中的一组(n=66名完成者/组)：1)高价值金融 对COC禁欲的激励措施，其中使用COC的频率预计将大幅减少或 完全消除，2)针对COC禁欲的低价值财务激励，其中使用COC的频率 预计减少或3)非临时控制组，其中COC的使用频率预计为 保持稳定。这项研究旨在证明，减少COC的使用可以改善生理和生化 心血管和免疫健康以及心理社会功能的指标。最重要的假设 被分配到积极治疗条件的个体将在生物心理社会方面表现出改善 与分配给非偶然控制组的个人进行比较。“剂量-反应”也是 预计被分配到高价值条件的个人将在COC使用方面表现出更大的减少， 从而相对于低值条件有更大的改善。这项研究将推动 领域：1)使用多方面的健康结果提供支持减少药物使用的前瞻性证据 作为COC治疗开发的可行终点，2)确定健康的生化指标 与减少COC使用相关的改进，以及3)为范式转换定义奠定基础 COC治疗成功的可能性，从而挑战对行为和药理学结果的预期 干预性发展。这些创新将加快对可卡因有希望的治疗方法的识别 使用障碍，对科学和临床实践产生持续和强大的影响。

ABSTRACT Promoting reductions in problem behaviors is common in medical practice wherein at-risk individuals are counseled to make moderate, sustainable changes in lifestyle. Reducing the percentage of heavy drinking days in individuals with alcohol use disorder is an accepted intervention target in alcohol addiction treatment, yet for other drug use disorders, complete abstinence remains the standard for demonstrating treatment efficacy. Interventions that promote reductions in drug use should improve biopsychosocial outcomes. Little research has been conducted to demonstrate benefits of reduced drug use, however. Demonstrating the benefits of reduced cocaine (COC) use would significantly advance treatment development by challenging expectations for outcomes from possible interventions. COC use produces a number of biopsychosocial detriments (e.g., cardiovascular toxicity, disrupted immune function, increased psychiatric comorbidities) that could be ameliorated by COC use reduction. No studies have prospectively or comprehensively evaluated this possibility to date, although preliminary data support this hypothesis. To fill this critical knowledge gap, we propose a randomized, controlled 12-week trial in which financial incentives will be used to reduce COC use. Subjects will be randomly assigned to one of three groups (n=66 completers/ group): 1) high value financial incentives for COC abstinence in which frequency of COC use is expected to be substantially reduced or completely eliminated, 2) low value financial incentives for COC abstinence in which frequency of COC use is expected to be reduced or 3) a non-contingent control group, in which frequency of COC use is expected to remain stable. This study aims to demonstrate that reduced COC use improves physiological and biochemical indicators of cardiovascular and immune fitness, as well as psychosocial function. The overarching hypothesis is that individuals assigned to the active treatment conditions will display improvements in biopsychosocial domains compared to individuals assigned to the non-contingent control group. A “dose-response” is also expected whereby individuals assigned to the high value condition will display greater reductions in COC use, and consequently greater improvements, relative to the low value condition. This research will advance the field by: 1) using multifaceted health outcomes to provide prospective evidence supporting reduced drug use as a viable endpoint for COC treatment development, 2) identifying biochemical indicators of health improvements associated with reduced COC use and 3) laying the foundation for a paradigm-shifting definition of COC treatment success, thereby challenging expectations for outcomes in behavioral and pharmacological intervention development. These innovations will accelerate identification of promising treatments for cocaine use disorder, resulting in a sustained and powerful impact on scientific and clinical practice.