Risk-Taking Following Trauma Cue Exposure in Substance Users with PTSD

描述（由申请人提供）：创伤后应激障碍（PTSD）和物质使用障碍（SUD）以高频率共同发生（布雷迪等人，2004; Cottler等人，1992; Jacobson等人，2001），并且这种诊断共现具有重大的临床和公共卫生意义。特别地，研究表明，在患有SUD的个体中共同发生的PTSD的存在与各种危险和冲动行为的高风险以及相关的负面临床结果（包括更严重的物质使用模式）相关（Back等人，2000; Cottler等人，1992; Najavits等人，2007; Salgado等人，2007），更大的法律的问题（Najavits等人，1999，2007; Ouimette等人，1999），更高风险的性行为和药物使用行为（Plotzker等人，2007），更大的HIV感染风险（霍夫et al.，1997），并且在SUD治疗结束后更快地复发到物质使用（Hien等人，2000; Ouimette等人，1999年，2007年）。此外，在患有（与不患有）PTSD的SUD患者中观察到的更差的治疗结果的发现通常不是简单地更大的合并症的结果（Ouimette等人，1999）或创伤暴露史（Hien等人，2000）表明，物质使用者中PTSD的存在是独特的，使他们面临更大的负面临床结果风险。尽管有这些发现，以及在患有PTSD的可卡因依赖性住院患者中总体上较高水平的冒险行为的初步发现（如通过基于实验室的任务所评估的）（与没有PTSD的患者相比; Tull，Trotman等人，2009），没有研究检查的因素或背景，沉淀PTSD-SUD人群中的危险行为，或在何种程度上选择的物质影响PTSD-SUD患者的危险行为。因此，拟议的实验研究旨在扩大现有的研究在这一领域通过检查210创伤暴露的SUD患者（依赖于可卡因，酒精，或可卡因和酒精）与或不与PTSD之间的想象创伤线索暴露的风险承担的影响。在不同的日期，具有标准A创伤暴露史的SUD患者将暴露于中性线索或个性化的想象创伤线索。在线索暴露之后，参与者将完成两个既定的冒险行为测量，气球锚风险任务（Lejuez等人，2002）和爱荷华州赌博任务（Bechara等人，1994年）。我们将研究创伤线索暴露（与中性线索暴露），选择的物质（可卡因与酒精与可卡因酒精依赖）和PTSD状态（当前PTSD与无PTSD史）对冒险行为的影响。我们期望找到可卡因依赖和PTSD对冒险行为的主要影响，以及线索暴露、选择的物质和PTSD状态之间的三方相互作用。具体来说，我们预计可卡因依赖性PTSD患者在创伤线索暴露后的风险水平将高于其他所有群体。生物学（唾液皮质醇），生理学（心率，皮肤电反应）和自我报告的反应线索也将进行检查，以更好地了解可能导致PTSD-SUD患者冒险的因素，从而说明其功能。 公共卫生相关性：通过研究创伤线索暴露的影响，物质的选择，和PTSD状态的风险承担低SES少数物质使用者在农村密西西比，拟议中的研究将发挥重要作用，减少差异的研究中的影响，PTSD患者SUD。此外，通过提高我们对PTSD和SUD可能导致这一人群危险行为的途径的理解，本研究的结果将促进有针对性的预防和干预计划的发展-这是精神卫生资源有限地区治疗中心的一个特别相关的考虑因素。

DESCRIPTION (provided by applicant): Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) co-occur with high frequency (Brady et al., 2004; Cottler et al., 1992; Jacobson et al., 2001), and this diagnostic co-occurrence has great clinical and public health significance. In particular, research indicates that the presence of co-occurring PTSD among individuals with a SUD is associated with heightened risk for a variety of risky and impulsive behaviors and associated negative clinical outcomes, including more severe substance use patterns (Back et al., 2000; Cottler et al., 1992; Najavits et al., 2007; Salgado et al., 2007), greater legal problems (Najavits et al., 1999, 2007; Ouimette et al., 1999), greater risky sexual and drug use behavior (Plotzker et al., 2007), greater risk for HIV infection (Hoff et al., 1997), and quicker relapse to substance use following discharge from SUD treatment (Hien et al., 2000; Ouimette et al., 1999, 2007). Further, findings that the worse treatment outcomes observed among SUD patients with (vs. without) PTSD are not the result of simply greater comorbidity in general (Ouimette et al., 1999) or a history of traumatic exposure (Hien et al., 2000) suggest that there is something unique to the presence of PTSD among substance users that places them at greater risk for negative clinical outcomes. Despite these findings, as well as preliminary findings of higher levels of risk-taking (as assessed through a laboratory-based task) in general among cocaine dependent inpatients with PTSD (vs. those without PTSD; Tull, Trotman, et al., 2009), no studies have examined the factors or contexts that precipitate risky behavior within a PTSD-SUD population, or the extent to which substance of choice influences risky behavior among PTSD-SUD patients. Thus, the proposed experimental study seeks to extend extant research in this area by examining the effect of imaginal trauma cue exposure on risk-taking among 210 trauma-exposed SUD patients (dependent on cocaine only, alcohol only, or cocaine and alcohol) with or without PTSD. On separate days, SUD patients with a history of Criterion A traumatic exposure will be exposed to a neutral cue or a personalized imaginal trauma cue. Following cue exposure, participants will complete two established behavioral measures of risk-taking, the Balloon Analogue Risk Task (Lejuez et al., 2002) and the Iowa Gambling Task (Bechara et al., 1994). We will examine the effect of trauma cue exposure (vs. neutral cue exposure), substance of choice (cocaine vs. alcohol vs. cocaine-alcohol dependence), and PTSD status (current PTSD vs. no history of PTSD) on risk-taking. We expect to find main effects of cocaine dependence and PTSD on risk-taking, as well as a three-way interaction between cue exposure, substance of choice, and PTSD status. Specifically, we expect that cocaine dependent patients with PTSD will exhibit the highest levels of risk-taking following trauma cue exposure than all other groups. Biological (salivary cortisol), physiological (heart rate, electrodermal response), and self-reported reactivity to cues will also be examined to better understand the factors that may lead to risk-taking among PTSD-SUD patients, thus speaking to its function. PUBLIC HEALTH RELEVANCE: By examining the effects of trauma cue exposure, substance of choice, and PTSD status on risk-taking among low SES minority substance users in rural Mississippi, the proposed study will play an important role in reducing disparities in research on the effects of PTSD among SUD patients. In addition, by improving our understanding of the pathways through which PTSD and SUDs may contribute to risky behavior in this population, results from this study will facilitate the development of targeted prevention and intervention programs - a particularly relevant consideration for treatment centers in areas with limited mental health resources.