Electrophysiological Predictors and Indicators of Contingency Management Treatment Response

电生理学预测因素和应急管理治疗反应指标

• 批准号: 10417037
• 负责人: SARAH E FORSTER
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-01-01 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10417037
• 关键词: Abstinence; Affect; Aftercare; Area; Base of the Brain; Behavior Therapy; Behavior assessment; Behavioral; Brain; Cessation of life; Clinical; Clinical Trials; Cocaine; Cocaine Dependence; Cocaine Users; Cocaine use disorder; Cognitive; Cost Measures; Custom; Data; Decision Making; Development; Diagnosis; Disease; Drug Screening; Drug Use Disorder; Effectiveness; Electroencephalography; Electrophysiology (science); Ethics; Evaluation; Event-Related Potentials; Fostering; Future; Goals; Homelessness; Hospitalization; Impairment; Imprisonment; Incentives; Individual; Individual Differences; Inherited; Intervention; Knowledge; Measurement; Measures; Mental Health; Methods; Mind; Modeling; Motivation; Neurocognitive; Opiate Addiction; Outcome; Outpatients; Participant; Patient Self-Report; Pattern; Performance; Pharmaceutical Preparations; Pharmacotherapy; Post-Traumatic Stress Disorders; Predictive Analytics; Prize; Probability; Process; Provider; Psychological reinforcement; Recovery; Recovery Support; Relapse; Reporting; Research; Research Training; Rewards; Self Efficacy; Self-control as a personality trait; Services; Severities; Short-Term Memory; Signal Transduction; Site; Substance Use Disorder; Targeted Research; Testing; Thinking; Training; Translations; Treatment Effectiveness; Treatment outcome; Urine; Variant; Veterans; Work; addiction; base; behavior measurement; behavioral health; clinical decision-making; clinically relevant; cognitive ability; cognitive control; cognitive function; contingency management; disorder later incidence prevention; evidence base; financial incentive; implementation barriers; implementation cost; improved; individual patient; individual response; military veteran; neuroadaptation; novel; opioid use disorder; predictive modeling; premature; programs; recruit; relating to nervous system; response; reward anticipation; scaffold; service member; substance use; substance use treatment; targeted treatment; treatment as usual; treatment planning; treatment response; voucher

Electrophysiological methods, including event-related potential and functional connectivity approaches, have strong potential to clarify mechanisms of substance use treatment response and characterize individual differences therein. Veterans are disproportionately affected by disorders of addiction, of which cocaine use disorder (CUD) is particularly problematic due to high relapse rates and the absence of approved pharmaco- therapy treatment options. Behavioral interventions for CUD, have therefore become an important focus of research and Contingency Management (CM) has emerged as the best-supported and most widely used approach. CM involves reinforcing cocaine abstinence (established through objective testing) with reliable, short-term reward, such as chances to win prizes (i.e., Prize-Based CM or PBCM). In response to substantial empirical support, national dissemination of PBCM has been supported by a VHA initiative since 2011. However, PBCM response rates are variable and long-term benefits are limited – problems magnified by the cost of implementation with respect to staffing and prizes. Measurement-based approaches to PBCM implementation have strong promise to improve the effectiveness and efficiency of CM programming but have not yet been investigated within the VA or considered in relation to promising neuromarkers. Importantly, two versions of PBCM are already utilized at VA sites and may differentially benefit individuals with distinct neurocognitive profiles. Specifically, VA PBCM programs employ either abstract (voucher prize) or concrete (tangible prize) incentives, the latter of which may more effectively incentivize abstinence in Veterans with poor future-oriented thinking and planning ability. While selection between existing PBCM variants is currently driven by practical considerations (e.g., provider convenience), measurement of pretreatment neurocognitive functioning could meaningfully and realistically inform clinical decision-making in this regard. This CDA aims to advance measurement-based implementation of CM by testing a novel neurocognitive model of CM with immediate implications for the use of abstract versus concrete PBCM incentives within the VA. Specifically, the future-minded decision-making (FMDM) model posits that CM scaffolds future-oriented goal representation and self-control to support abstinence during in the moment use-related decision-making. For individuals with greater FMDM impairment, concrete, readily-accessible incentives may be more effective than abstract monetary rewards (e.g., vouchers) which require future-oriented thinking and planning to inherit value. To test this model, neurocognitive substrates of FMDM will be examined as predictors of differential treatment response in voucher (VoucherPBCM) versus tangible prize (TangiblePBCM) versions of the intervention used within the VA. Treatment-related change in neural and cognitive-behavioral correlates of FMDM will also be evaluated in PBCM relative to treatment-as-usual (TAU) care. A total of 180 Veterans with CUD will be allocated to VoucherPBCM (n=70), TangiblePBCM (n=70), or TAU (n=40) conditions and followed for a 12 week treatment interval. Pre- and post-treatment electroencephalography (EEG) and cognitive-behavioral assessments will be used to measure FMDM-related constructs (working memory, self- control, future-oriented decision-making, future reward representation) and related neuromarkers. These measures will subsequently be investigated as predictors of differential treatment response in VoucherPBCM versus Tangible PBCM. Longitudinal change in FMDM-related neural substrates and cognitive abilities will also be evaluated for evidence of neuroadaptation (e.g., changes in functional connectivity) and enhancement of FMDM function through PBCM. The proposed research will be supported by focused training in the areas of (1) predictive analytics, (2) functional connectivity analysis of EEG data, (3) longitudinal evaluation of neuroadaptive mechanisms, and (4) clinical trials research. Together, research and training aims will support development of an independent program of research targeting precision implementation of CM within the VA.

电生理方法，包括事件相关的电位和功能连接方法， 具有强大的潜力来阐明物质使用治疗反应的机制并表征个体 其中的差异。退伍军人受可卡因使用的疾病的影响不成比例 疾病（CUD）由于高继电器率和缺乏认可的药物 - 治疗方法。因此，CUD的行为干预已成为 研究与应急管理（CM）已成为最受欢迎，最广泛使用的人 方法。 CM涉及以可靠的，可靠的， 短期奖励，例如赢得价格的机会（即基于奖品的CM或PBCM）。响应实质性 自2011年以来，VHA倡议支持了经验支持，PBCM的全国性传播。 但是，PBCM的响应率是可变的，长期收益受到限制 - 问题由 关于人员和价格的实施成本。基于测量的PBCM方法 实施有很大的希望，可以提高CM编程的有效性和效率，但具有 尚未在VA中进行调查或与承诺神经标志物有关的考虑。重要的是，两个 PBCM的版本已经在VA站点使用，可能会对不同的人有所不同 神经认知概况。特别是VA PBCM计划员工摘要（代金券奖）或具体 （有形奖）激励措施，后者可能会更有效地激励退伍军人的禁欲 贫穷的未来的思维和计划能力。而现有PBCM变体之间的选择是 目前由实际考虑（例如提供者便利性），预处理测量的驱动 神经认知功能可能意味着在这方面充分而现实地为临床决策提供信息。 该CDA旨在通过测试一种新型神经认知来提高基于测量的CM实施 CM的模型对使用抽象与混凝土PBCM激励措施的使用直接影响 VA。具体而言，未来有意识的决策（FMDM）模型认为CM脚手架以未来为导向 目标代表和自我控制，以支持与使用相关的决策期间的戒酒。 对于具有较大FMDM损害的个体，具体，易于访问的激励措施可能更有效 比抽象的货币奖励（例如，凭证）需要以未来为导向的思维和计划继承 价值。为了测试该模型，FMDM的神经认知底物将被检查为差异的预测指标 优惠券（代价BCM）与有形奖品（ConsiblePBCM）版本的治疗响应版本 VA内使用的干预措施。与治疗相关的神经和认知行为相关性的变化 FMDM还将在PBCM中相对于治疗 - 常用（TAU）护理进行评估。共有180名退伍军人 CUD将分配给代凭证（n = 70），有形PBCM（n = 70）或tau（n = 40）条件，并且 其次是12周的治疗间隔。治疗前后的脑电图（EEG）和 认知行为评估将用于测量与FMDM相关的构建体（工作记忆，自我 控制，面向未来的决策，未来的奖励代表）和相关的神经标志物。这些 随后，将研究措施作为代凭证中差异治疗反应的预测指标 与有形的PBCM相对于。 FMDM相关神经底物和认知能力的纵向变化也将 评估神经适应的证据（例如，功能连通性的变化）和增强 FMDM通过PBCM函数。拟议的研究将通过（1）领域的重点培训来支持 预测分析，（2）脑电图数据的功能连通性分析，（3） 神经适应机制和（4）临床试验研究。研究和培训目标将支持 开发针对VA中CM精确实施的独立研究计划。