Enhancing treatment outcomes among veterans with alcohol use disorder: Clinical and neural markers of adjunctive approach-avoidance training

提高患有酒精使用障碍的退伍军人的治疗效果：辅助接近-避免训练的临床和神经标志物

• 批准号: 10533497
• 负责人: Jessica Bomyea
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-10-01 至 2026-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10533497
• 关键词: Address; Affect; Alcohol consumption; Alcohols; Amygdaloid structure; Back; Behavior; Behavioral; Beverages; Brain; Caring; Characteristics; Clinical; Clinical Trials; Cognitive; Communities; Complex; Computers; Corpus striatum structure; Cues; Data; Desire for food; Development; Equipment and supply inventories; Foundations; Functional Magnetic Resonance Imaging; Goals; Heavy Drinking; Impairment; Individual; Informal Social Control; Inpatients; Intervention; Life; Measures; Medial; Methods; Mission; Modeling; Motivation; Neurobiology; Neurocognitive; Neurosciences; Occupational; Outcome; Patients; Prediction of Response to Therapy; Prefrontal Cortex; Process; Quality of life; Randomized Controlled Trials; Reaction; Reaction Time; Recovery; Recovery of Function; Relapse; Rewards; Role; Services; Severities; Substance of Abuse; Techniques; Testing; Therapeutic; TimeLine; Training; Treatment outcome; Veterans; Work; adverse outcome; alcohol abstinence; alcohol abuse therapy; alcohol cue; alcohol intervention; alcohol response; alcohol use disorder; base; comorbidity; confirmatory trial; cost; cue reactivity; disability; drinking; drinking behavior; effective intervention; efficacy evaluation; functional disability; functional independence; hazardous drinking; improved; improved outcome; innovation; neuroimaging; novel; portability; reduced alcohol use; relating to nervous system; response; reward processing; skills; social; standard care; substance use; treatment program

Veterans with alcohol use disorders (AUD) would be greatly served by development of effective interventions to address high relapse rates and difficulty with resuming optimal functional recovery (i.e., re-engaging in vocational, social, and daily life roles that are critical to maintaining alcohol consumption goals). Approach bias toward alcohol, an implicit motivational response to alcohol cues observable across behavioral and neural indicators, is a core feature of AUD that impedes recovery but is not routinely treated in standard care. Treatment options that target approach bias may improve outcomes by decreasing the appetitive pull of alcohol, so that individuals are better able to disengage from habitual drinking behaviors in the service of their functional goals and objectives. Approach Avoidance Training (AAT) is a computer-delivered treatment program that shifts behavioral and neural indicators of approach bias for alcohol and has been shown to improve drinking-related outcomes in AUD when used in conjunction with standard care. Given the promise of this intervention for AUD, there is a critical need to determine if this treatment can be successfully used for Veterans who commonly present with complex comorbidities, and to pinpoint cognitive and neurobiological processes of change. The overall objectives of this proposal are to determine whether Alcohol Approach Avoidance Training (AAT) improves recovery outcomes in Veterans undergoing standard care for AUD with co-occurring conditions, and to identify the underlying cognitive and neural substrates modified. The central hypothesis is that AAT training will improve critical recovery outcomes for Veterans and improve behavioral and neural indicators of approach bias. We will explore whether effects of AAT generalize to related top-down and bottom-up neurocognitive processes. We will also explore potential predictors of treatment response. The overall objectives will be addressed in a randomized controlled trial of 136 Veterans completing standard care in our local VA setting with either AAT or a control condition. Aim 1 will determine if repeatedly practicing avoidance of alcohol cues through AAT can improve recovery outcomes and hazardous drinking. Aim 2 will determine if AAT modifies approach bias by measuring this construct with multiple assessment methods (i.e., behavioral, fMRI). Exploratory aims will examine if AAT modifies inhibition (top-down) and cue reactivity (bottom up) processing, and the extent to which baseline comorbidity severity, treatment engagement characteristics, or baseline approach bias (behavioral task reaction times, brain response during fMRI) are associated with clinical outcomes. The project is expected to determine if AAT shows clinical potential that would warrant expansion to other substances of abuse and a larger multisite confirmatory efficacy trial in Veterans with AUD. Results of the study will inform the utility of AAT as an adjunctive AUD treatment for Veterans, potentially offering a novel, low-cost, and portable alternative option to improve recovery in these individuals. Consistent with the RR&D mission to maximize “functional independence, quality of life and participation in their lives and community,” the project will provide a foundation for neuroscience-based alternative therapeutic options to improve recovery in Veterans with AUD.

制定有效的干预措施将极大地帮助患有酒精使用障碍（AUD）的退伍军人 解决高复发率和恢复最佳功能恢复的困难（即重新参与 对维持饮酒目标至关重要的职业、社会和日常生活角色）。 对酒精的一种内隐的动机反应，可以在行为和神经方面观察到酒精线索 指标，是 AUD 的一个核心特征，它阻碍康复，但在标准治疗中并未得到常规治疗。 针对方法偏差的选择可能会通过降低酒精的食欲拉力来改善结果，以便 个人能够更好地摆脱习惯性饮酒行为，以实现其功能目标 避免接近训练 (AAT) 是一种由计算机提供的可改变的治疗计划。 酒精方法偏差的行为和神经指标，并已被证明可以改善与饮酒相关的问题 考虑到这种干预措施对 AUD 的前景，与标准护理结合使用时的结果。 迫切需要确定这种治疗是否可以成功用于退伍军人 存在复杂的合并症，并查明认知和神经生物学变化过程。 该提案的总体目标是确定是否进行酒精接近训练（AAT） 改善接受 AUD 标准护理并伴有并发病症的退伍军人的康复结果，以及 识别潜在的认知和神经基础被修改的中心假设是 AAT 训练。 将改善退伍军人的关键康复结果，并改善方法的行为和神经指标 我们将探讨 AAT 的影响是否可以推广到相关的自上而下和自下而上的神经认知。 我们还将探索治疗反应的潜在预测因素。 在一项随机对照试验中解决了这一问题，该试验涉及 136 名退伍军人，他们在我们当地的 VA 环境中完成了标准护理 AAT 或控制条件将决定是否通过反复练习避免酒精暗示。 AAT 可以改善康复结果，目标 2 将决定 AAT 是否改变方法。 通过使用多种评估方法（即行为、探索性目标）测量这种结构来消除偏差。 检查 AAT 是否改变抑制（自上而下）和提示反应性（自下而上）处理，以及改变的程度 基线合并症严重程度、治疗参与特征或基线方法偏差（行为任务 该项目预计与临床结果相关。 确定 AAT 是否显示出临床潜力，足以保证扩展到其他滥用物质和更大的范围 对患有 AUD 的退伍军人进行的多中心验证疗效试验的研究结果将告诉您 AAT 作为一种治疗方法的实用性。 为退伍军人提供辅助 AUD 治疗，有可能为治疗提供一种新颖、低成本、便携式的替代选择 改善这些人的康复，这与 RR&D 最大化“功能”的使命是一致的。 独立性、生活质量以及对生活和社区的参与”，该项目将提供 基于神经科学的替代治疗方案的基础，以改善使用 AUD 的退伍军人的康复。