Prevention of Relapse in Addiction

预防成瘾复吸

• 批准号: 7966911
• 负责人: Kenzie Preston
• 金额: $ 108.66万
• 依托单位: NATIONAL INSTITUTE ON DRUG ABUSE
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/7966911
• 关键词: Abstinence; Acute; Adrenergic alpha-Agonists; Alcohols; Anger; Attention; Behavioral; Chicago; Clonidine; Cocaine; Collaborations; Cues; Data; Data Analyses; Data Collection; Devices; Drug usage; Electronics; Environment; Exposure to; Goals; Handheld Computers; Heroin; Heroin Abuse; Hour; Human; Illicit Drugs; Individual; Intervention; Laboratory Animals; Life; Logistic Regressions; Manuscripts; Measurement; Measures; Methadone; Modeling; Monitor; Moods; Nicotine; Obesity; Outcome; Outpatients; Participant; Patient Self-Report; Patients; Pattern; Persons; Pharmaceutical Preparations; Population; Preparation; Randomized Clinical Trials; Relapse; Reporting; Research; Research Personnel; Role; Site; Smoker; Stress; Testing; Time; Universities; addiction; animal data; aripiprazole; base; cocaine use; cohort; craving; design; diaries; disorder later incidence prevention; drug craving; improved; multidrug abuse; pre-clinical; preclinical study; prevent; programs; response; weight maintenance

A major initiative for our section is to examine the role of exposure to putative relapse triggers (such as environmental cues and stress) through the use of ecological momentary assessment (EMA). We are conducting studies in heroin/cocaine-using methadone-maintained outpatients and in obese individuals who are in a weight-maintenance program. Participants carry electronic diaries to record the base rates of exposure to putative relapse triggers as well as the presence of these triggers during relapse. In the first completed study, we prospectively monitored the acute daily-life precipitants of craving for, and use of, cocaine and heroin. In a cohort design, 114 methadone-maintained cocaine- and heroin-abusing outpatients provided EMA data on handheld computers for up to 14,918 person-days (mean 130.9 days per participant, range 6-189). Of those 114, a total of 102 provided acute pre-craving or pre-use data and were thus included in the present analyses. Changes in reports of mood and exposure to putative drug-use triggers at random intervals during the five hours preceding each self-reported episode of drug craving or use, analyzed via repeated-measures logistic regression (SAS GLIMMIX macro). The five hours preceding drug use showed orderly increases in reports of Saw Drugs, Offered Drugs, Wanted to see what would happen if I used, Tempted to use out of the blue, Handled $10 or more, Angry, Worried, Criticized by others, Uncomfortable, and Good mood, but not Bored or Sad. The five hours preceding drug craving showed a different pattern of reports, e.g. an orderly increase in Sad but no increase in Good mood. These findings confirm that polydrug-abusing individuals can provide behavioral data in their daily environments using handheld computers, and that those data can reveal orderly patterns, including prospectively detectable harbingers of craving and use. We are also exploring the use of handheld electronic devices for treatment delivery in patients daily environment. In addition, we are using handheld electronic devices to improve outcome measurement in our randomized clinical trials. This aspect of our research derives from laboratory-animal data showing that stress-induced reinstatement of cocaine seeking and/or heroin seeking can be prevented with the alpha-adrenergic agonist clonidine, while cue-induced reinstatement of such drug seeking can be prevented with aripiprazole. We are conducting two trials of clonidine, one to evaluate its effect on response to stress and drug cues, and the second to evaluate its efficacy in relapse prevention. We are currently conducting a study in which methadone-maintained outpatients carry handheld computers throughout the day to provide real-time data on cravings for heroin and cocaine, lapses to drug use, and base rates of putative lapse precipitants. We have demonstrated the feasibility of this form of data collection in our population and are using it in the clonidine trial to determine whether clonidines relapse-prevention effect is specific to subtypes of relapse. Finally, we completed a collaboration with investigators at the University of Chicago on a two-site study to investigate the time course of craving in abstinent smokers, with particular attention to the possibility of incubation, a phenomenon seen in preclinical studies, in which craving increases with duration of abstinence. Data analysis is underway, and a manuscript is in preparation. Incubation of craving may help explain the long-lasting vulnerability to relapse in individuals formerly dependent on nicotine, alcohol, or illicit drugs.

我们部分的一项主要举措是通过使用生态瞬时评估（EMA）来检查暴露于假定的复发触发因素（例如环境线索和压力）的作用。 我们正在对使用海洛因/可卡因的美沙酮维持门诊患者和正在接受体重维持计划的肥胖个体进行研究。 参与者携带电子日记来记录暴露于假定的复发触发因素的基本比率以及在复发期间这些触发因素的存在。 在第一项完成的研究中，我们前瞻性地监测了日常生活中对可卡因和海洛因的渴望和使用的急性诱因。 在队列设计中，114 名服用美沙酮的可卡因和海洛因滥用门诊患者在手持电脑上提供了长达 14,918 人日的 EMA 数据（平均每个参与者 130.9 天，范围 6-189）。 在这 114 名参与者中，共有 102 名提供了强烈的渴望前或使用前数据，因此被纳入本次分析。 在每次自我报告的药物渴望或使用事件之前的五个小时内，随机间隔内报告的情绪和假定的药物使用触发因素的变化，通过重复测量逻辑回归（SAS GLIMMIX 宏）进行分析。 吸毒前 5 小时显示，看到毒品、提供毒品、想看看如果我吸毒会发生什么、突然想吸毒、处理过 10 美元或更多、愤怒、担心、受到他人批评、不舒服等报告有序增加和好心情，但不无聊或悲伤。药物渴望前五个小时显示出不同的报告模式，例如悲伤有序增加，但好心情没有增加。 这些发现证实，多种药物滥用者可以使用手持电脑提供日常环境中的行为数据，并且这些数据可以揭示有序的模式，包括前瞻性可检测的渴望和使用的先兆。 我们还在探索使用手持电子设备在患者的日常环境中提供治疗。 此外，我们正在使用手持电子设备来改善随机临床试验中的结果测量。 我们研究的这一方面源自实验室动物数据，表明可以使用α-肾上腺素能激动剂可乐定来预防压力诱导的可卡因寻求和/或海洛因寻求的恢复，而使用阿立哌唑可以预防提示诱导的此类药物寻求的恢复。 。 我们正在进行两项可乐定试验，一项是评估其对压力和药物提示反应的影响，第二项是评估其预防复发的功效。 我们目前正在进行一项研究，让接受美沙酮治疗的门诊患者全天携带手持电脑，以提供有关海洛因和可卡因的渴望、药物滥用情况以及假定的药物滥用诱因的基本比率的实时数据。 我们已经证明了这种形式的数据收集在我们的人群中的可行性，并在可乐定试验中使用它来确定可乐定的复发预防效果是否针对复发亚型。 最后，我们与芝加哥大学的研究人员合作完成了一项两地研究，以调查戒烟者烟瘾的时间过程，特别关注潜伏期的可能性，这是临床前研究中发现的一种现象，在这种现象中，烟瘾会增加随着禁欲的持续时间。数据分析正在进行中，手稿正在准备中。烟瘾的酝酿可能有助于解释以前依赖尼古丁、酒精或非法药物的人为何长期容易复发。