Evaluation Of Treatments Of Opioid And Cocaine Dependence

阿片类药物和可卡因依赖的治疗评估

• 批准号: 8933802
• 负责人: Kenzie Preston
• 金额: $ 125.97万
• 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/8933802
• 关键词: Abstinence; Address; Amaze; Area; Behavior; Behavioral; Biological Markers; Brain imaging; Businesses; Clonidine; Cocaine; Cocaine Dependence; Commit; Communities; Cues; Data; Drug Use Disorder; Drug usage; Electronics; Employment; Environmental Exposure; Evaluation; Evidence based treatment; Exposure to; Goals; Hour; Individual; Individual Differences; Influentials; Intervention; Laboratories; Measures; Modeling; Moods; Occupations; Opiate Addiction; Outcome; Participant; Patients; Pattern; Pharmaceutical Preparations; Randomized Clinical Trials; Reporting; Research; Schedule; Sex Characteristics; Sexual Development; Solutions; Stress; Stressful Event; Substance Addiction; Taxonomy; Technology; Technology Transfer; Testing; Time; Underemployment; Update; Woman; Work; addiction; base; craving; design; diaries; drug craving; experience; improved; insight; men; mind control; psychosocial; response; self reported behavior; social; stressor; substance abuser; time use; treatment strategy

The Treatment Section continues its long-term projects to improve treatment for substance dependence through behavioral, pharmacologic, and combined behavioral and pharmacologic interventions. In addition to the innovatively designed randomized clinical trial of clonidine that we completed in the past year, we are continuing to study individual differences that might be important for personalized treatment and for patient-treatment matching. We have made a point of addressing sex differences, because men and women with drug-use disorders differ in course, outcome, and possible biomarkers such as cue-induced activation of putative brain control network areas. In our ecological momentary assessment (EMA) study, in which participants report their mood, behavior, and drug use on electronic diaries as they go about their daily lives, we evaluated differences related to drug use in the 72 men and 42 women. We used stringent correction for multiple comparisons, but still found a large number of sex differences. In random-prompt entries, women and men reported significantly different patterns of drug-cue exposure, with women more likely to report having seen cocaine or been tempted to use in the past hour. Women also had higher craving after past-hour exposure to drug cues. In reports of drug use, women, compared to men, were more likely to report that they had used more cocaine than they had meant to, tended to feel guilty more often after drug use, and to have used despite trying not to use. These findings provide real-time behavioral evidence that women respond differently than men to drug cues and to drug use, consistent with laboratory and brain-imaging findings. This information may be useful for development of sex-specific treatment strategies. We also found evidence that our taxonomy of lapse triggers did not include items that were salient for women, suggesting that the classic, still-influential formative research on which it was based needs to be updated. We are currently replicating these analyses in participants in a larger study. In that study, participants initiate EMA reports for each stressful event they experience, as well each time they use drugs. We plan to investigate whether men and women experience stressful events differently and show different relationships between stressful events and drug use; this information will be incorporated into the mobile intervention we are starting to develop. Another factor we are examining for incorporation into treatment, independent of sex differences, is actual patterns of drug craving and drug use. We analyzed ecological momentary assessment (EMA) data on the timing of cocaine craving and use in the context of their relationship with a societal construct of daily temporal organization: 9-to-5 Monday-to-Friday business hours. Few of our participants report full-time work and fewer still report a 9-to-5 job. One possibility is that underemployed polydrug misusers largely disregard such conventions, but another possibility is that, in some ways, they implicitly abide by them. At baseline, 34% of participants reported full-time employment in the preceding 3 years, and most participants' current work status fluctuated throughout the study. In a generalized linear mixed model using current work status as a time-varying predictor, cocaine craving was significantly more frequent during business hours, while actual use was significantly more frequent after business hoursregardless of current work status. This finding suggests that the societal conventions reflected in business hours influence drug-use patterns even in individuals whose daily schedules are not dictated by employment during those hours. This may reflect an internalization of the social sanctions that help keep drug use under some degree of control. Finally we continue to develop Geographical Momentary Assessment (GMA), a descriptive approach to better measure and understand the relationships among mood, drug use, and environmental exposure to psychosocial stressors. We remain committed to transforming description into intervention. For example, we have shown that electronic-diary studies can provide amazing insight into the daily lives of substance abusers during treatment and data that are sensitive to behavioral changes during even brief periods of abstinence. The technologies that enable us to collect data on drug use, craving, and stress in the field may also be used for delivery of treatment in the field, perhaps in response to the patients own self-reported behaviors or previously identified triggers.

治疗部门继续其长期项目，以通过行为，药理和行为和药理干预措施来改善对物质依赖的治疗。 除了我们在过去一年中完成的可乐定的创新随机临床试验外，我们还在继续研究个体差异，这些差异对于个性化治疗和患者治疗匹配可能很重要。 我们提出了解决性别差异的目的，因为患有药物使用障碍的男人和女性在结果，结果以及可能的生物标志物（例如提示引起的假定脑控制网络领域激活）等可能的生物标志物。 在我们的生态瞬时评估（EMA）研究中，参与者在日常生活中报告了他们对电子日记的情绪，行为和药物的使用，我们评估了与72名男性和42名女性药物使用有关的差异。我们使用严格的校正进行了多次比较，但仍然发现大量的性别差异。在随机预测的条目中，男女报告的药物毒品暴露方式显着不同，女性更有可能在过去一个小时内报告过可卡因或被诱惑使用。在过去的时间暴露于毒品线索之后，妇女也渴望更高。在毒品使用的报告中，与男性相比，女性更有可能报告她们使用的可卡因比预定的更多，在吸毒后往往更频繁地感到内gui，尽管试图不使用使用。这些发现提供了实时的行为证据，即女性对药物提示和对药物使用的反应不同，与实验室和大脑成像的发现一致。该信息可能对制定特定性别治疗策略有用。我们还发现证据表明，我们对失误触发器的分类法不包括对女性重要的项目，这表明需要更新基于的经典，仍然不受欢迎的形成性研究。我们目前正在大型研究中的参与者中复制这些分析。在这项研究中，参与者每次使用药物时都会为他们遇到的每个压力事件启动EMA报告。我们计划调查男人和女人的压力事件是否有所不同，并在压力事件和吸毒之间显示出不同的关系；这些信息将纳入我们开始开发的移动干预措施中。 我们正在检查将纳入治疗的另一个因素，与性别差异无关，是药物渴望和吸毒的实际模式。我们分析了可卡因渴望和使用时与日常临时组织的社会结构的关系的生态瞬时评估（EMA）数据：9至5周一至周五的营业时间。我们的参与者中很少有人报告全职工作，而更少的参与者仍报告9比5的工作。一种可能性是，就业的多毒虐待者在很大程度上无视此类惯例，但另一种可能性是，在某些方面，它们隐含地遵守了这些惯例。在基线上，有34％的参与者报告了前3年的全职工作，并且在整个研究过程中，大多数参与者的当前工作状况都波动。在使用当前工作状态作为时间变化的预测指标的广义线性混合模型中，在工作时间内可卡因的渴望明显更为频繁，而在业务小时后，实际使用量明显更频繁，而无需当前的工作状态。这一发现表明，在营业时间中反映的社会惯例即使在那些时间内不受就业规定决定的个人中，也会影响毒品使用模式。这可能反映了社会制裁的内在化，这些制裁有助于在某种程度上控制毒品。 最后，我们继续开发地理瞬时评估（GMA），这是一种描述性方法，可以更好地衡量和了解情绪，吸毒和环境与社会心理压力源的关系。我们仍然致力于将描述转变为干预措施。例如，我们已经表明，电子二进制研究可以在治疗过程中对滥用药物的日常生活和对行为变化敏感的数据的日常生活提供惊人的见解。使我们能够收集有关吸毒，渴望和野外压力的数据的技术也可以用于在野外提供治疗，也许是为了响应患者自己的自我报告行为或先前确定的触发器。