Technology Enhanced Behavioral Activation Treatment for Substance Use

技术增强药物滥用行为激活治疗

• 批准号: 8993150
• 负责人: Stacey B Daughters
• 金额: $ 50.2万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-04-15 至 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8993150
• 关键词: Abstinence; Address; Affect; African American; Aftercare; Alcohol or Other Drugs use; Behavior Therapy; Behavioral; Behavioral Model; Biological Markers; Budgets; Cellular Phone; Communities; Comorbidity; Complex; Data; Depressed mood; Drug abuse; Drug user; Functional Magnetic Resonance Imaging; Funding; Grant; HIV; HIV Infections; HIV risk; Health Services Accessibility; Heterogeneity; Illicit Drugs; Intervention; Life; Low income; Mediating; Mental Depression; Mental Health; Mental disorders; Minority Groups; Modeling; National Institute of Drug Abuse; Nature; Neurosciences; North Carolina; Outcome; Patients; Poverty; Professional counselor; Progress Reports; Provider; Randomized Controlled Trials; Relapse; Relative (related person); Rest; Rewards; Risk; Risk Behaviors; Sampling; Staging; Substance Use Disorder; Technology; Treatment outcome; addiction; arm; base; comparative effectiveness; cost effective; depressive symptoms; dissemination trial; effective intervention; ethnic minority population; follow-up; improved; innovative technologies; neural circuit; neurobiological mechanism; physical conditioning; prevent; public health relevance; relating to nervous system; sex risk; success; treatment as usual; treatment program; treatment response

 DESCRIPTION (provided by applicant): Comorbid substance use disorder (SUD) and depression disproportionately affect ethnic minorities, and is associated with elevated rates of post treatment relapse to substance use, HIV risk behavior, and associated poor mental and physical health outcomes. Although efficacious, the often complex, specialized nature of CBT poses problems in its integration into substance use treatment programs. Moreover, budget cuts for mental health and substance use treatment reduce availability of publically funded treatment programs and staff to patient ratios. To address this limitation, a behavioral activation (BA) treatment, the Life Enhancement Treatment for Substance Use (LETS ACT), was developed to treat depressive symptoms among a predominantly African American sample of low income illicit drug users currently receiving residential substance use treatment. Empirical evidence indicates that LETS ACT is associated with significantly better outcomes then a control condition for treatment retention, post treatment abstinence, HIV sexual risk behavior, depressive symptoms, and environmental reward. Although these strong outcomes suggest that LETS ACT may be ready for a Stage III dissemination trial, the effects of LETS ACT on abstinence were not significant beyond a 3- month post treatment follow-up, and there was a significant indirect effect of LETS ACT homework compliance on post treatment substance use and HIV sexual risk behavior via environmental reward. These findings point to the need to identify cost-effective delivery-vehicles to increase treatment engagement outside of clinician sessions. Finally, identifying neuroscience based biomarkers (neuromarkers) underlying key theoretical aspects of BA (i.e., reward sensitivity), and their relation to heterogeneity in BA treatment response among substance users with depression are critical for the identification of accurately targeted interventions. The current proposal will expand upon findings in R01 DA026424 by addressing the critical needs of depressed low income substance users to (1) determine if a smartphone enhanced treatment for LETS ACT (LETS ACT-SE) is associated with increased long term treatment engagement, and in turn, improved long term treatment outcomes, and (2) use functional magnetic resonance imaging (fMRI) to identify the effects of LETS ACT-SE on the neuromarkers of reward sensitivity. The application cuts across multiple NIDA initiatives aiming to (1) improve behavioral interventions using innovative technologies to boost effects and increase implementability (PA-13-077), (2) develop effective interventions to prevent new HIV infection (PA-12- 281), (2) identify the underlying mechanisms that impact HIV risk (PA-14-061), (3) identify neural circuits underlying substance use comorbidity with psychiatric disorders (PA-14-026), and (4) identify neurobiological mechanisms underlying drug abuse to improve treatment (PA-13-338).

 描述（由适用提供）：合并症药物使用障碍（SUD）和抑郁症不成比例地影响少数民族，并且与治疗后继电器升高到药物使用，HIV风险行为以及相关的精神和身体健康状况不佳有关。尽管有效，但CBT的经常复杂，专业的性质在整合到药物使用治疗方案中会带来问题。此外，精神健康和药物使用治疗的预算削减降低了公共资助的治疗计划和员工与患者比例的可用性。为了解决这一局限性，开发了一种行为激活（BA）治疗，增强物质使用的寿命治疗（Lets ACT），以治疗主要是非裔美国人的低收入非法非法药物样本，目前正在接受住宅药物使用治疗。经验证据表明，让我们的行动与治疗保留的控制条件明显更好有关，治疗后的缓刑，艾滋病毒性风险行为，抑郁症状和环境奖励。尽管这些强大的结果可能已经准备就绪，尽管这些强大的结果可能已经准备好以进行III期分发性试验，但在此期间效果不佳，并在此期间效果不大，并在此期间效果不大，并且在此期间效果不佳，并且在此期间效果不佳，并且在此期间效果不佳，并且在此期间效果不佳，并且在此期间效果不佳，并且在此期间效果不佳，并且在此期间效果不佳。通过环境奖励，治疗后药物使用和HIV性风险行为。这些发现表明，有必要确定具有成本效益的交付车，以在临床课程之外增加治疗的参与度。最后，确定基于神经科学的生物标志物（神经标志物）BA的关键理论方面（即奖励敏感性）及其与抑郁症药物使用者在BA治疗反应中的关系对于确定准确靶向的干预措施至关重要。 The current proposal will expand upon findings in R01 DA026424 by addressing the critical needs of depressed low income subject users to (1) determine if a smartphone enhanced treatment for LETS ACT (LETS ACT-SE) is associated with increased long term treatment engagement, and in turn, improved long term treatment outcomes, and (2) use functional magnetic resonance imaging (fMRI) to identify the effects of LETS ACT-SE on the neuromarkers of reward灵敏度。跨多个NIDA倡议的应用削减旨在（1）使用创新技术来改善行为干预措施以促进效果并增加实施（PA-13-077），（2）开发有效的干预措施，以防止新的HIV感染（PA-12-281）（PA-12-281），（2）识别基础的稳定机制，识别HIV风险（PA-14-061），（3）（3），（3）具有精神疾病（PA-14-026），并且（4）确定药物滥用潜在的神经生物学机制以改善治疗（PA-13-338）。