Brain-to-brain neurofeedback during naturalistic dynamic stimuli to reduce craving in heroin addiction

自然动态刺激期间的脑对脑神经反馈可减少海洛因成瘾的渴望

• 批准号: 10725836
• 负责人: Rita Z Goldstein
• 金额: $ 25.35万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10725836
• 关键词: Abstinence; Alcohols; Attention; Brain; Brain region; COVID-19 pandemic; Cannabis; Characteristics; Chronic; Complex; Coupling; Cues; Data; Development; Disease; Drug Addiction; Drug usage; Early treatment; Environment; Feedback; Functional Magnetic Resonance Imaging; Goals; Habits; Heroin; Heroin Dependence; Human; Individual; Inpatients; Intervention; Knowledge; Learning; Longitudinal Studies; Measures; Memory; Morbidity - disease rate; Neurobiology; Neurocognitive; Neurons; Neurosciences; Opioid; Overdose; Participant; Pattern; Permeability; Persons; Pharmaceutical Preparations; Process; Protocols documentation; Public Health; Recovery; Relapse; Rewards; Sampling; Self Direction; Signal Induction; Signal Transduction; Smoker; Stimulant; Stimulus; Substance Use Disorder; Synaptic Transmission; Testing; Time; Training; Work; addiction; alcohol use disorder; behavioral study; brain based; brain behavior; craving; cue reactivity; drug craving; drug of abuse; executive function; experience; heroin use; imaging study; improved; improved outcome; innovation; interest; medication-assisted treatment; mortality; movie; neural; neural circuit; neural patterning; neurofeedback; non-drug; novel; opioid epidemic; opioid overdose; opioid use disorder; overdose death; recruit; reinforcer; response; scaffold; successful intervention

The opioid epidemic remains a major public health crisis in the US, with relapse rates and overdose-related fatalities continuing to rise. However, the mechanistic explorations of viable interventions in individuals with opioid use disorder have been particularly scarce. Here we will explore a novel brain-based intervention to decrease craving in individuals with heroin use disorder (iHUD) in early treatment. A core characteristic of drug addiction is an enhanced reactivity to drug related cues and reduced processing of other reinforcers in the natural environment, as reliably observed across numerous brain networks and associated with enhanced craving (a predictor of drug use outside the lab). Our recent studies in iHUD suggest that this brain-behavior cue-induced biased pattern improves with abstinence/treatment. Therefore, we will test whether preemptively changing such neural cue reactivity could expedite the recovery process as measured with reduced drug craving. Specifically, we hypothesize that training can help iHUD achieve an intentional modulation of their cue reactivity signal. Using one’s own brain signal, real-time fMRI neurofeedback (rt-fMRI NF) allows participants to volitionally modulate brain activity in targeted brain regions shown in smokers and heavy alcohol drinkers to be effective in reducing drug cue neural reactivity, as associated with abstinence/decreases in craving. However, the permeability of this approach is not uniform. Here for the first time, we will test whether the NF effect can be enhanced by using the signal derived from the brains of others (i.e., brain-to-brain neural transmission). Specifically, our first aim in this cutting-edge exploratory application is to identify the brain regions that distinguish between early (abstinent for <1 month) as compared to later (abstinent for >3 months) time-in-treatment in iHUD. Our second aim is to use the unique multivariate neural patterns derived later in treatment as NF provided to a newly recruited sample of iHUD in early treatment, with the goal of increasing neuronal coupling between both groups. To increase ecological validity and better approximate actual real-world experiences in iHUD, the stimulus is a dynamic, narrative-based, and context-rich movie. Our working hypothesis is that, as compared to iHUD in early treatment where drug cue reactivity is more automatic and harder to control (impacting non drug processing), recovering individuals are better able to regulate it allowing them to reduce craving (and curtail, or entirely eliminate, drug- seeking) even in potent drug-related situations. Therefore, during rt-fMRI NF, we expect greater recovery (and lower cue-induced craving) in the new sample of iHUD early in treatment who show the most neural coupling/alignment with the neural patterns of those in later recovery. In short, in this innovative R21 proposal we will answer the following question: Can the neural patterns of addicted individuals in later recovery be used to provide scaffolding for the nascent recovery process early in treatment, helping to reduce craving? Results of this proof-of-concept study can be used in later longitudinal studies to develop real-time NF-based training to improve outcomes in iHUD as generalizable to other substance use disorders.

阿片类药物流行仍然是美国的重大公共卫生危机，继电器率和过量相关的公共卫生危机 死亡人数继续增长。但是，在患有 卵毒素障碍特别稀缺。在这里，我们将探索一种基于大脑的新型干预措施 早期治疗中海洛因使用障碍（IHUD）患者的渴望减少。药物的核心特征 成瘾是对药物相关线索的反应性增强，并且自然中其他增强剂的加工降低 环境，正如在众多大脑网络中可靠地观察到的，并与渴望增强有关（a 实验室外的药物使用的预测指标）。我们最近在Ihud的研究表明，这种大脑行为提示引起了 通过禁欲/治疗，有偏见的模式改善。因此，我们将测试是否先进行此类更改 神经提示反应性可以加快通过降低药物渴望测量的恢复过程。具体来说， 我们假设训练可以帮助IHUD有意调制其提示反应性信号。使用 一个人自己的大脑信号，实时fMRI神经反馈（RT-FMRI NF）允许参与者自愿调节 吸烟者显示的针对性大脑区域的大脑活动和大量饮酒者有效减少 药物提示神经反应性，与渴望的禁欲/降低有关。但是，渗透性 方法不统一。在这里，我们将第一次测试是否可以通过使用该效果来增强NF效应 信号源自他人的大脑（即脑对脑神经传播）。具体来说，我们的第一个目标 尖端的探索性应用是确定区分早期区域的大脑区域 <1个月）与以后的Ihud（避免> 3个月）相比。我们的第二个目标是使用 NF提供给新招募的样本，以后在治疗后期得出的独特多元神经元模式 IHUD在早期治疗中，目的是增加两组之间的神经元耦合。增加 生态有效性和更好地近似iHud的实际实际体验，刺激是一种动态的， 基于叙事的电影和上下文丰富的电影。我们的工作假设是，与早期治疗相比 药物提示反应性更加自动，更难控制（影响非药物处理），恢复 个人可以更好地调节它，从而使他们减少渴望（并削减或完全消除毒品 - 即使在有效的毒品相关情况下）。因此，在RT-FMRI NF期间，我们预计恢复更大（并且 在治疗初期，新的IHUD样本中的提示引起的渴望）显示出最中性的 与以后恢复的人的神经模式的耦合/对齐。简而言之，在这个创新的R21提案中 我们将回答以下问题：以后恢复中添加个体的神经模式可以使用 为了在治疗的早期提供脚手架，以帮助减少渴望？结果 这项概念验证研究可用于以后的纵向研究，以开发基于NF的实时培训 改善IHUD的结果是可以推广到其他药物使用障碍的。