Autonomous Digital CBT Intervention for Opioid Use Disorder in Individuals with Co-Occurring Internalizing Disorders

针对同时发生内化障碍的个体中阿片类药物使用障碍的自主数字 CBT 干预

• 批准号: 10774464
• 负责人: JUSTIN Jack ANKER
• 金额: $ 48.59万
• 依托单位: UNIVERSITY OF MINNESOTA
• 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/10774464
• 关键词: Adherence; Adopted; Affect; Alcohol abuse; Alcohols; Anxiety; Automobile Driving; Behavioral; Chronic; Clinical Trials; Cognitive; Cognitive Therapy; Coping Skills; Development; Devices; Diagnostic; Disease; Drug usage; Electronics; Emotions; Enrollment; Feasibility Studies; Feedback; Goals; Health; Human; Impulsivity; Individual; Internet; Intervention; Knowledge; Mental Depression; Methods; Modeling; Modification; Neurobiology; Outcome; Participant; Pathologic; Pharmaceutical Preparations; Phase; Predisposition; Preparation; Process; Protocols documentation; Regulatory Pathway; Safety; Symptoms; System; Testing; Therapeutic; Therapeutic Intervention; Time; Training; Treatment outcome; Validation; Work; addiction; alcohol use disorder; clinical efficacy; comorbidity; coping; cost; design; diaries; digital; digital delivery; digital platform; digital treatment; drug of abuse; early onset; efficacy evaluation; experience; flexibility; follow-up; improved; meetings; negative affect; neuroadaptation; neurobehavioral; novel therapeutics; opioid use; opioid use disorder; pilot test; pleasure; post intervention; primary outcome; programs; prototype; recruit; response; success; theories; therapeutic target; tool; usability

Project Summary The prevailing neuroscientific characterization of addiction is that of evolving neuro-behavioral responses to chronic drug use that are initially motivated by increasing pleasure (impulsive drug use) that over time causes neuro-adaptations such that drug use is increasingly motivated by relief from negative affect (compulsive use). The compulsive stage of addiction can be seen as a “vicious cycle” since the short-term relief from negative affect through drug use ultimately exacerbates negative affect through neuroadaptations to chronic use. Our early work demonstrated that the vicious cycle was a primary factor in maintaining comorbidity between alcohol use disorder (AUD) and internalizing disorders (anxiety and depression). This provided the ground work for the development and validation of a cognitive-behavioral therapy program for AUD comorbidity that directly targeted the vicious cycle of addiction (VC-CBT). Further, we developed a fully autonomous and easily scaled digital platform to deliver VC-CBT that has proved to be as effective as the therapist-delivered version. The intervention is premised on educating individuals about the reversibility of the vicious cycle, and training them to use proven coping skills to manage negative affect without drugs can significantly aid them in achieving desired treatment goals. In this project, we leverage the trans-addiction status of the neuroscientific underpinnings of the VC-CBT intervention and its flexibility as a digital therapeutic to develop and test a digital treatment for comorbidity in opioid use disorder (OUD). Relative to other drugs of abuse, the progression from initial impulsive use to negatively reinforced compulsive use is known to be truncated and nearly universal among those who routinely use opioids, and those with co-occurring internalizing disorders are especially susceptible. This, along with the relatively high lethality of OUD, makes it an ideal near-term target for this trans-addiction therapy. To achieve this, we propose to test the clinical efficacy of digitally-delivered VC-CBT for OUD-INTD comorbidity in a UG3/UH3 program consisting of two phases. The overarching aim of Phase 1 is the modification and pilot testing of the established digitally-delivered negative affect VC-CBT for application in OUD. The overarching aim of Phase 2 is to conduct a scientifically rigorous clinical trial of the modified VC- CBT for OUD. The impact of this work would be to provide a scalable and inexpensive means of improving the otherwise poor OUD treatment outcomes among those with co-occurring anxiety or depression. Moreover, the project would support the viability of trans-addiction interventions that target processes common to multiple addiction types.

项目摘要 成瘾的主要神经科学表征是对神经行为反应的发展 随着时间的流逝，越来越多的愉快娱乐（冲动性吸毒）最初是由长期使用的慢性药物使用 神经适应性，使吸毒的使用越来越多地避免了负面影响（强迫使用）。 强迫性成瘾阶段可以看作是“恶性循环”，因为短期缓解负面 通过药物使用的影响最终通过神经适应到长期使用而加剧了负面影响。我们的 早期工作表明，恶性循环是维持酒精之间合并症的主要因素 使用障碍（AUD）和内部化障碍（焦虑和抑郁）。这为 直接的合并症认知行为疗法计划的开发和验证 针对成瘾的恶性循环（VC-CBT）。此外，我们开发了一个完全自主且容易缩放的 数字平台提供的VC-CBT已被证明与治疗师递送版本一样有效。 干预以教育个人有关恶性循环的可逆性的前提，并培训他们 使用经过验证的应对技巧来管理不使用药物的负面影响可以极大地帮助他们实现 期望的治疗目标。在这个项目中，我们利用神经科学的反式增添状态 VC-CBT干预的基础及其作为数字疗法的灵活性，用于开发和测试数字 在阿片类药物使用障碍（OUD）中合并症的治疗。相对于其他虐待药物，从 已知最初的冲动使用对负强化的强迫使用被截断，几乎是通用的 在那些经常使用阿片类药物以及患有同时发生内部性疾病的人中 易受影响的。这是OUD的相对高致死性，使其成为理想的近期目标 跨性疗法。为了实现这一目标，我们提议测试数字交付的VC-CBT的临床效率 对于由两个阶段组成的UG3/UH3程序中的Oud-Intd合并症。第1阶段的总体目的 是对应用的数字化负面影响VC-CBT的修改和试验测试 在Oud。第2阶段的总体目的是对修改的VC-进行科学严格的临床试验 CBT用于OUD。这项工作的影响是提供一种可扩展且廉价的方法来改善 否则，在焦虑或抑郁症的人中，OUD治疗结果差。而且， 项目将支持针对多个针对的跨加工干预措施的可行性 成瘾类型。