Prevention of Relapse in Addiction

预防成瘾复吸

• 批准号: 7593304
• 负责人: Kenzie Preston
• 金额: $ 128.43万
• 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/7593304
• 关键词: Abstinence; Adrenergic alpha-Agonists; Alcohols; Attention; Chicago; Clonidine; Cocaine; Cues; Daily; Data; Data Collection; Devices; Drug usage; Electronics; Environment; Exposure to; Goals; Handheld Computers; Heroin; Human; Illicit Drugs; Individual; Intervention; Laboratories; Methadone; Modeling; Nicotine; Obesity; Outpatients; Participant; Patients; Pharmaceutical Preparations; Population; Rate; Relapse; Research; Research Personnel; Role; Site; Smoker; Stress; Testing; Time; Universities; addiction; animal data; base; craving; day; diaries; disorder later incidence prevention; pre-clinical; preclinical study; prevent; programs; response; rimonabant; 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/cocaineusing 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. We are also exploring the use of handheld electronic devices for treatment delivery in patients daily environment. Another current focus 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 the CB1 antagonist rimonabant. 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 them in the clonidine trial to determine whether its relapse- prevention effect is specific to subtypes of relapse. Finally, we are collaborating 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. Incubation of craving may help explain the long-lasting vulnerability to relapse in individuals formerly dependent on nicotine, alcohol, or illicit drugs.

我们部分的一个主要倡议是检查通过使用生态瞬时评估（EMA）通过使用生态触发触发因素（例如环境线索和压力）的作用。 我们正在对海洛因/可卡因的美沙酮维护门诊患者以及在体重维护计划中的肥胖个人进行研究。 参与者携带电子日记以记录假定的复发触发因素的基本速率，以及在复发期间的存在。 我们还在探索使用手持电子设备在患者日常环境中治疗交付的使用。 我们研究的另一个重点来自实验室 - 动物数据，表明应激引起的可卡因寻求和/或海洛因寻求恢复可以通过α-肾上腺素能激动剂克洛尼丁进行预防，而CUE诱导的该药物寻求的恢复可以通过CB1拮抗剂rimonanabant来预防。 我们正在进行两项可乐定试验，一种评估其对压力和药物提示的影响的影响，第二次评估其在预防复发方面的疗效。 我们目前正在进行一项研究，在该研究中，美沙酮保养的门诊病人全天携带手持计算机，以提供有关海洛因和可卡因的渴望的实时数据，吸毒的失误以及推定的失去沉淀剂的基本速率。 我们已经证明了这种数据收集形式在我们的人群中的可行性，并在可乐定试验中使用它们来确定其复发效应是否特定于复发亚型。 最后，我们正在与芝加哥大学的研究人员合作进行了一项两次研究，以调查戒烟者渴望的时间过程，特别关注孵化的可能性，这是临床前研究中看到的这种现象，其中渴望随着禁欲的持续时间而增加。 渴望的孵化可能有助于解释以前依赖尼古丁，酒精或非法药物的个体复发的持久脆弱性。