Neural Circuitry Underlying Alcohol Use Disorders in Men and Women Veterans

男性和女性退伍军人酒精使用障碍的神经回路

• 批准号: 9143250
• 负责人: Claudia B. Padula
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-10-01 至 2021-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9143250
• 关键词: Abstinence; Alcohol or Other Drugs use; Amygdaloid structure; Anterior; Anxiety; Attention; Award; Base of the Brain; Behavior; Brain; Brain imaging; Caring; Cell Nucleus; Characteristics; Chronic; Clinical; Comorbidity; Complex; Data; Diagnosis; Diagnostic; Disease; Dorsal; Drug usage; Emotions; Evidence based treatment; Female; Foundations; Functional Magnetic Resonance Imaging; Functional disorder; Funding; Future; Gender; General Population; Goals; Individual; Insula of Reil; Knowledge; Lead; Measures; Medial; Mediating; Mediator of activation protein; Mental Depression; Mental disorders; Mentorship; Mission; Modeling; Neurobiology; Neurosciences; Nucleus Accumbens; Outcome; Outpatients; Pathogenesis; Play; Population; Post-Traumatic Stress Disorders; Prefrontal Cortex; Probability; Quality of life; Recruitment Activity; Relapse; Research; Research Activity; Research Personnel; Rewards; Risk; Role; Sampling; Seeds; Standardization; Structure; Substance Use Disorder; Symptoms; System; Technology; Testing; Time; Training; Treatment outcome; Veterans; Woman; addiction; alcohol effect; alcohol use disorder; base; career; cingulate cortex; combat; cost; craving; design; drinking; drinking behavior; effective therapy; emotion dysregulation; experience; high risk; high risk behavior; improved; individualized medicine; innovation; insight; male; men; neural circuit; neurobiological mechanism; neuroimaging; neuropsychiatric disorder; psychiatric symptom; public health relevance; relapse prediction; relapse risk; reward processing; success; tool; translational research program; treatment program; treatment strategy

 DESCRIPTION (provided by applicant): Rates of alcohol use disorders are high among combat Veterans, and alcohol use disorder (AUD) is the most prevalent and costly substance use disorder among Veterans (SAMSHA, 2012). Current AUD is estimated at 16% in recently deployed veterans seeking VA care (VHA, 2011), and is approximately four times as common among combat Veterans than in the general population (Kessler et al., 2005). Care for individuals with AUD is standardized for across Veterans. An objective care framework that identifies individuals at highest risk for relapse may improve clinical outcomes. In addition, women may be more susceptible to consequences of problematic drinking behaviors than men, despite fewer years of drinking and less total drinks consumed yet research on AUD in women Veterans is sparse. Individuals with psychiatric co-morbidities have poorer outcomes than those with AUD alone, yet most research to date has excluded those with co-morbidities, leading to research results that are not generalizable to all Veterans with AUD. Evidence suggests that one component of the neurobiological mechanisms underlying AUD include dysregulation of emotional salience and reward circuits. It is not yet known exactly how dysfunction in brain circuits contribute to AUD, and how gender and co-morbidities moderate these effects, but research that answers these questions is critical. The current diagnostic and assessment system does not provide a model for objectively identifying individuals at highest risk for relapse following treatment. The checklist of symptoms that defines AUD does not reflect underlying neurobiology, yet brain circuit function predisposes individuals to AUD (e.g., to relieve anxiety or seek reward) and the effects of AUD can produce chronic changes to these circuits even after abstinence. We also know that these circuits may be moderated by other individual characteristics such as gender and/or the presence of a psychiatric co-morbidity. Technological advances in brain imaging have revolutionized our capacity to understand the brain circuits that underlie complex behaviors such as addiction. The most significant advancement in brain imaging research has been to identify core nodes of the large-scale circuits that are dysfunctional in mental health disorders. Despite this advance, there is a critical gap in integrated brain-based models of addiction. The proposed CSR&D CDA-2 seeks to fill this gap by conducted a neuroimaging study to assess the degree to which disconnections in networks implicated in reward and emotion circuits contribute to risk of relapse following treatment. We will achieve this via three specific aims: Aim 1: Define the neural circuits of emotion and reward processing that underlie AUD in Veterans. Aim 2: Test the relationship between defined neural circuits and treatment outcome (abstinence vs. relapse) and probability of relapse risk. Aim 3: Explore the impact of gender, psychiatric co-morbidities, and craving on the model developed in Aim 2. To test these aims, we will recruit 100 Veterans (50 men and 50 women) from outpatient and residential substance use treatment programs. In order to provide the most generalizable information, we will not exclude female Veterans or those with co-occurring depression, anxiety and PTSD. Currently there are no neuroimaging studies that have examined brain circuits as they relate to relapse risk in men and women Veterans with AUD. Findings from the proposed study will be the first to determine if brain circuits underlying in AUD can be used to predict relapse in this population. This study is a foundational first step and will lay the groundwork in using innovative neuroimaging technology to identify individuals at greatest risk who may need prolonged or more precise treatment strategies. This neuroscience based translational program of research will help vulnerable Veteran populations obtain more effective treatments and achieve better outcomes.

 描述（由申请人提供）： 退伍军人中酒精使用障碍的比例很高，而酒精使用障碍 (AUD) 是退伍军人中最普遍和最昂贵的物质使用障碍（SAMSHA，2012 年），在最近部署的寻求 VA 护理的退伍军人中，目前的 AUD 估计为 16%（ VHA，2011），并且在退伍军人中的发病率大约是一般人群的四倍（Kessler 等人，2005）。对退伍军人中 AUD 患者的护理是标准化的。此外，尽管针对女性的 AUD 研究表明女性饮酒年数较少且饮酒总量较少，但识别出复发风险最高的个体的客观护理框架可能会改善临床结果。患有精神疾病的退伍军人人数很少，但迄今为止，大多数研究都排除了患有精神疾病的退伍军人，因此研究结果并不适用于所有患有 AUD 的退伍军人。的组成部分AUD 的神经生物学机制包括情绪显着性和奖励回路的失调，目前尚不清楚大脑回路功能障碍如何导致 AUD，以及性别和合并症如何调节这些影响，但目前回答这些问题的研究至关重要。诊断和评估系统没有提供一个模型来客观地识别治疗后复发风险最高的个体。定义 AUD 的症状清单并不反映潜在的神经生物学，但脑回路功能使个体容易患 AUD（例如，缓解焦虑或寻求奖励），即使在戒酒后，AUD 的影响也会对这些回路产生慢性变化。我们还知道，这些回路可能会受到其他个人特征的调节，例如性别和/或精神共病的存在。脑成像技术的进步彻底改变了我们理解成瘾等复杂行为背后的大脑回路的能力，尽管如此，脑成像研究中最重要的进步是识别出在精神健康障碍中功能失调的大规模回路的核心节点。这前进，那里 拟议的 CSR&D CDA-2 旨在通过一项神经影像学研究来评估与奖励和情绪回路有关的网络断开对成瘾复发风险的影响程度，从而填补这一空白。我们将通过三个具体目标来实现这一目标： 目标 1：定义退伍军人中 AUD 的情绪和奖励处理神经回路 目标 2：测试定义的神经回路与治疗结果之间的关系。 （戒烟与复发）和复发风险的概率 目标 3：探索性别、精神共病和渴望对目标 2 中开发的模型的影响。为了测试这些目标，我们将招募 100 名退伍军人（50 名男性和 50 名男性）。 50 名女性）参加门诊和住院药物使用治疗计划 为了提供最普遍的信息，我们不会排除女性退伍军人或同时患有抑郁症、焦虑症和创伤后应激障碍（PTSD）的人。神经影像学研究检查了患有 AUD 的男性和女性退伍军人的大脑回路，该研究的结果将首次确定 AUD 的大脑回路是否可用于预测该人群的复发。这是基础性的第一步，将为使用创新的神经影像技术来识别可能需要长期或更精确治疗策略的高危个体奠定基础。这项基于神经科学的转化研究计划将帮助弱势退伍军人群体获得更有效的治疗并取得更好的效果。结果。