Neurocircuitry of clinical insight predicting relapse outcomes in opioid addiction

预测阿片类药物成瘾复发结果的临床洞察神经回路

基本信息

批准号：
10655449
负责人：
Scott J Moeller
金额：
$ 60.64万
依托单位：
STATE UNIVERSITY NEW YORK STONY BROOK
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-01 至 2025-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10655449
关键词：
Abstinence Accidents Accounting Acquaintances Addictive Behavior Address Adherence American Anterior Area Behavior Behavioral Biological Markers Brain Cessation of life Choice Behavior Chronic Clinical Clinical Research Country Data Drops Drug Addiction Drug Metabolic Detoxication Drug usage Eating Behavior Epidemic Female Functional Magnetic Resonance Imaging Functional disorder Future Health Heroin Heroin Users Impairment Individual Investigation Judgment Laboratories Link Manic Maps Measures Mediating Methadone Morbidity - disease rate Motivation Neurocognitive Neurocognitive Deficit Opiate Addiction Opioid Outcome Participant Perception Pharmaceutical Preparations Prefrontal Cortex Proxy Psychopathology Psychotic Disorders Questionnaires Relapse Reporting Research Schizophrenia Self Perception Self-control as a personality trait Severities Severity of illness Standardization Stimulus Substance Use Disorder Task Performances Therapeutic Thinness Time Treatment outcome United States Visit Work addiction behavior change cingulate cortex clinical practice drug addict drug use behavior follow-up fortification grasp heroin use illicit opioid improved indexing insight long term recovery male medication-assisted treatment neural circuit neural correlate neuromechanism neuropsychiatric disorder novel opioid epidemic opioid use opioid use disorder overdose death prognostic value prolonged abstinence prospective reading comprehension relapse prediction relapse prevention theories treatment adherence

项目摘要

PROJECT SUMMARY Impaired self-awareness of illness severity (insight) is associated with increased morbidity and poorer treatment outcome across multiple neuropsychiatric diseases. Although the study of insight has traditionally been limited to psychotic disorders (e.g., schizophrenia, mania), emerging theory and evidence suggest that this construct may also be highly relevant to drug addiction. For example, drug-addicted individuals often overestimate their addiction-related self-control, underestimate their neurocognitive impairments, and often do not perceive a need for treatment despite the pervasive consequences precipitated by their drug use. For individuals with opioid use disorder (OUD) especially, because first-line treatment often involves medication- assisted therapy that must be taken for long and indefinite periods of time, a strong and sustained personal engagement with treatment is required to prevent relapse (which is the norm, not the exception). In this R01 application, we undertake the first systematic investigation of insight and its underlying neural circuitry as biomarkers and longitudinal predictors of relapse and treatment adherence in individuals with OUD. Recently- detoxified and medication-maintained OUD participants (primary drug: heroin) and matched healthy controls (HC) will complete a novel functional magnetic resonance imaging (fMRI) ‘insight’ task, during which they respond to statements about the severity of their drug use and perceived need for behavior change. Specific Aims include uncovering the behavioral and neural correlates of drug-related insight in OUD, and examining the ability of this circuitry (A) to predict future opioid use and (B) to recover functioning over time with abstinence. We hypothesize that lower opioid use and better treatment adherence (avoiding relapse) will be linked with more intact baseline functioning, and more improvements in functioning from baseline to 6-month follow-up, of the rostral anterior cingulate cortex extending into the ventromedial prefrontal cortex (rACC/vmPFC). This rACC/vmPFC region, insofar as it mediates personal relevance in health and is disrupted in drug addiction (and other psychopathologies), provides a plausible and a priori candidate region for studying insight circuitry. If the anticipated relationships are observed, our results will shed light on a critical construct in OUD – and in drug addiction, more generally – that has the potential to perpetuate drug use, but that to date has a very lean tradition of empirical study, especially with regard to underlying brain mechanisms. A better understanding of this circuitry can suggest novel treatment targets for increasing treatment adherence in OUD, which in turn can be beneficial for addressing the current opioid epidemic.

项目摘要疾病严重程度（Insight）的自我意识受损与发病率增加和较差有关多种神经精神疾病的治疗结果。尽管传统上对洞察力的研究有仅限于精神病（例如精神分裂症，躁狂症），新兴理论和证据表明该结构也可能与吸毒成瘾高度相关。例如，毒品成瘾的人经常高估了与成瘾相关的自我控制，低估了他们的神经认知障碍，并且经常确实如此尽管其吸毒所规定的普遍后果，但不认为需要治疗。为了特别是患有阿片类药物使用障碍（OUD）的人，因为一线治疗通常涉及药物治疗 - 必须长时间和无限期的辅助疗法，这是一个强大而持续的个人需要进行治疗以防止继电器（这是常态，而不是例外）。在此R01中应用，我们进行了洞察力及其基本神经电路的首个系统投资 OUD个体的救济和治疗依从性的生物标志物和纵向预测指标。最近- 排毒和药物维护的OUD参与者（初级药物：海洛因）并匹配健康对照（HC）将完成一种新型的功能磁共振成像（fMRI）“洞察力”任务，在此任务回应有关其药物使用严重程度以及对行为改变需求的陈述。具体的目的包括揭示OUD中与药物相关见解的行为和神经相关性，并检查该电路（a）预测未来阿片类药物使用的能力以及（b）随着时间的推移恢复功能节制。我们假设较低的阿片类药物使用和更好的治疗依从性（避免继电器）将是与更完整的基线功能相关，从基线到6个月的功能进行了更多改进随访，前扣带回皮层延伸到腹侧前额叶皮层（RACC/VMPFC）。这个RACC/VMPFC地区，就介导了健康方面的个人相关性并受到干扰在药物成瘾（和其他心理病理学）中，提供了一个合理的和先验的候选区域洞察电路。如果观察到预期的关系，我们的结果将揭示 Oud - 更普遍地在吸毒成瘾中 - 有可能使吸毒的使用延续，但迄今为止具有实证研究的非常精益的传统，尤其是在潜在的大脑机制方面。更好了解该电路可以表明新的治疗目标，以提高OUD的治疗依从性，反过来，这可能有益于解决当前的阿片类药物流行。