Cognitive Reappraisal for Mitigating Incubation of Cocaine Cue-Reactivity

减轻可卡因线索反应潜伏期的认知重新评估

• 批准号: 10812738
• 负责人: Muhammad Adeel Parvaz
• 金额: $ 81.59万
• 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 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10812738
• 关键词: Abstinence; Accounting; Affect; Affective; Aftercare; Alcohols; Arousal; Attention; Attenuated; Back; Behavior Therapy; Behavioral; COVID-19 pandemic; Cessation of life; Chronic; Clinic; Clinical; Clinical Research; Cocaine; Cocaine Users; Cocaine use disorder; Cognitive; Control Groups; Cross-Sectional Studies; Cues; Data; Down-Regulation; Drug Addiction; Drug usage; Electroencephalography; Enrollment; Evidence based intervention; Exposure to; Foundations; Incubated; Individual; Intervention; Longitudinal Studies; Measures; Mediating; Minority; Neurocognitive; Outcome; Outcome Measure; Participant; Patient Self-Report; Pharmaceutical Preparations; Population; Prediction of Response to Therapy; Procedures; Process; Randomized; Regulation; Relapse; Reporting; Research; Research Personnel; Smoker; Substance Use Disorder; Surveys; Techniques; Testing; Time; Training; United States; addiction; attentional bias; clinical effect; clinical outcome assessment; clinically significant; cocaine cue; cocaine overdose; cocaine relapse prevention; cocaine use; cognitive process; cognitive reappraisal; comparison control; craving; cue reactivity; drug seeking behavior; emotion regulation; follow-up; gaze; human study; improved; innovation; novel; outcome prediction; predict clinical outcome; prolonged abstinence; public health emergency; randomized, controlled study; reduced substance use; relapse prediction; relapse prevention; substance use; treatment research; treatment response; visual tracking

SUMMARY Cocaine use is endemic nationwide. According to a national survey, over 2.5% of the population of individuals 12 years and older reported crack or cocaine use in the past year, accounting for over 10,000 deaths related to cocaine overdose. Recent data suggests that the COVID-19 pandemic has exacerbated substance use in the United States. Only a small minority of cocaine users seek formal treatment for their addiction, and even in those who do, the relapse rate remains disturbingly high with some studies reporting rates as high as 90%, 12 months after treatment. Relapse in addicted individuals is presumed to precipitate from the re-exposure to cues that were previously associated with drug use. Over the course of chronic drug use, these cues are afforded enhanced attention (or attention-bias), which has shown to promote motivated arousal, culminating in compulsive drug-seeking or relapse. We have used the late positive potential (LPP), an EEG-derived marker of motivated arousal to show that, unlike commonly believed, arousal to drug cues (or cue-reactivity) increases (or incubates) during the first six months of abstinence. Such incubation of cue-reactivity is posited to confer disproportionately high relapse vulnerability in addicted individuals. Our recently acquired follow-up data show that addicted individuals are able to down-regulate drug cue-reactivity (as evident via a decrease in LPP amplitude) via cognitive reappraisal (an emotion-regulation technique) training, which then leads to a reduction in spontaneous attention-bias to drug cues (quantified using eye-tracking). Here, we propose to integrate the two pieces of evidence to test whether cognitive reappraisal training can reduce the incubation of drug cue-reactivity (Aim 1) and improve clinical outcomes (e.g., reduce craving and prolong cocaine abstinence duration; Aim 2) during the first 6 months of abstinence in individuals with cocaine use disorder (iCUD). We will further explore whether changes in attention-bias to drug cues and/or blunting of incubation of cue-reactivity tracks treatment response and predicts clinical outcomes at 6 months follow-up (exploratory aim). For this purpose, we propose to enroll 126 iCUD, half of whom will be randomized to undergo cognitive reappraisal training and the other half will instead complete a control task. In this longitudinal study, participants will complete these procedures at 1-week, 1-, 3-, and 5-months post abstinence initiation, and will then come back one month after (at 6 months post abstinence initiation) for the assessment of clinical outcomes. Thus, this novel study aims to bridge between the lab and the clinic by advancing basic mechanistic understanding of a novel evidence-based intervention to provide cognitive markers for tracking treatment response and predicting outcomes in addiction. Successful completion of this study would lay the foundation for further basic and clinical studies that will examine other putative mechanisms and potentially also use the same framework for the neurocognitive examination of similar cognitive interventions in other substance use disorders as well as in other behavioral addictions.

概括 可卡因的使用是全国范围的。根据全国调查，超过2.5％的个人人口 12岁及以上报告了过去一年的破解或可卡因使用，占10,000多人的死亡 可卡因过量。最近的数据表明，COVID-19的大流行使药物的使用加剧了 美国。只有少数可卡因用户为成瘾而寻求正式治疗，甚至在那些 谁这样做，一些研究率高达90％，12个月，复发率仍然令人不安 治疗后。假定成瘾的个体的复发是从重新曝光到提示的沉淀 以前与吸毒有关。在长期使用毒品的过程中，这些提示得到了 加强注意力（或注意偏见），已证明可以促进动机的唤醒，最终导致强迫性 寻求毒品或复发。我们已经使用了晚期积极潜力（LPP），这是脑电图的动机标记 唤醒表明，与普遍认为的那样，引起药物线索（或提示反应性）会增加（或孵化） 在禁欲的头六个月中。提出了这种提示反应性的孵育，以赋予不成比例 上瘾的个体的高复发脆弱性。我们最近获得的后续数据显示 个体能够通过下调药物提示反应性（通过LPP振幅的降低而明显） 认知重新评估（一种情感调节技术）训练，然后导致自发的减少 对药物提示的注意偏置（使用眼线场定量）。在这里，我们建议整合两部分 测试认知重新评估训练是否可以降低药物提示反应性的证据（AIM 1） 并改善临床结果（例如，减少渴望和延长可卡因戒酒持续时间；目标2） 可卡因使用障碍（ICUD）中禁欲的前6个月。我们将进一步探讨是否 注意力提示的注意力偏置和/或提示反应性孵育的钝化跟踪治疗反应 并预测在6个月随访时的临床结果（探索目的）。为此，我们建议注册 126 ICUD，其中一半将被随机接受认知重新评估训练，另一半将会 而是完成控制任务。在这项纵向研究中，参与者将在1周完成这些程序， 节制后的1-，3和5个月，然后将在一个月后回来（后6个月后 节制启动）评估临床结果。因此，这项小说的研究旨在桥接 实验室和诊所通过推进对新型循证干预措施的基本机械理解 提供认知标记以跟踪治疗反应并预测成瘾的结果。成功的 这项研究的完成将为进一步的基础研究和临床研究奠定基础，以检查其他 假定的机制，并有可能使用相同的框架进行类似的神经认知检查 其他物质使用障碍以及其他行为成瘾中的认知干预措施。