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：
10242866
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/10242866
关键词：
Abstinence Accounting Acquaintances Addictive Behavior Address Adherence American Anterior Area Behavior Behavioral Biological Biological Markers Brain Cessation of life Choice Behavior Chronic Clinical Clinical Research Country Data Drops Drug Addiction Drug usage Eating Behavior Ensure Epidemic Female Functional Magnetic Resonance Imaging Functional disorder Future Health Heroin Heroin Users Impairment Individual Investigation Judgment Laboratories Lead Light 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 Recovery 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 use behavior follow-up grasp heroin use illicit opioid indexing insight magnetic resonance imaging biomarker male neural circuit neural correlate neuromechanism neuropsychiatric disorder novel opioid epidemic opioid use opioid use disorder overdose death prevent prognostic value prospective reading comprehension relapse prediction 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.

项目概要对疾病严重程度的自我意识（洞察力）受损与发病率增加和贫困有关尽管传统上对洞察力的研究一直在研究多种神经精神疾病的治疗结果。仅限于精神障碍（例如精神分裂症、躁狂症），新出现的理论和证据表明这种结构也可能与吸毒成瘾高度相关，例如，吸毒成瘾的人经常。高估了与成瘾相关的自我控制能力，低估了他们的神经认知障碍，并且经常这样做尽管吸毒造成了普遍的后果，但他们并不认为需要治疗。尤其是患有阿片类药物使用障碍 (OUD) 的个体，因为一线治疗通常涉及药物治疗 - 辅助治疗必须长期且无限期地进行，强烈而持续的个人治疗需要参与治疗以防止复发（在本 R01 中这是常态，而不是例外）。应用程序中，我们对洞察力及其底层神经回路进行了首次系统研究 OUD 患者复发和治疗依从性的生物标志物和纵向预测因子。戒毒和药物维持的 OUD 参与者（主要药物：海洛因）和匹配的健康对照（HC）将完成一项新颖的功能磁共振成像（fMRI）“洞察”任务，在此期间他们回应有关其吸毒严重程度和行为改变的感知需求的陈述。目标包括揭示 OUD 中与药物相关的洞察力的行为和神经关联，并检查该电路的能力 (A) 预测未来阿片类药物的使用以及 (B) 随着时间的推移恢复功能我们追求减少阿片类药物的使用和更好的治疗依从性（避免复发）。与更完整的基线功能以及从基线到 6 个月的功能更多改善相关后续，头侧前扣带皮层延伸至腹内侧前额叶皮层 (rACC/vmPFC) 该 rACC/vmPFC 区域在调节个人健康相关性方面受到干扰。在吸毒成瘾（和其他精神病理学）中，为研究提供了一个合理且先验的候选区域如果观察到预期的关系，我们的结果将揭示一个关键的结构。 OUD——以及更普遍的吸毒成瘾——有可能使吸毒永久化，但迄今为止具有非常精益的实证研究传统，尤其是在大脑潜在机制方面。了解该电路可以提出新的治疗目标，以提高 OUD 的治疗依从性，这反过来又可能有利于解决当前的阿片类药物流行问题。