Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, UK.
Psychopharmacology (Berl). 2012 May;221(2):273-84. doi: 10.1007/s00213-011-2571-2. Epub 2011 Nov 22.
Treatments based on exposure/response prevention (Exp/RP) produce only modest benefits in substance dependence disorders. However, a new strategy, which has shown promise in animal models of addiction involves combining Exp/RP with extinction-enhancing pharmacological treatments. A prototype of the latter is D-cycloserine (DCS), a partial agonist at the glycine site of the NMDA receptor.
In a laboratory-based randomised, double-blind, placebo-controlled trial with non-treatment-seeking heavy smokers (n = 32), we examined the efficacy of Exp/RP combined with DCS (125 mg). Two sessions of Exp/RP were carried out during which cue reactivity was monitored. Effects on attentional bias and/or subjective craving and smoking behaviour were also evaluated after at least 48 h and 2 weeks following session 2 of Exp/RP.
Within- and between-session reductions in cue reactivity were observed in both treatment groups, although the DCS group did not show an enhanced reduction by the end of session 2. However, a subtle effect of DCS on the emotionality subscale of the Tobacco Craving Questionnaire was observed, with a trend towards a sustained reduction in this aspect of craving at 2-week follow-up.
Our findings suggest that two sessions of Exp/RP combined with DCS does not enhance the reduction in episodic cue reactivity in non-treatment seeking smokers. A trend towards a greater sustained reduction in the emotionality scale of the TCQ in the DCS group suggests that further detailed study of the effects of combined Exp/RP-DCS on different aspects of craving is warranted, especially in smokers with a current intention to quit.
基于暴露/反应预防（Exp/RP）的治疗方法在物质依赖障碍中仅产生适度的益处。然而，一种新的策略，在成瘾的动物模型中显示出希望，涉及将 Exp/RP 与增强消退的药理学治疗相结合。后者的一个原型是 D-环丝氨酸（DCS），一种 NMDA 受体甘氨酸部位的部分激动剂。
在一项基于实验室的随机、双盲、安慰剂对照试验中，我们招募了非治疗性的重度吸烟者（n=32），研究了 Exp/RP 与 DCS（125mg）联合治疗的效果。在 Exp/RP 的两个疗程中，监测了线索反应性。在 Exp/RP 疗程结束至少 48 小时和 2 周后，还评估了对注意力偏向和/或主观渴望和吸烟行为的影响。
在两个治疗组中都观察到了线索反应性的治疗期间和治疗后减少，尽管 DCS 组在疗程结束时并没有表现出更显著的减少。然而，DCS 对烟草渴望问卷的情感分量表产生了微妙的影响，在 2 周随访时，这种渴望的情感方面呈现出持续减少的趋势。
我们的研究结果表明，在非治疗性吸烟者中，两次 Exp/RP 结合 DCS 并不能增强对偶发性线索反应性的减少。DCS 组在 TCQ 的情感分量表上持续减少的趋势表明，进一步详细研究 Exp/RP-DCS 联合治疗对不同方面渴望的效果是值得的，尤其是在当前有戒烟意愿的吸烟者中。
