Department of Behavioral Science, University of Kentucky, College of Medicine, 1100 Veterans Drive, Medical Behavioral Science Building Room 140, Lexington, KY 40536, USA; Department of Psychology, University of Kentucky, College of Arts and Sciences, 171 Funkhouser Drive, Lexington, KY 40506, USA; Department of Psychiatry, University of Kentucky, College of Medicine, 3470 Blazer Parkway, Lexington, KY 40509, USA.
Department of Psychology, University of Kentucky, College of Arts and Sciences, 171 Funkhouser Drive, Lexington, KY 40506, USA.
Drug Alcohol Depend. 2020 Feb 1;207:107803. doi: 10.1016/j.drugalcdep.2019.107803. Epub 2019 Dec 16.
Cocaine abusers have impaired inhibitory Cocaine use is associated with impaired inhibitory control. This study determined the feasibility, acceptability, and initial efficacy of inhibitory-control training to cocaine or neutral images in cocaine use disorder patients.
Participants were randomly assigned to inhibitory-control training to cocaine (N = 20) or neutral (N = 20) images. Feasibility was assessed by percent of patients eligible for participation after a behavioral qualification session, time-to-target enrollment, percent of clinic visits attended, percent of participants who completed 80 % or more training sessions, and percent of follow-up visits attended. Acceptability was determined using a Treatment Acceptability Questionnaire. Initial efficacy was determined during training and a follow-up phase with urine samples tested qualitatively and quantitatively for cocaine. Participants in both conditions received monetary incentives delivered on an escalating schedule for clinic attendance.
The groups were well matched and no differences on demographic or substance use variables were observed. Attendance was stable during the treatment period with high overall attendance in both groups (average sessions attended: cocaine image group = 97 %; neutral image group = 90 %). No group differences were observed in the percentage of follow-up sessions attended (95 % for the cocaine-image group; 88 % of neutral-image group). Ratings on the Treatment Acceptability Questionnaire were high (i.e., mean scores ≥ 80 for all items rated on 101-unit visual analog scales). Participants in the cocaine- and neutral-image conditions did not differ significantly in terms of cocaine use during the training nor follow-up phase. Inhibitory-control training improved stop signal performance but not delay discounting.
The procedures were feasible and acceptable. Inhibitory-control training to cocaine images did not reduce cocaine use relative to the neutral image training condition. The inability to detect significant differences in cocaine use across the groups is not surprising given the small sample size. More research is needed to determine the utility of inhibitory-control training for cocaine use disorder. Future trials should determine whether inhibitory-control training to cocaine images augments the efficacy of other behavioral interventions.
可卡因滥用者的抑制能力受损。可卡因的使用与抑制控制受损有关。本研究旨在确定抑制控制训练对可卡因或中性图像在可卡因使用障碍患者中的可行性、可接受性和初步疗效。
参与者被随机分配到抑制控制训练对可卡因（N=20）或中性（N=20）图像。通过行为资格评估后，有资格参加的患者比例、达到目标的时间、参加诊所就诊的比例、完成 80%或更多训练课程的参与者比例以及参加随访就诊的比例来评估可行性。通过治疗接受性问卷来确定可接受性。在训练期间和随访期间，对尿液样本进行定性和定量检测以确定可卡因的使用情况，以此来确定初步疗效。两组患者均接受递增式金钱奖励，以激励其参加诊所就诊。
两组患者匹配良好，在人口统计学和物质使用变量方面没有差异。在治疗期间，两组患者的就诊率都很稳定，总体就诊率都很高（可卡因图像组平均就诊次数：97%；中性图像组：90%）。两组在随访就诊比例方面没有差异（可卡因图像组为 95%；中性图像组为 88%）。治疗接受性问卷的评分很高（即，所有项目的评分均≥10 分制的 80 分）。在训练和随访阶段，可卡因图像和中性图像条件下的参与者在可卡因使用方面没有显著差异。抑制控制训练改善了停止信号的表现，但对延迟折扣没有影响。
该程序是可行和可接受的。与中性图像训练条件相比，对可卡因图像进行抑制控制训练并不能减少可卡因的使用。鉴于样本量较小，两组之间在可卡因使用方面没有显著差异并不奇怪。需要进一步的研究来确定抑制控制训练对可卡因使用障碍的效用。未来的试验应确定对可卡因图像进行抑制控制训练是否可以增强其他行为干预的效果。
