Garfield Joshua B B, Piercy Hugh, Arunogiri Shalini, Lubman Dan I, Campbell Samuel C, Sanfilippo Paul G, Gavin Jeff, Hopwood Malcolm, Kotler Eli, George Suzanne, Okedara Goke, Piccoli Lara R, Manning Victoria
Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia.
Turning Point, Eastern Health, 110 Church Street, Richmond, Melbourne, Victoria, 3121, Australia.
Trials. 2021 Jan 6;22(1):21. doi: 10.1186/s13063-020-04927-6.
Globally, methamphetamine use has increased in prevalence in recent years. In Australia, there has been a dramatic increase in numbers of people seeking treatment, including residential rehabilitation, for methamphetamine use disorder (MUD). While residential rehabilitation is more effective for MUD than withdrawal treatment (i.e. "detoxification") alone, relapse rates remain high, with approximately half of rehabilitation clients using methamphetamine within 3 months of rehabilitation. "Approach bias modification" (ABM) is a computerised cognitive training approach that aims to dampen automatically triggered impulses to approach drugs and drug-related stimuli. ABM has been demonstrated to reduce alcohol relapse rates, but no randomised controlled trials of ABM for MUD have yet been conducted. We aim to test whether a novel "personalised" form of ABM, delivered during rehabilitation, reduces post-treatment methamphetamine use, relative to a sham-training control condition. Secondary outcomes will include dependence symptoms, cravings, and approach bias.
We aim to recruit 100 participants attending residential rehabilitation for MUD at 3 sites in the Melbourne metropolitan area. Participants will complete baseline measures of methamphetamine use, craving, dependence severity, and approach bias before being randomised to receiving 6 sessions of ABM or "sham" training. In the active condition, ABM will be personalised for each participant, using those methamphetamine images that they rate as most relevant to their recent methods of methamphetamine use as "avoidance" images and using positive images representing their goals or healthy sources of pleasure as "approach" images. Approach bias and craving will be re-assessed following completion of training, and methamphetamine use, dependence, and craving will be assessed 4 weeks and 3 months following discharge from residential treatment.
This study is the first randomised controlled trial of ABM for MUD and also the first ABM study to test using a personalised set of both approach and avoid images for ABM training. If effective, the low cost and easy implementation of ABM means it could be widely implemented as a standard part of MUD treatment.
Australian New Zealand Clinical Trials Registry ACTRN12620000072910. Registered on 30 January 2020 (prospectively registered): https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378804&isReview=true.
近年来，全球甲基苯丙胺的使用 prevalence 呈上升趋势。在澳大利亚，寻求甲基苯丙胺使用障碍（MUD）治疗（包括住院康复治疗）的人数急剧增加。虽然住院康复治疗对 MUD 比单纯的脱毒治疗（即“戒毒”）更有效，但复发率仍然很高，约有一半的康复患者在康复后 3 个月内使用甲基苯丙胺。“趋近偏向矫正”（ABM）是一种计算机化认知训练方法，旨在抑制自动触发的接近毒品和与毒品相关刺激的冲动。ABM 已被证明可降低酒精复发率，但尚未进行针对 MUD 的 ABM 随机对照试验。我们旨在测试一种新型的“个性化”ABM 形式，在康复期间进行，相对于假训练对照条件，是否能减少治疗后甲基苯丙胺的使用。次要结果将包括依赖症状、渴望和趋近偏向。
我们旨在招募 100 名在墨尔本都会区 3 个地点接受 MUD 住院康复治疗的参与者。参与者将在被随机分配接受 6 次 ABM 或“假”训练之前，完成甲基苯丙胺使用、渴望、依赖严重程度和趋近偏向的基线测量。在积极治疗组中，ABM 将针对每个参与者进行个性化设置，使用他们认为与近期甲基苯丙胺使用方法最相关的甲基苯丙胺图像作为“回避”图像，并使用代表他们目标或健康愉悦来源的积极图像作为“趋近”图像。在训练完成后重新评估趋近偏向和渴望，并在住院治疗出院后 4 周和 3 个月评估甲基苯丙胺使用、依赖和渴望情况。
本研究是第一项针对 MUD 的 ABM 随机对照试验，也是第一项使用个性化的趋近和回避图像集进行 ABM 训练测试的 ABM 研究。如果有效，ABM 的低成本和易于实施意味着它可以作为 MUD 治疗的标准组成部分广泛实施。
澳大利亚新西兰临床试验注册中心 ACTRN12620000072910。于 2020 年 1 月 30 日注册（前瞻性注册）：https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378804&isReview=true。
