Forster Sarah E, Forman Steven D, Gancz Naomi N, Siegle Greg J, Dickey Michael Walsh, Steinhauer Stuart R
VISN 4 Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, United States.
University of Pittsburgh, Department of Psychiatry, United States.
Contemp Clin Trials Commun. 2021 Jun 12;23:100796. doi: 10.1016/j.conctc.2021.100796. eCollection 2021 Sep.
Electrophysiological measures can predict and reflect substance use treatment response. Veterans are disproportionately affected by disorders of addiction; cocaine use disorder (CUD) being particularly problematic due to high relapse rates and the absence of approved pharmacotherapies. Prize-based Contingency Management (PBCM) is an evidence-based behavioral intervention for CUD, involving incentives for cocaine abstinence but treatment response is variable. Measurement-based adaptation of PBCM has promise to improve effectiveness but remains to be usefully developed.
This trial aims to determine if individuals with distinct neurocognitive profiles differentially benefit from one of two existing versions of PBCM. CUD patients will be randomized into treatment-as-usual or 12-weeks of PBCM using either monetary or tangible prize incentives. Prior to randomization, EEG will be used to assess response to monetary versus tangible reward; EEG and cognitive-behavioral measures of working memory, cognitive control, and episodic future thinking will also be acquired. Substance use and treatment engagement will be monitored throughout the treatment interval and assessments will be repeated at post-treatment.
Results of this trial may elucidate individual differences contributing to PBCM treatment response and reveal predictors of differential benefits from existing treatment variants. The design also affords the opportunity to evaluate treatment-related changes in neurocognitive functioning over the course of PBCM. Our model posits that PBCM scaffolds future-oriented goal representation and self-control to support abstinence. Individuals with poorer functioning may be less responsive to abstract monetary reward and will therefore achieve better outcomes with respect to abstinence and treatment engagement when tangible incentives are utilized.
电生理测量可以预测和反映物质使用治疗反应。退伍军人受成瘾性疾病的影响尤为严重；由于高复发率和缺乏获批的药物治疗方法，可卡因使用障碍（CUD）问题尤为突出。基于奖励的应急管理（PBCM）是一种针对CUD的循证行为干预措施，包括对可卡因戒断的激励措施，但治疗反应存在差异。基于测量的PBCM调整有望提高有效性，但仍有待有效开发。
本试验旨在确定具有不同神经认知特征的个体是否能从两种现有版本的PBCM之一中获得不同程度的益处。CUD患者将被随机分为常规治疗组或使用金钱或实物奖励进行为期12周的PBCM治疗组。在随机分组之前，脑电图（EEG）将用于评估对金钱奖励与实物奖励的反应；还将获取工作记忆、认知控制和情景未来思维的EEG及认知行为测量数据。在整个治疗期间监测物质使用情况和治疗参与度，并在治疗后重复进行评估。
本试验的结果可能阐明导致PBCM治疗反应的个体差异，并揭示现有治疗变体不同益处的预测因素。该设计还提供了评估PBCM过程中神经认知功能与治疗相关变化的机会。我们的模型假定，PBCM构建了面向未来的目标表征和自我控制，以支持戒断。功能较差的个体可能对抽象的金钱奖励反应较小，因此在使用实物奖励时，在戒断和治疗参与方面可能会取得更好的效果。
