Substance Abuse Clinical Trial
Official title:
fMRI Study of a Dual Process Treatment Protocol With Substance Dependent Adults
The purpose of this study is to determine whether drug-dependent adults who participate in a dual processing relapse prevention treatment protocol that allows for sensory-based exposure experiences over 10-weeks in outpatient treatment will show significant brain change related to diminished cue reactivity, and greater improvement in self-efficacy, anxiety, somatization, and treatment retention, as compared to the standard care patients in a relapse prevention program.
The substance abuse literature consistently shows that negative emotional states and
subjective stress are highly predictive of relapse and significantly influence behavioral
motivation. From a neurobiological perspective, stress associated with withdrawal and
substance abuse experiences stimulates chemical and hormonal changes in the brain creating a
protracted hyperaroused state. Further, cognitive control resources (i.e., cognitive coping
skills/relapse prevention training) have been shown to exert minimal impact on behavioral
decision-making in the presence of intense affective material. Thus, implicit cognitive
processes play a significant role in drug use behavior, decreasing self regulation capacities
and increasing risk of. Specifically, high levels of stress can compromise prefrontal cortex
functioning, with the nucleus accumbens, orbitofrontal cortex and amygdala functional changes
related to increased cue reactivity.
Taken together, the current literature strongly suggests that verbally-based therapies may
have limited utility as a singular form of treatment in early substance abuse recovery, as
the brain may not be functionally ready for executive level processing. Instead, the
multidisciplinary substance abuse literature suggests that psychosocial treatment methods
need to include a range of learning approaches that allow for visual-sensory processing, in
addition to traditional verbal-based processing. Integrated multi-modal interventions are
needed to offer opportunities for activation of these different brain regions to facilitate
cognitive-affective balance in behavioral decision-making.
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