fMRI Study of a Dual Process Treatment Protocol With Substance Dependent Adults

NCT ID: NCT01320748

Last Updated: 2018-11-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

29 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-02-28

Study Completion Date

2013-01-31

Brief Summary

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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.

Detailed Description

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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.

Conditions

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Substance Abuse Substance Dependence Alcohol Abuse Drug Use Relapse

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Investigators

Study Groups

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Dual Processing

Group Type EXPERIMENTAL

Dual Processing

Intervention Type BEHAVIORAL

A 10-week, 20-session program, which meets two times per week for 2 hours each time. It is a psychosocial intervention that combines a visual processing (structured drawing activities to engage in sensory-based cue exposure) and a verbal processing component (structured cognitive-behavioral therapy). The treatment focuses on sensory-based emotional expression and cognitive reappraisal and containment strategies that facilitate emotional regulation around a patient's drug and alcohol use experiences.

Relapse Prevention

Group Type ACTIVE_COMPARATOR

Relapse Prevention

Intervention Type BEHAVIORAL

The program's standard care outpatient program is a Relapse Prevention 10-week, 20-session, psychosocial intervention program, which meets two times per week for 2 hours each time. This RP program is based on Gorski's Relapse Prevention model and is a primarily didactic approach.

Interventions

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Dual Processing

A 10-week, 20-session program, which meets two times per week for 2 hours each time. It is a psychosocial intervention that combines a visual processing (structured drawing activities to engage in sensory-based cue exposure) and a verbal processing component (structured cognitive-behavioral therapy). The treatment focuses on sensory-based emotional expression and cognitive reappraisal and containment strategies that facilitate emotional regulation around a patient's drug and alcohol use experiences.

Intervention Type BEHAVIORAL

Relapse Prevention

The program's standard care outpatient program is a Relapse Prevention 10-week, 20-session, psychosocial intervention program, which meets two times per week for 2 hours each time. This RP program is based on Gorski's Relapse Prevention model and is a primarily didactic approach.

Intervention Type BEHAVIORAL

Other Intervention Names

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Group Therapy DP Group Therapy RP

Eligibility Criteria

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Inclusion Criteria

* Age \< 18 years old
* Signed informed consent for this study
* History of chemical dependency
* Meets Inova CATS Relapse Prevention admission criteria
* Must have at least 60 days of sobriety prior to admission with documentation of negative drug and alcohol screening
* Documentation of HIV negative test result (completed in the past year)
* Willing and able to attend an out-patient drug treatment group for two hours twice a week for 10 weeks
* Willing to complete study-required evaluations (including assessments, questionnaires, drug/alcohol testing, week 8 qualitative interview)
* A score \< 25 on the MoCA (Montreal Cognitive Assessment)


* Willing and able to participate in the fMRI arm of the study
* If of childbearing capacity, must have negative screening urine pregnancy test and be willing to use birth control as specified in the consent document

Exclusion Criteria

* History of taking "anti-craving" medication in the past 90 days
* Other medical illness or florid psychiatric symptoms that would render the participant inappropriate for study participation
* History of receiving treatment for addictions other than substance use (i.e. food, gambling, sex)
* Clinical determination of dementia or organic brain syndrome
* History of major head injury
* Incapable of consenting for themselves due to cognitive impairment
* Enrollment in another study that might interfere with analysis of this study


* Left-handed
* Cardiac pacemakers or other body metals
* Other criteria identified on the "MRI Screening Form" that would indicate that having an MRI would be unsafe
* Pregnancy
* Claustrophobia (for the fMRI testing)
* Muscular or back problems that would prevent participant from being able to lie in the scanner for 90 minutes
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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George Mason University

OTHER

Sponsor Role collaborator

Georgetown University

OTHER

Sponsor Role collaborator

Inova Health Care Services

OTHER

Sponsor Role lead

Responsible Party

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Maria Hadjiyane

Senior Director Behavioral Health Adult Ambulatory Services

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Holly C Matto, PhD

Role: PRINCIPAL_INVESTIGATOR

Virginia Commonwealth University, School of Social Work

Locations

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Georgetown Center for Functional And Molecular Imaging, Georgetown University Medical Center

Washington D.C., District of Columbia, United States

Site Status

Inova Heath Services Comprehensive Addictions Treatment Services (ICATS)

Falls Church, Virginia, United States

Site Status

Countries

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United States

References

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Brewer JA, Potenza MN. The neurobiology and genetics of impulse control disorders: relationships to drug addictions. Biochem Pharmacol. 2008 Jan 1;75(1):63-75. doi: 10.1016/j.bcp.2007.06.043. Epub 2007 Jul 3.

Reference Type BACKGROUND
PMID: 17719013 (View on PubMed)

Brewin CR. A cognitive neuroscience account of posttraumatic stress disorder and its treatment. Behav Res Ther. 2001 Apr;39(4):373-93. doi: 10.1016/s0005-7967(00)00087-5.

Reference Type BACKGROUND
PMID: 11280338 (View on PubMed)

Brewin CR, Dalgleish T, Joseph S. A dual representation theory of posttraumatic stress disorder. Psychol Rev. 1996 Oct;103(4):670-86. doi: 10.1037/0033-295x.103.4.670.

Reference Type BACKGROUND
PMID: 8888651 (View on PubMed)

Charney DS. Psychobiological mechanisms of resilience and vulnerability: implications for successful adaptation to extreme stress. Am J Psychiatry. 2004 Feb;161(2):195-216. doi: 10.1176/appi.ajp.161.2.195.

Reference Type BACKGROUND
PMID: 14754765 (View on PubMed)

Chee MW, Sriram N, Soon CS, Lee KM. Dorsolateral prefrontal cortex and the implicit association of concepts and attributes. Neuroreport. 2000 Jan 17;11(1):135-40. doi: 10.1097/00001756-200001170-00027.

Reference Type BACKGROUND
PMID: 10683845 (View on PubMed)

Childress AR, Ehrman RN, Wang Z, Li Y, Sciortino N, Hakun J, Jens W, Suh J, Listerud J, Marquez K, Franklin T, Langleben D, Detre J, O'Brien CP. Prelude to passion: limbic activation by "unseen" drug and sexual cues. PLoS One. 2008 Jan 30;3(1):e1506. doi: 10.1371/journal.pone.0001506.

Reference Type BACKGROUND
PMID: 18231593 (View on PubMed)

Coffey SF, Stasiewicz PR, Hughes PM, Brimo ML. Trauma-focused imaginal exposure for individuals with comorbid posttraumatic stress disorder and alcohol dependence: revealing mechanisms of alcohol craving in a cue reactivity paradigm. Psychol Addict Behav. 2006 Dec;20(4):425-35. doi: 10.1037/0893-164X.20.4.425.

Reference Type BACKGROUND
PMID: 17176177 (View on PubMed)

Fein G, Di Sclafani V, Meyerhoff DJ. Prefrontal cortical volume reduction associated with frontal cortex function deficit in 6-week abstinent crack-cocaine dependent men. Drug Alcohol Depend. 2002 Sep 1;68(1):87-93. doi: 10.1016/s0376-8716(02)00110-2.

Reference Type BACKGROUND
PMID: 12167554 (View on PubMed)

Goldin PR, McRae K, Ramel W, Gross JJ. The neural bases of emotion regulation: reappraisal and suppression of negative emotion. Biol Psychiatry. 2008 Mar 15;63(6):577-86. doi: 10.1016/j.biopsych.2007.05.031. Epub 2007 Sep 21.

Reference Type BACKGROUND
PMID: 17888411 (View on PubMed)

Goldstein M, Brendel G, Tuescher O, Pan H, Epstein J, Beutel M, Yang Y, Thomas K, Levy K, Silverman M, Clarkin J, Posner M, Kernberg O, Stern E, Silbersweig D. Neural substrates of the interaction of emotional stimulus processing and motor inhibitory control: an emotional linguistic go/no-go fMRI study. Neuroimage. 2007 Jul 1;36(3):1026-40. doi: 10.1016/j.neuroimage.2007.01.056. Epub 2007 Mar 12.

Reference Type BACKGROUND
PMID: 17509899 (View on PubMed)

Goodman A. Neurobiology of addiction. An integrative review. Biochem Pharmacol. 2008 Jan 1;75(1):266-322. doi: 10.1016/j.bcp.2007.07.030. Epub 2007 Jul 27.

Reference Type BACKGROUND
PMID: 17764663 (View on PubMed)

Houben K, Schoenmakers TM, Wiers RW. I didn't feel like drinking but I don't know why: the effects of evaluative conditioning on alcohol-related attitudes, craving and behavior. Addict Behav. 2010 Dec;35(12):1161-3. doi: 10.1016/j.addbeh.2010.08.012. Epub 2010 Aug 11.

Reference Type BACKGROUND
PMID: 20810220 (View on PubMed)

Koob GF. The neurobiology of addiction: a neuroadaptational view relevant for diagnosis. Addiction. 2006 Sep;101 Suppl 1:23-30. doi: 10.1111/j.1360-0443.2006.01586.x.

Reference Type BACKGROUND
PMID: 16930158 (View on PubMed)

Matto HC, Strolin-Goltzman J. Integrating social neuroscience and social work: innovations for advancing practice-based research. Soc Work. 2010 Apr;55(2):147-56. doi: 10.1093/sw/55.2.147.

Reference Type BACKGROUND
PMID: 20408356 (View on PubMed)

Matto HC, Strolin JS, Mogro-Wilson C. A pilot study of a dual processing substance user treatment intervention with adults. Subst Use Misuse. 2008;43(3-4):285-94. doi: 10.1080/00952990701202848.

Reference Type BACKGROUND
PMID: 18365931 (View on PubMed)

Matto H. A bio-behavioral model of addiction treatment: applying dual representation theory to craving management and relapse prevention. Subst Use Misuse. 2005;40(4):529-41. doi: 10.1081/ja-200030707.

Reference Type BACKGROUND
PMID: 15830734 (View on PubMed)

Moeller SJ, Maloney T, Parvaz MA, Dunning JP, Alia-Klein N, Woicik PA, Hajcak G, Telang F, Wang GJ, Volkow ND, Goldstein RZ. Enhanced choice for viewing cocaine pictures in cocaine addiction. Biol Psychiatry. 2009 Jul 15;66(2):169-76. doi: 10.1016/j.biopsych.2009.02.015. Epub 2009 Apr 9.

Reference Type BACKGROUND
PMID: 19358975 (View on PubMed)

Ochsner KN, Ray RD, Cooper JC, Robertson ER, Chopra S, Gabrieli JD, Gross JJ. For better or for worse: neural systems supporting the cognitive down- and up-regulation of negative emotion. Neuroimage. 2004 Oct;23(2):483-99. doi: 10.1016/j.neuroimage.2004.06.030.

Reference Type BACKGROUND
PMID: 15488398 (View on PubMed)

Phan KL, Wager T, Taylor SF, Liberzon I. Functional neuroanatomy of emotion: a meta-analysis of emotion activation studies in PET and fMRI. Neuroimage. 2002 Jun;16(2):331-48. doi: 10.1006/nimg.2002.1087.

Reference Type BACKGROUND
PMID: 12030820 (View on PubMed)

Schneider F, Habel U, Wagner M, Franke P, Salloum JB, Shah NJ, Toni I, Sulzbach C, Honig K, Maier W, Gaebel W, Zilles K. Subcortical correlates of craving in recently abstinent alcoholic patients. Am J Psychiatry. 2001 Jul;158(7):1075-83. doi: 10.1176/appi.ajp.158.7.1075.

Reference Type BACKGROUND
PMID: 11431229 (View on PubMed)

Shaham Y, Erb S, Stewart J. Stress-induced relapse to heroin and cocaine seeking in rats: a review. Brain Res Brain Res Rev. 2000 Aug;33(1):13-33. doi: 10.1016/s0165-0173(00)00024-2.

Reference Type BACKGROUND
PMID: 10967352 (View on PubMed)

Tanabe J, Tregellas JR, Dalwani M, Thompson L, Owens E, Crowley T, Banich M. Medial orbitofrontal cortex gray matter is reduced in abstinent substance-dependent individuals. Biol Psychiatry. 2009 Jan 15;65(2):160-4. doi: 10.1016/j.biopsych.2008.07.030. Epub 2008 Sep 18.

Reference Type BACKGROUND
PMID: 18801475 (View on PubMed)

Uhl GR, Drgon T, Johnson C, Fatusin OO, Liu QR, Contoreggi C, Li CY, Buck K, Crabbe J. "Higher order" addiction molecular genetics: convergent data from genome-wide association in humans and mice. Biochem Pharmacol. 2008 Jan 1;75(1):98-111. doi: 10.1016/j.bcp.2007.06.042. Epub 2007 Jul 25.

Reference Type BACKGROUND
PMID: 17764662 (View on PubMed)

van Reekum CM, Johnstone T, Urry HL, Thurow ME, Schaefer HS, Alexander AL, Davidson RJ. Gaze fixations predict brain activation during the voluntary regulation of picture-induced negative affect. Neuroimage. 2007 Jul 1;36(3):1041-55. doi: 10.1016/j.neuroimage.2007.03.052. Epub 2007 Apr 6.

Reference Type BACKGROUND
PMID: 17493834 (View on PubMed)

Related Links

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http://inova.org/cats

Inova Health System, Comprehensive Addiction Treatment Services (CATS)

http://www.nida.nih.gov/NIDAHome.html

National Institute on Drug Abuse

Other Identifiers

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IHS 11-001

Identifier Type: -

Identifier Source: org_study_id

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