Cocaine addiction remains a major public health concern. Effective behavioral therapies for addiction such as cognitive behavioral therapy (CBT) target the extinction of learned drug associations in attaining their relapse prevention goals but have limited efficacy associated with high rates of recidivism. A proposed clinical drug trial supported by functional magnetic resonance imaging (fMRI) studies would test a working hypothesis that enhancing glutamate neurotransmission with the cognitive enhancer D-cycloserine (DCS) facilitates CBT-related relapse prevention by potentiating the behavioral and neural representation of the extinction of cocaine cue responses.
Aim 1 of the proposed exploratory/developmental research plan would use a placebo-controlled, double-blind clinical trial design to determine if the short-term oral administration of DCS significantly enhances the relapse prevention, functional recovery, treatment retention, and cocaine craving reduction goals of an extinction-based CBT. Sixty cocaine-dependent men enrolled in a 4-week outpatient substance abuse treatment program (SATP) would be randomized to three treatment arms of the study (treatment as usual, CBT/placebo or CBT/DCS). A hypothesis that DCS represents a useful adjunct to CBT in producing a significant and durable enhancement of relapse prevention would be tested.
Aim 2 would use behavioral, skin conductance, and fMRI response to Stroop tasks to define differences between the DCS and placebo groups in the rate and extent of extinction of the attentional bias for drug use reminders.
This aim would test the specific hypothesis that DCS administration potentiates a CBT-related extinction of prior cocaine contingencies by enhancing the neural representation of extinction learning and memory.
Aim 3 would use an exploratory pharmacogenetic imaging analysis to assess the influence of allelic variation for common haplotypes of genes involved in endocannabinoid signaling that regulate extinction processes on the impact of DCS on the clinical and neural response to CBT. The long term goal of the proposed translational research plan is to develop significantly more effective treatment plans promoting relapse prevention and recovery for cocaine, and perhaps other, addictions.

Public Health Relevance

The proposed R21 would determine whether administration of the cognitive enhancer D-cycloserine (DCS) potentiates the relapse prevention and recovery goals of cognitive behavioral therapy in men and women with cocaine addiction. Longitudinal fMRI studies and the influence of sequence variation in endocannabinoid system genes would assess the role of extinction learning and memory in CBT-related and DCS-facilitated relapse prevention and the role of variation in extinction-related genes in interindividual differences in treatment response, respectively.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Exploratory/Developmental Grants (R21)
Project #
5R21DA025243-02
Application #
7637781
Study Section
Human Development Research Subcommittee (NIDA)
Program Officer
Kautz, Mary A
Project Start
2008-06-15
Project End
2010-05-31
Budget Start
2009-06-01
Budget End
2010-05-31
Support Year
2
Fiscal Year
2009
Total Cost
$33,375
Indirect Cost
Name
Emory University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
066469933
City
Atlanta
State
GA
Country
United States
Zip Code
30322
Kilts, Clint D; Kennedy, Ashley; Elton, Amanda L et al. (2014) Individual differences in attentional bias associated with cocaine dependence are related to varying engagement of neural processing networks. Neuropsychopharmacology 39:1135-47
Kennedy, Ashley P; Gross, Robin E; Ely, Tim et al. (2014) Clinical correlates of attentional bias to drug cues associated with cocaine dependence. Am J Addict 23:478-84
Cisler, Josh M; Steele, J Scott; Lenow, Jennifer K et al. (2014) Functional reorganization of neural networks during repeated exposure to the traumatic memory in posttraumatic stress disorder: an exploratory fMRI study. J Psychiatr Res 48:47-55
Cisler, Josh M; Elton, Amanda; Kennedy, Ashley P et al. (2013) Altered functional connectivity of the insular cortex across prefrontal networks in cocaine addiction. Psychiatry Res 213:39-46
Kennedy, Ashley P; Gross, Robin E; Whitfield, Natasha et al. (2012) A controlled trial of the adjunct use of D-cycloserine to facilitate cognitive behavioral therapy outcomes in a cocaine-dependent population. Addict Behav 37:900-7
Cisler, Josh M; Olatunji, Bunmi O (2012) Emotion regulation and anxiety disorders. Curr Psychiatry Rep 14:182-7