GROUP COGNITIVE BEHAVIOR THERAPY--DUAL DIAGNOSIS WOMEN

这项研究的提出是因为需要开发有效的治疗方法， 患有创伤后应激障碍（PTSD）和物质使用共病的女性 疾病（SUD）。 据估计，患有创伤后应激障碍的妇女占29%至39%， SUD治疗样本，并记录显示比 只有患有枯萎病的女性 到目前为止，还没有有效的治疗方法 已经确定了大量人口。 为了解决这个问题， 申请人已经开发了一种治疗手册， 行为团体治疗专门适应他们的临床需要， NIDA行为疗法第一阶段治疗项目的一部分 发展计划。 这个24届，高度结构化的计划提供了一个 认知行为和人际应对的强化演练 技能，使用在教育中经验验证的技术， 文献，使治疗可及和从事这一点 人口 它是成本敏感的（即，a组格式），已修订 根据其影响的实际经验和实证结果， 目标是被认为对这些妇女最重要的主题（例如，HIV风险）。 其 主要目标是戒除一切物质。 初步经验结果 基于17名患者的研究结果显示， 在几个领域取得了具有临床意义的改善：（a）在药物使用方面 早在治疗后一个月，并持续3个月的随访- 上，（B）在PTSD症状中;和（c）在理论上最相关的领域中 到治疗和认知。 出席率很高（67%的可用 会议），以及对治疗的联盟和满意度的评级， 非常强壮。 这项拟议中的研究旨在将这种有希望的治疗方法带到下一个 第1阶段评价的逻辑水平，即相对于"常规治疗" 对照组 为了最大限度地发挥控制组的作用， 测试CB治疗的效果，所有患者将被限制在 他们在参与时可能参加的治疗数量和类型 本研究 目标样本是治疗中的25名患者， 控制条件 该研究将：（a）估计 与对照组相比，使用减少物质使用作为 主要结果测量;（B）使用预期的"消费者"测试手册， 它（四名独立于调查人员的治疗师）;（c）评估 患者每月一次，直至9个月治疗后随访期， 评估收益的维持情况;以及（d）从心理测量学上验证两个新的 从理论上讲，从这种治疗中衍生出来的工具（治疗师） 依从性量表和患者"治疗的核心组成"量表， 试图测量治疗作用的假设机制）。

The proposed study arises from the need to develop effective treatment for women with comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD). Women with PTSD are estimated to comprise 29% to 39% of SUD treatment samples, and are documented to show a more severe course than women with wither disorder alone. As yet, no effective treatment for this substantial population has been identified. To attend to this problem, the applicant has developed a treatment manual explicating a new, cognitive behavioral group therapy specifically adapted to their clinical needs as part of a Stage 1 treatment project of the NIDA Behavioral Therapies Development Program. This 24-session, highly structured program offers an intensive rehearsal of cognitive behavioral, and interpersonal coping skills, using techniques empirically validated in the educational literature to make the treatment accessible and engaging for this population. It is cost-sensitive (i.e., a group format), has been revised on the basis of actual experience and empirical results of its impact, and targets topics believed most central for such women (e.g., HIV risk). Its primary goal is abstinence from all substances. Initial empirical results of its impact, based on 17 patients, show statistically significant and clinically meaningful improvements in several areas: (a) in substance use as early as one month into treatment and lasting through a 3-month follow- up, (b) in PTSD symptoms; and (c) in the domain most theoretically relevant to the treatment, cognitions. Attendance was high (67% of available sessions), and ratings of alliance and satisfaction with the treatment were very strong. The proposed study is designed to take this promising treatment to the next logical level of Stage 1 evaluation that is, against a "treatment-as-usual" control group. To maximize the usefulness of such as control group in testing the effects of the CB treatment, all patients will be restricted in the amount and types of treatments they may attend while participating in this study. The target sample is 25 patients each in the treatment and control conditions. The study will: (a) estimate the effect size of the treatment compared to the control, using reduction in substance use as the primary outcome measure; (b) test the manual using expected "consumers of it (four therapists independent of the investigators); (c) evaluate patients monthly through a 9-month post-treatment follow-up period to assess maintenance of gains; and (d) psychometrically validate two new instruments that are theoretically derived from this treatment (a therapist adherence scale, and a patient "core components of treatment" scale that attempts to measure hypothesize mechanisms of action of the treatment).