A Stage II Efficacy Study of CBT for PTSD in Community Addiction Treatment

描述(由申请人提供)：本申请是最初为响应NIDA PA-07-111行为与综合治疗发展计划(RO1)而提出的研究的重新提交，目前提交给NIH-RO1-FOA。同时发生的药物使用和精神障碍在普通人群中很常见，在临床环境中甚至更普遍，并与负面治疗和生活结果相关。创伤后应激障碍(PTSD)是最普遍的共生障碍之一，令临床医生苦恼，也是自然损耗、复发药物和酒精以及精神症状恶化的危险因素。已经开发和测试了几种针对共生创伤后应激障碍的行为疗法，但这些疗法尚未被发现与比较条件下有效，保留率中等至较差，也没有整合到现有的成瘾治疗服务中，也没有由典型的社区成瘾顾问提供。本建议建立在首席研究员完成的一系列第一阶段研究的基础上，在成瘾治疗计划中对创伤后应激障碍实施认知行为疗法(CBT)。到目前为止，第一阶段研究的累积结果表明，针对创伤后应激障碍的CBT对创伤后应激障碍症状、物质使用和良好保留率(65%-70%)具有良好的效果。这项研究提出了一项针对228名参与者的第二阶段疗效研究，这些参与者被招募到七个典型的社区成瘾治疗计划中，并被随机分为：a)CBT+创伤后应激障碍+照常治疗；b)个体成瘾咨询(IAC)+照常治疗；或c)单独照常治疗。社区成瘾咨询师将提供所有治疗方法。在基线、3个月和6个月时评估的主要结果是：创伤后应激障碍症状严重程度、物质使用严重程度和滞留。这项拟议的研究可能会产生重大影响，因为它可以推进一种行为疗法，这种疗法可以减少药物和酒精的使用，治疗共病的精神疾病，并考虑先验地将其转化为常规的社区环境和提供者。这项第二阶段的研究利用了研究团队的经验，在第一阶段的研究活动中发现了一种有希望的治疗方法。此外，研究团队还与由常规成瘾顾问和患者组成的典型社区成瘾治疗项目建立了富有成效的研究关系的记录。在这些背景下的研究应有助于提高外部有效性，并促进将有效的以研究为基础的治疗方法转化为社区。

DESCRIPTION (provided by applicant): This application is a resubmission of research originally proposed in response to NIDA PA-07-111 Behavioral & Integrative Treatment Development Program (RO1), and presently to the NIH-RO1-FOA. Co-occurring substance use and psychiatric disorders are common in the general population, even more prevalent in clinical settings, and associated with negative treatment and life outcomes. Posttraumatic stress disorder (PTSD) is among the most widespread of co-occurring disorders, vexing to clinicians, and a risk factor for attrition, relapse to drugs and alcohol, and deterioration in psychiatric symptoms. There have been several behavioral therapies for co-occurring PTSD developed and tested, but these treatments have not been found effective versus comparison conditions, have moderate to poor retention rates, and have not been integrated within existing addiction treatment services or delivered by typical community addiction counselors. The present proposal builds upon a series of completed Stage I studies by the principal investigator, implementing a cognitive behavioral therapy (CBT) for PTSD in addiction treatment programs. The cumulative findings of the Stage I studies thus far demonstrate the CBT for PTSD to have promising effects on PTSD symptoms, substance use, and good retention rates (65-70 percent). This present research proposes a Stage II efficacy study of 228 participants recruited across seven typical community addiction treatment programs, and randomized to: a) CBT for PTSD + treatment-as-usual; b) Individual Addiction Counseling (IAC) + treatment-as-usual; or c) Treatment-as-usual alone. Community addiction counselors will deliver all treatments. Primary outcomes assessed at baseline, 3- and 6-months are: PTSD symptom severity, substance use severity and retention. The proposed research has the potential for significant impact by advancing a behavioral therapy that can reduce drug and alcohol use, attend to comorbid psychiatric conditions, and consider, a priori, translation to routine community settings and providers. This Stage II research capitalizes on the experience of the research team with a promising treatment, as found in the Stage I research activities. In addition, the research team has a track record of productive research relationships with typical community addiction treatment programs composed of routine addiction counselors and patients. Research within these settings should serve to enhance external validity and facilitate the translation of effective research-based treatments into the community.