Web-based CBT for Substance Misusing and PTSD Symptomatic OEF/OIF Veterans

描述（由申请人提供）：超过2/3（69%）的退伍军人从持久自由行动（OEF）和伊拉克自由行动（OIF）在退伍军人管理局（VA）医疗中心屏幕积极的心理健康问题。最常见的是创伤后应激障碍（PTSD）。物质使用问题也很普遍，特别是在有创伤后应激障碍症状的退伍军人中。尽管他们的心理健康需要，OEF/OIF退伍军人与创伤后应激障碍更有可能寻求治疗的身体投诉比心理健康问题。虽然行为卫生保健已被纳入初级保健在VA医疗中心，退伍军人遇到重大障碍获得这种护理。虽然，心理社会干预，如认知行为疗法（CBT）已被发现是有效的治疗有问题的物质使用和创伤后应激障碍，提供者在非专业护理不太可能有时间或适当的培训，以提供这种复杂的干预。为了解决这一公共卫生问题，我们建议修改一个有效的基于网络的CBT干预与物质使用障碍（治疗教育系统; TES）的个人的内容，以目标物质使用，创伤后应激障碍和其他问题之间常见的OEF/OIF退伍军人。具体目标是：目标1。为OEF/OIF退伍军人开发一种互动的、基于网络的心理社会治疗，这些退伍军人使用危险或有问题的物质，并有PTSD症状。计划的干预措施将在理论上以CBT方法为基础，并将通过一个互动系统提供，该系统采用有效促进知识和技能的信息技术。开发将由专家合作者、OEF/OIF退伍军人焦点小组和反馈会议提供信息，在反馈会议上，专家和第二组退伍军人被要求评估该计划的测试版。AIM 2.评估基于网络的干预措施对OEF/OIF退伍军人使用危险或有问题的物质和PTSD症状的有效性。我们计划在两个初级保健VA治疗中心进行对照试验。参与者将被随机分配到：（1）反映向大多数OEF/OIF退伍军人提供的治疗模式的治疗（TAU）（n=81）或（2）TAU加基于网络的CBT干预（n=81）。主要结果将是：a）过去30天内大量饮酒天数和/或非法或非处方药物使用天数; B）生活质量;和c）PTSD症状。AIM 3.评价基于网络的干预加上TAU相对于单独TAU的成本和成本效益。将估计成本效益比，以确定每增加一个质量调整生命年和增加禁欲的基于网络的干预的增量成本。分析将从社会的角度考虑成本和成本效益，以及从VA系统的角度为项目层面的采用决策提供信息。这项研究的结果有可能显着改善OEF/OIF退伍军人中物质使用和相关疾病的心理社会治疗，并使基于科学的干预措施能够迅速广泛地传播到这一人群。 公共卫生相关性：虽然在VA初级保健中心，来自持久自由行动（OEF）和伊拉克自由行动（OIF）的退伍军人中有相当一部分人同时存在创伤后应激障碍和物质使用问题，但大多数人没有得到充分的治疗。为了解决这一公共卫生问题，我们建议修改有效的基于网络的CBT干预的内容，该干预将针对OEF/OIF退伍军人中常见的物质使用，创伤后应激障碍和其他问题，并将进行经济分析，比较我们的成本和收益基于网络的干预与VA初级保健机构的常规治疗。这项研究的结果有可能显着改善OEF/OIF退伍军人中物质使用和相关疾病的心理社会治疗，并使基于科学的干预措施能够迅速广泛地传播到这一人群。

DESCRIPTION (provided by applicant): Over 2/3 (69%) of veterans from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) at Veterans' Administration (VA) medical centers screen positive for mental health problems. The most prevalent is post-traumatic stress disorder (PTSD). Substance use problems are also prevalent, particularly among veterans with PTSD symptoms. Despite their mental health needs, OEF/OIF veterans with PTSD are more likely to seek treatment for physical complaints than for mental health concerns. Although behavioral health care has been integrated into primary care in VA medical centers, veterans encounter significant barriers accessing this care. Although, psychosocial interventions such as cognitive-behavioral therapy (CBT) have been found to be efficacious for the treatment of problematic substance use and PTSD, providers in non- specialty care are unlikely to have the time or proper training to deliver this complex intervention. To address this public health concern, we propose to modify the content of an efficacious web-based CBT intervention for individuals with substance use disorders (Therapeutic Education System; TES), to target substance use, PTSD and other problems common among OEF/OIF veterans. The specific aims are: AIM 1. Develop an interactive, web-based psychosocial treatment for OEF/OIF veterans with hazardous or problematic substance use and PTSD symptoms. The planned intervention will be theoretically grounded in a CBT approach and will be delivered via an interactive system that employs informational technologies which are effective in promoting knowledge and skills. Development will be informed by expert collaborators, focus groups of OEF/OIF veterans, and feedback sessions in which experts and a 2nd group of veterans are asked to evaluate a beta-version of the program. AIM 2. Evaluate the efficacy of the web-based intervention with OEF/OIF veterans with hazardous or problematic substance use and PTSD symptoms. We plan to conduct a controlled trial in two primary care VA treatment centers. Participants will be randomized to: (1) Treatment as Usual (TAU) reflecting the model of treatment provided to most OEF/OIF veterans (n=81) or (2) TAU plus the web-based CBT intervention (n=81). Primary outcomes will be: a) number of heavy drinking days and/or number of days of illicit or non-prescribed drug use in the past 30 days; b) Quality of Life; and c) PTSD symptoms. AIM 3. Evaluate the cost and cost-effectiveness of the web-based intervention plus TAU relative to TAU alone. Cost-effectiveness ratios will be estimated to identify the incremental costs of the web-based intervention per increased quality adjusted life years (QALYs) and increased abstinence. Analysis will consider costs and cost effectiveness from a societal perspective, as well as from the VA system perspective to inform the adoption decision at a program level. Results of this study have the potential to markedly improve psychosocial treatment for substance use and related disorders among OEF/OIF veterans and enable rapid and widespread diffusion of a science-based intervention to this population. PUBLIC HEALTH RELEVANCE: Although a significant minority of veterans from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) in VA primary care centers present with co-occurring PTSD and substance use problems, most do not receive adequate treatment. To address this public health concern, we propose to modify the content of an efficacious web-based CBT intervention that will target substance use, PTSD and other problems common among OEF/OIF veterans, and will conduct an economic analysis that will compare costs & benefits of our web-based intervention with usual treatment at VA primary care settings. Results of this study have the potential to markedly improve psychosocial treatment for substance use and related disorders among OEF/OIF veterans and enable rapid and widespread diffusion of a science-based intervention to this population.