SEQUENCE OF SYMPTOM CHANGE DURING AUD OR PTSD TREATMENT FOR COMORBID PTSD/AUD

描述（由申请人提供）：目前研究的广泛，长期目标是改善患有PTSD和酒精滥用和依赖（AUD）的个体的治疗结果。先前的研究已经确定PTSD和AUD经常共病。虽然已经开发了联合治疗，但它们复杂而漫长，其疗效好坏参半。PTSD或AUD单独存在很好的治疗方法，然而，这些治疗在多大程度上有效治疗共病症状表现尚未得到充分解决。为了解决这一研究空白，我们将评估两种被广泛接受的治疗方法;认知加工疗法（CPT）是一种有效的PTSD治疗方法，复发预防（RP）是一种广泛使用的有效AUD治疗方法。本申请的目的是评估患有PTSD/AUD的个体中与CPT或RP治疗相关的PTSD症状和酒精使用和渴望的变化，沿着结果的介导者和调节者。我们将建立在我们以前的工作，使用每日电话交互式语音应答（IVR）系统，以测试自我用药模型和与每种治疗相关的主要和次要症状目标的症状变化顺序。该研究将从VA和社区招募235名PTSD/AUD参与者，仅进行CPT、RP或IVR评估（AO）。AO条件下的受试者将在治疗期后重新随机分配至RP或CPT。将在治疗前、治疗后即刻、治疗后3个月、6个月、9个月和12个月对个体进行评估，并在整个治疗期间每天监测症状。创建一个更全面的模型，在创伤后应激障碍和酒精使用广泛使用的选择性治疗的症状变化是至关重要的测试理论的创伤后应激障碍/AUD，评估这些治疗与创伤后应激障碍/AUD的使用，并实施这些治疗与创伤后应激障碍/AUD患者在标准的临床实践。

DESCRIPTION (provided by applicant): The broad, long-term objective of the current research is to improve treatment outcomes for individuals with comorbid PTSD and alcohol abuse and dependence (AUD). Prior research has established that PTSD and AUD are frequently comorbid. Although combined treatments have been developed, they are complex and lengthy with mixed results as to their efficacy. Excellent treatments exist for PTSD or AUD alone, however, it has not been adequately addressed to what extent these treatments are effective in treating comorbid symptom presentations. To address this research gap, we will evaluate two widely accepted treatments for each respective disorder; Cognitive Processing Therapy (CPT) an effective PTSD treatment and Relapse Prevention (RP), a widely used effective AUD treatment. The purpose of the present application is to evaluate changes in both PTSD symptoms and alcohol use and cravings associated with CPT or RP treatment in individuals with PTSD/AUD, along with mediators and moderators of outcomes. We will build on our prior work using a daily telephone Interactive Voice Response (IVR) system to test models of self-medication and the sequence of symptom change for both primary and secondary symptom targets associated with each therapy with. The study will randomize 235 PTSD/AUD participants recruited from the VA and from the community to CPT, RP, or IVR assessment only (AO). Those in the AO condition will be re-randomized after the treatment phase to either RP or CPT. Individuals will be assessed pretreatment, immediately post-treatment, 3-, 6-, 9-, and 12-months post-treatment and will monitor symptoms daily throughout treatment. Creating a more comprehensive model of symptom change in PTSD and alcohol use with widely used selective treatments is critical in testing theories of PTSD/AUD, evaluating these treatments for use with PTSD/AUD, and implementing these therapies with PTSD/AUD patients in standard clinical practice.