Adapting Alcohol Behavioral Couple Therapy for Service Members in Post-Deployment

描述（申请人提供）：这一R34提案，“适应酒精行为夫妇治疗服务成员在部署后，”响应PA-13-078，“行为和综合治疗发展计划”，旨在适应和测试一个完善的民用酒精行为夫妇治疗（ABCT）的方法（McCrady & Epstein，2009），以满足从持久自由行动（OEF），伊拉克自由行动（OIF）和新黎明行动（OND）返回的服务成员面临的独特需求和挑战。在OIF/OEF/OND服务的200万人员中，多达38%的人报告酗酒问题，50%的人报告婚姻暴力，25%的人患有抑郁症和/或自杀念头，31%的人患有创伤后应激障碍（PTSD），19-22%的人患有创伤性脑损伤（TBI）。对于65%重新融入婚姻关系的士兵来说，这些酒精和相关问题与严重的不和谐有关。我们提出的手册指导治疗方案ABCT_Military将提供我们现有的核心（a）基于禁欲的酒精相关干预措施和（B）夫妇干预措施，但在内容，插图和交付方面进行了调整，以使治疗可口并与部署后的服务成员相关。将开发四个新的可选模块，以解决士兵及其家属从战区返回后因饮酒而加剧的问题;这些模块旨在帮助夫妇科普以下症状：1.亲密伴侣暴力; 2.抑郁症; 3. PTSD和4. TBI。当前提案的具体目标是：（1）修改我们现有的ABCT_民用模式，以治疗部署后的士兵，并开发可选内容模块，以15次门诊形式解决这一人群中的相关共病挑战;（2）使用阶段1a连续队列设计来测试治疗方案的可行性和初步功效，以及（3）完成比较TAU与TAU+ABCT_Military的1b期小型随机对照试验（RCT）。为了实现这些目标，法语国家组织/自由行动组织/国家民主组织的男女军人，如在部署后或脱离现役、酗酒、已婚或与愿意参加治疗的伴侣有固定关系，将 通过马萨诸塞州全州退伍军人赋权倡导（SAVE）计划招募，该计划每年向军队所有部门的700多名男女军人提供转介。在对两个队列（每组6对夫妇）进行手动开发和迭代测试（阶段1a）后，小型RCT（阶段1b）中的44对夫妇将被随机分配到TAU（n=22对夫妇）或TAU + ABCT_Military（n=22对夫妇），然后将完成治疗后随访。的

DESCRIPTION (provided by applicant): This R34 proposal, "Adapting Alcohol Behavioral Couple Therapy for Service Members in Post-Deployment," in response to PA-13-078, "Behavioral & Integrative Treatment Development Program," seeks to adapt and test a well-established civilian Alcohol Behavioral Couple Therapy (ABCT) approach (McCrady & Epstein, 2009) to meet the unique needs and challenges facing returning service members from Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND). Among the two million personnel who have served in OIF/OEF/OND, up to 38% report alcohol problems, 50% report marital violence, 25% suffer from depression and/or thoughts of suicide, 31% have Post Traumatic Stress Disorder (PTSD), and 19-22% have Traumatic Brain Injury (TBI). For the 65% of solders re-integrating into marital relationships, these alcohol and related problems are associated with significant discord. Our proposed manual-guided treatment protocol, ABCT_Military, will deliver our existing core sets of (a) abstinence-based, alcohol-related interventions, and (b) couple interventions, but with adaptations in content, illustration, and delivery, to make the treatment palatable and relevant to post-deployment service members. Four new optional modules will be developed to address issues exacerbated by and aggravating problem drinking among soldiers and their families following return from theater; the modules are designed to help couples cope with symptoms of: 1. Intimate Partner Violence; 2. Depression; 3. PTSD, and 4.TBI. Specific Aims in the current proposal are: (1)To modify our existing, ABCT_civilian model to treat soldiers in post deployment, and develop optional content modules to address relevant co-morbid challenges in this population in a 15 session outpatient format; (2) To test feasibility and preliminary efficacy of the treatment protocol using a Stage 1a successive cohort design, and (3) To complete a Stage 1b small Randomized Controlled Trial (RCT) comparing Treatment as Usual (TAU) to TAU+ABCT_Military. To achieve these aims, male and female OIF/OEF/OND service members who are in post-deployment or separated from active service, are drinking excessively, and are married or in a committed relationship with a partner willing to participate in the treatment, will be recruited through the Massachusetts Statewide Advocacy for Veterans' Empowerment (SAVE) program, which provides referrals to over 700 service men and women annually across all branches of the military. After manual development and iterative testing on two cohorts of 6 couples each (Stage 1a), 44 couples in the small RCT (stage 1b) will be randomly assigned to either TAU (n=22 couples) or TAU + ABCT_Military (n=22 couples), then will complete a follow up interview post treatment. The