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

描述（由申请人提供）：作为对PA-13-078“行为与综合治疗发展计划”的回应，这份R34提案“为服役人员在部署后调整酒精行为夫妻疗法”，旨在调整和测试一种完善的民用酒精行为夫妻疗法（ABCT）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）中返回的服役人员所面临的独特需求和挑战。在OIF/OEF/OND服务的200万人员中，高达38%的人报告有酗酒问题，50%的人报告有婚姻暴力，25%的人患有抑郁症和/或自杀念头，31%患有创伤后应激障碍（PTSD）， 19-22%患有创伤性脑损伤（TBI）。对于重新融入婚姻关系的65%的士兵来说，这些酒精和相关问题与严重的不和有关。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治疗方案(a)以戒酒为基础的酒精相关干预措施，以及(b)夫妻干预措施，但在内容、说明和交付方面进行了调整，使治疗对部署后的服务成员来说是可接受的和相关的。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问题而恶化的问题；这些模块旨在帮助夫妻应对以下症状：亲密伴侣暴力；2. 抑郁症;3. 创伤后应激障碍和创伤性脑损伤。当前提案的具体目标是：(1)修改我们现有的ABCT_civilian模型，以治疗部署后的士兵，并开发可选的内容模块，以15次门诊形式解决这一人群的相关共病挑战；(2)采用1a期连续队列设计测试治疗方案的可行性和初步疗效；(3)完成1b期小型随机对照试验（RCT），比较常规治疗（TAU）和TAU+ABCT_Military。为了实现这些目标，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承诺关系的OIF/OEF/OND服务人员将接受治疗

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