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

描述(由申请人提供)：针对PA-13-078，“行为与综合治疗发展计划”，R34提案“调整部署后服役人员的酒精行为夫妇疗法”，旨在调整和测试成熟的平民酒精行为夫妇疗法(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)返回的服役人员所面临的独特需求和挑战。在OIF/OEF/OND的200万名工作人员中，高达38%的人报告了酒精问题，50%的人报告了婚姻暴力，25%的人患有抑郁症和/或有自杀念头，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。我们拟议的手动指导治疗方案ABCT_MARTICAL将提供我们现有的核心成套治疗方案(A)基于戒酒的与酒精相关的干预措施，以及(B)夫妇干预措施，但在内容、说明和交付方面进行了调整，使治疗变得令人满意，并与部署后服务人员相关。将开发四个新的可选模块，以解决士兵及其家人在从战区返回后因酗酒问题而加剧的问题；这些模块旨在帮助夫妇应对以下症状：1.亲密伴侣暴力；2.抑郁症；3.创伤后应激障碍和4.创伤后应激障碍。当前提案的具体目标是：(1)修改我们现有的ABCT_平民模式，以在部署后治疗士兵，并开发可选内容模块，以15次门诊形式应对这一人群中相关的共同疾病挑战；(2)采用1a阶段连续队列设计检验治疗方案的可行性和初步疗效；(3)完成1b阶段小型随机对照试验(RCT)，比较常规治疗(TAU)和TAU+ABCT_MARTIC。为了实现这些目标，在部署后或脱离现役、酗酒、已婚或与愿意参与治疗的伴侣有承诺关系的男女OIF/OEF/OND服务人员将 通过马萨诸塞州全州退伍军人赋权倡导(SAVE)计划招募，该计划每年为所有军种的700多名男女军人提供转介。在手工开发和迭代测试两组各6对夫妇(阶段1a)后，小型随机对照试验(阶段1b)中的44对夫妇将被随机分配到TAU(n=22对)或TAU+ABCT_Military(n=22对)，然后完成治疗后的后续访谈。这个

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