The Impact of CBT for Insomnia on Alcohol Treatment Outcomes among Veterans

CBT 治疗失眠对退伍军人酒精治疗结果的影响

• 批准号: 9753816
• 负责人: JOHN E MCGEARY
• 金额: $ 18.22万
• 依托单位: UNIVERSITY OF MISSOURI-COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-01 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9753816
• 关键词: Aftercare; Alcohol consumption; Alcohol dependence; Alcohol or Other Drugs use; Alcohols; Attention; Behavioral; Cognitive; Cognitive Therapy; Comorbidity; Computational algorithm; DSM-V; Data Analyses; Education; Effectiveness; Emotional; Emotions; Enrollment; Family; Goals; Health; Heavy Drinking; Individual; Intervention; Investigation; Lead; Long-Term Effects; Medical center; Mental Depression; Military Personnel; Outcome; Outpatients; Participant; Patients; Post-Traumatic Stress Disorders; Process; Productivity; Quality of life; Randomized; Randomized Controlled Trials; Relapse; Reporting; Research; Risk Factors; Safety; Severities; Short-Term Memory; Sleep; Sleep Disorders; Sleep disturbances; Sleeplessness; Stimulus; Symptoms; Testing; Treatment Efficacy; Treatment outcome; United States National Institutes of Health; Veterans; Work; alcohol abuse therapy; alcohol related consequences; alcohol related problem; alcohol response; alcohol use disorder; base; cognitive benefits; cost effectiveness; craving; drinking; effective therapy; emotion regulation; evidence base; falls; follow up assessment; follow-up; improved; innovation; interest; intervention effect; negative affect; pilot trial; post intervention; prevent; psychologic; public health relevance; recruit; reduce symptoms; relapse prediction; retention rate; satisfaction; service member; skills; sleep health; substance abuse treatment; sustained attention; tool; treatment as usual; treatment effect

PROJECT SUMMARY / ABSTRACT Alcohol use disorders (AUDs) are prevalent among Veterans and result in significant physical and psychological burden. Among those who receive treatment for AUDs, 1 in 3 relapses to problematic drinking within one year of treatment. Thus, additional strategies are needed to enhance alcohol treatment outcomes. One promising approach involves providing concurrent treatment for a common complaint – difficulty falling or staying asleep. As many as 63% of Veterans with AUDs report co-occurring symptoms of insomnia. Given the negative impact of insomnia on attention and emotion regulation, insomnia symptoms may decrease patients’ abilities to attend to alcohol treatment and manage negative emotions that lead to craving and relapse. Moreover, approximately 50% of individuals with AUDs report using alcohol to help them sleep, making relapse more likely for those with no other tools or skills to help them sleep. Indeed, sleep disturbance has been identified as a risk factor for relapse among individuals in alcohol treatment. Thus, effective treatment of sleep problems may enhance alcohol treatment for a substantial number of individuals with AUDs. Cognitive Behavioral Therapy for Insomnia (CBTi) has been effective in reducing insomnia severity in individuals with AUDs; however, no investigations have examined the efficacy of CBTi delivered concurrently with AUD treatment to determine its impact on treatment engagement. This R21 aims to examine the feasibility, acceptability, and initial efficacy of a CBTi supplement to ongoing outpatient alcohol treatment at the VA. We will conduct a randomized pilot trial with 80 Veterans who meet DSM-5 criteria for AUD and the episodic criterion for Insomnia Disorder. Participants will be randomly assigned to a minimal-treatment (education) control involving sleep hygiene education in addition to treatment as usual (eTAU; n = 40) or TAU+CBTi (n = 40). Outcomes will be assessed at the end of the active intervention period (6 weeks) and 6 weeks post- intervention. Outcomes of interest include recruitment and retention rates, treatment satisfaction, percentage of abstinent days, percentage of heavy drinking days, alcohol-related consequences, use of alcohol as a sleep aid, sleep efficiency, ability to sustain attention, working memory, negative affect, and emotion regulation. Data analyses will focus on size of treatment effects. Results will inform an R01 application to examine the efficacy, cost-effectiveness, and potential mechanisms of CBTi in preventing or delaying relapse to problematic drinking among Veterans with insomnia and AUDs. This study will provide initial evidence that treatment of insomnia not only improves sleep but also allows participants to derive greater benefit from intensive outpatient alcohol treatment.

项目概要/摘要 酒精使用障碍 (AUD) 在退伍军人中普遍存在，会导致严重的身体和健康问题 心理负担。在接受 AUD 治疗的患者中，三分之一的人再次出现酗酒问题 治疗一年内。因此，需要额外的策略来增强酒精治疗的效果。 一种有希望的方法是针对常见的症状（跌倒困难或 保持睡眠状态。多达 63% 患有 AUD 的退伍军人报告同时出现失眠症状。鉴于 失眠对注意力和情绪调节产生负面影响，失眠症状可能会降低患者的注意力 参与酒精治疗和管理导致渴望和复发的负面情绪的能力。 此外，大约 50% 的 AUD 患者报告称，他们使用酒精来帮助睡眠，从而导致旧病复发 对于那些没有其他工具或技能来帮助睡眠的人来说更有可能。事实上，睡眠障碍已经 被确定为酒精治疗个体复发的危险因素。因此，有效治疗睡眠 问题可能会加强对大量 AUD 患者的酒精治疗。认知的 失眠行为疗法（CBTi）可有效减轻患有失眠症的人的失眠严重程度 澳元；然而，没有调查检验 CBTi 与 AUD 同时给药的功效 治疗以确定其对治疗参与度的影响。这个R21旨在检验可行性， CBTi 补充剂对 VA 正在进行的门诊酒精治疗的可接受性和初步疗效。我们 将对 80 名符合 DSM-5 AUD 和偶发事件标准的退伍军人进行随机试点试验 失眠症的标准。参与者将被随机分配接受最低限度的治疗（教育） 除照常治疗外，还包括睡眠卫生教育的控制（eTAU；n = 40）或 TAU+CBTi（n = 40）。结果将在积极干预期结束时（6 周）和干预后 6 周进行评估 干涉。感兴趣的结果包括招募率和保留率、治疗满意度、 禁欲天数、大量饮酒天数的百分比、酒精相关后果、以酒精作为睡眠 帮助、睡眠效率、维持注意力的能力、工作记忆、负面情绪和情绪调节。数据 分析将集中于治疗效果的大小。结果将告知 R01 应用程序以检查功效， CBTi 在预防或延缓酗酒问题复发方面的成本效益和潜在机制 患有失眠和澳元的退伍军人。这项研究将为治疗失眠提供初步证据 不仅可以改善睡眠，还可以让参与者从密集的门诊酒精中获得更大的益处 治疗。