Preventing Alcohol Misuse among Young Adult Veterans through Brief Online Intervention

项目总结/摘要 伊拉克和阿富汗战争的年轻成年退伍军人代表了大量饮酒的风险人群 并导致长期使用的问题。不幸的是，很少有人寻求酒精治疗。的 这项计划中的研究的目的是更全面地测试一个非常简短的，廉价的，单次会议， 和网络交付的个性化规范反馈（PNF）干预由我们的团队开发，并评估 在一项成功的R34试点研究中， 在难以接触和抗拒治疗的人群中增加寻求行为健康治疗的行为 老百姓。我们在成功的试点工作的基础上，通过（1）建立一个大型的公开数据库， 年轻退伍军人饮酒和寻求治疗的规范，（2）专注于接触最近 与军队分离，酗酒，但最近没有寻求任何行为健康 治疗，（3）评估提供PNF内容的增强干预如何与治疗具体相关 寻求影响准备行为和实际治疗的启动，以及（4）测试假设的中介 以及与该人群相关的干预饮酒和治疗开始结果的调节因子。在目标1中， 我们通过收集饮酒和寻求治疗的情况， 来自试点中代表性不足的退伍军人的信息，如女性退伍军人（总样本N = 2，500）。在 目的2，然后我们使用这些规范在随机对照试验的PNF干预，旨在达到 重度饮酒的年轻退伍军人目前没有接受行为健康护理（N = 800），并测试是否 关于寻求治疗的额外反馈可以帮助促进在这种治疗中开始治疗。 抵抗组。比较接受增强PNF的参与者在3、6、9和12个月时的结局 条件（N = 400）到仅注意力控制条件（N = 400）。在目标3中，我们测试干预的介质 对饮酒结果的功效（即，感知规范的变化，治疗开始的增加），并探索 结果的主持人，以确定简短的干预是否更适合资深参与者， 年龄、性别、饮酒原因（社会与应对）、感知的耻辱感、创伤后应激障碍和抑郁症状， 独自饮酒。拟议的研究提供了显着的方法进步，目前的PNF 通过针对未满足行为健康需求的共病人群的方法。对公众健康影响 这种方法的前景很好，因为干预完全在互联网上进行，可以接触到退伍军人 在治疗环境之外。自我维持计划使用有限的时间和人员，并可在 移动的电话和平板电脑。这种干预可以覆盖对传统疗法有抵抗力的大量人群 并作为一种独立的方法来预防饮酒后果和促进治疗的启动 在酒精滥用和共病问题成为慢性病之前，及早采取行动。

Project Summary/Abstract Young adult veterans from the wars in Iraq and Afghanistan represent a population at risk for heavy drinking and resulting long-term problems from use. Unfortunately, few seek treatment for alcohol concerns. The objective of this planned research is to more fully test the efficacy of a very brief, inexpensive, single-session, and web-delivered personalized normative feedback (PNF) intervention developed by our team and evaluated in a successful pilot R34 study to prevent alcohol misuse and associated negative consequences, as well as increase behavioral health treatment seeking behaviors among a difficult to reach and treatment resistant veteran population. We expand on our successful pilot work by (1) building a large publicly available database of young veteran drinking and treatment seeking norms, (2) focusing on reaching veterans who have recently separated from the military and drink heavily but who have not recently sought any behavioral health treatment, (3) evaluating how an enhanced intervention offering PNF content specifically related to treatment seeking affects preparatory behaviors and actual treatment initiation, and (4) testing hypothesized mediators and moderators of intervention drinking and treatment initiation outcomes relevant for this population. In Aim 1, we add to our large database of drinking norms for the population by collecting drinking and treatment seeking information from veterans underrepresented in the pilot, such as female veterans (total sample N = 2,500). In Aim 2, we then use these norms in a randomized controlled trial of the PNF intervention designed to reach heavy drinking young veterans who are not currently receiving behavioral health care (N = 800) and test if additional feedback about treatment seeking can help promote treatment initiation among this treatment resistant group. Outcomes at 3, 6, 9, and 12 months are compared for participants receiving an enhanced PNF condition (N = 400) to an attention-only control condition (N = 400). In Aim 3, we test mediators of intervention efficacy on drinking outcomes (i.e., changes in perceived norms, increases in treatment initiation) and explore moderators of outcomes to determine if the brief intervention works better for veteran participants based on age, gender, reasons for drinking (social versus coping), perceived stigma, PTSD and depression symptoms, and solitary drinking. The proposed research offers significant methodological advancements to current PNF approaches by targeting a comorbid population with unmet behavioral health needs. The public health impact of the approach is promising as the intervention is hosted entirely on the Internet and can reach veterans outside of treatment settings. The self-sustaining program uses limited time and personnel and is available on mobile phones and tablets. The intervention can reach a large population resistant to conventional therapies and functions as a stand-alone approach to prevent drinking consequences and promote treatment initiation early, before alcohol misuse and comorbid problems become chronic.