A Mobile App to Address Co-Occurring Sleep Problems and Heavy Alcohol Use among Veterans Outside of Care Settings

项目摘要/摘要 这项提案的长期目标是改善9/11事件后酗酒退伍军人的治疗结果 目前没有通过退伍军人事务部医疗保健获得护理的疾病(澳元)和失眠 系统(VA)或其他设置。许多9/11事件后的退伍军人正在与澳元作斗争，这可能特别 伴随着失眠的共同发生。超过50%的退伍军人有行为健康 在不需要寻求治疗的情况下，必须利用技术进步来开发和测试干预措施 这可以覆盖到没有寻求治疗的退伍军人，并针对失眠和澳门氏症两种症状。CBT-I是 一线治疗失眠，已被发现可以改善退伍军人的失眠症状 其他人群进行了多项研究。然而，很少有研究检验CBT-I的疗效 在处理AUD症状方面；事实上，AUD通常是将个体排除在CBT-I试验之外的标准。CBT-I是 通常是单独、成组或通过远程医疗面对面提供，但这些形式几乎没有覆盖范围 患有失眠和AUD的退伍军人不寻求行为健康护理。因此，我们建议进行Beta测试 并对一款有前景的手机应用程序进行试点随机对照试验，以解决失眠问题 退伍军人(失眠教练)，通过循证的短暂酒精干预内容，在9/11后得到加强 患有失眠和AUD的退伍军人，不在治疗环境中。迷人且易于使用的移动设备 APP将CBT-I的各个方面与简短的酒精干预内容(例如，饮酒规范反馈， 复发预防策略)，以改善AUD和失眠症状，这两种症状通常会 在专注于单一疾病的治疗中未得到解决，但在综合治疗中是必要的 由于AUD和失眠症状的相互作用。本项目包含四个目标：(1)提炼和增加简要 酒精干预内容到流行的退伍军人管理局开发的失眠教练移动应用程序并测试可用性， 该应用程序在Beta测试阶段的可行性和可接受性，(2)测试增强失眠的疗效 对饮酒和失眠结果进行辅导，并与对照组进行比较；(3)评估改变学习的机制 如何以及对谁的干预效果最好，以及(4)探索干预措施增加的潜力 AUD退伍军人的治疗启动(寻求护理的意愿，准备行为)，他们经常 由于后勤和与污名有关的障碍，很难从事护理工作。这项提议的独特优势 其重点是服务不足的人口(包括有针对性地招募妇女和种族/少数民族 利用移动技术提供干预以克服护理障碍，以及使用 针对AUD和失眠的新型综合干预措施。这项研究旨在生产出一种可行的、 以证据为基础、易于获得的治疗方法，可对药物使用结果产生重大影响。

PROJECT SUMMARY/ABSTRACT The long-term goal of this proposal is to improve treatment outcomes for post 9/11 veterans with alcohol use disorder (AUD) and insomnia who are not currently accessing care through the Veterans Affairs Healthcare System (VA) or other settings. Many post-9/11 veterans struggle with AUD and this can be especially pronounced with the co-occurrence of insomnia. With upwards of 50% of veterans who have behavioral health needs not seeking treatment, it is imperative to utilize advances in technology to develop and test interventions that can reach non-treatment seeking veterans and target both symptoms of insomnia and AUD. CBT-I is the first line of treatment for insomnia, and it has been found to improve insomnia symptoms among veterans and other populations across a number of studies. However, very little research has examined the efficacy of CBT-I in addressing AUD symptoms; indeed, AUD is often a criterion excluding individuals from CBT-I trials. CBT-I is often delivered individually, in groups, or face-to-face over telehealth, yet these formats do little to reach veterans with insomnia and AUD that do not seek behavioral health care. Therefore, we propose to beta test and conduct a pilot randomized controlled trial of a promising mobile app for addressing insomnia among veterans (Insomnia Coach), enhanced with evidence-based brief alcohol intervention content, among post 9/11 veterans with insomnia and AUD that are outside of treatment settings. The engaging and easy-to-use mobile app integrates aspects of CBT-I with brief alcohol intervention content (e.g., drinking normative feedback, relapse prevention strategies) to improve upon both AUD and insomnia symptoms, which often go unaddressed in treatments focused on a single disorder, but are necessary to target in integrated treatments due to the interplay of AUD and insomnia symptoms. This project contains four aims: (1) refine and add brief alcohol intervention content to the popular VA-developed Insomnia Coach mobile app and test usability, feasibility, and acceptability of the app in a beta testing phase, (2) test the efficacy of the enhanced Insomnia Coach on alcohol use and insomnia outcomes compared to control, (3) assess mechanisms of change to learn how and for whom the intervention works best, and (4) explore the intervention's potential to increase treatment initiation (willingness to seek care, preparatory behaviors) among veterans with AUD who are often difficult to engage in care due to logistical and stigma-related barriers. The unique strengths of this proposal are its focus on an underserved population (including targeted recruitment of women and racial/ethnic minority veterans), utilization of mobile technology for intervention delivery to overcome barriers to care, and use of a novel integrated intervention to target both AUD and insomnia. This study intends to produce a viable, evidence-based, and easy-to-access treatment that can have substantial impacts on substance use outcomes.