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

一款解决退伍军人在护理机构之外同时发生的睡眠问题和酗酒问题的移动应用程序

• 批准号: 10647530
• 负责人: Eric Roland Kuhn
• 金额: $ 25.98万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-15 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10647530
• 关键词: Address; Affect; Aftercare; Alcohol consumption; Alcohols; American; Behavior; Behavioral; Caring; Cognitive Therapy; Data; Disease; Ethnic Origin; Exclusion; Exclusion Criteria; Frequencies; Goals; Health Services Accessibility; Healthcare; Healthcare Systems; Heavy Drinking; Individual; Intervention; Interview; Learning; Link; Mediating; Mental Depression; Mental Health; Military Personnel; Motivation; Occupational; Outcome; Participant; Persons; Phase; Population; Post-Traumatic Stress Disorders; Prevalence; Prevention strategy; Public Health; Race; Randomized, Controlled Trials; Reporting; Research; Risk; Sampling; Schedule; Self Direction; Sleep; Sleep Disorders; Sleeplessness; Stigmatization; Surveys; Symptoms; Technology; Testing; Transportation; Treatment outcome; Underserved Population; Veterans; Veterans Health Administration; Woman; Work; alcohol consequences; alcohol misuse; alcohol use disorder; barrier to care; behavioral health; brief alcohol intervention; care seeking; comparison control; drinking; drinking behavior; dual diagnosis; efficacy evaluation; efficacy testing; ethnic minority; evidence base; follow-up; health communication; high risk; improved; improvement on sleep; interest; intervention delivery; intervention effect; marijuana use disorder; meetings; military veteran; mobile application; mobile computing; normative feedback; novel; physical conditioning; post 9/11; preference; primary outcome; racial minority; recruit; relapse prevention; secondary outcome; sex; sleep health; sleep quality; social media; social stigma; standard care; substance use; telehealth; treatment as usual; usability; willingness

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.

项目总结/摘要 该提案的长期目标是改善9/11后酗酒退伍军人的治疗结果 疾病（AUD）和失眠，目前没有通过退伍军人事务部医疗保健获得护理 系统（VA）或其他设置。许多9/11后的退伍军人与澳元斗争，这可能特别 同时伴有失眠超过50%的退伍军人有行为健康问题 不需要寻求治疗，必须利用技术进步来开发和测试干预措施 这可以达到非寻求治疗的退伍军人和目标失眠和AUD的症状。CBT-I是 治疗失眠的第一线，它已被发现可以改善退伍军人的失眠症状， 其他人群进行了大量研究。然而，很少有研究检查CBT-I的疗效 在解决AUD症状;事实上，AUD通常是排除CBT-I试验个体的标准。CBT-I是 通常是单独、分组或通过远程医疗面对面地提供，但这些形式几乎无法达到 患有失眠症和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 并对一款有前途的移动的应用程序进行随机对照试验， 退伍军人（Incident Coach），增强了基于证据的简短酒精干预内容，在9/11事件后 患有失眠和AUD的退伍军人在治疗环境之外。易于使用的移动的 应用程序将CBT-I的各个方面与简短的酒精干预内容（例如，喝规范反馈， 复发预防策略），以改善AUD和失眠症状，这些症状通常会 在专注于单一疾病的治疗中未得到解决，但在综合治疗中必须针对 由于AUD和失眠症状的相互作用。本项目主要有四个目标：（1）提炼和补充简要 酒精干预内容到流行的VA开发的Increase Coach移动的应用程序和测试可用性， 在beta测试阶段，应用程序的可行性和可接受性，（2）测试增强的Increase的功效 与对照组相比，对酒精使用和失眠结果进行指导，（3）评估学习变化的机制 如何以及对谁进行干预效果最好，以及（4）探索干预的潜力，以增加 治疗开始（寻求护理的意愿，准备行为）在患有AUD的退伍军人中， 由于后勤和与耻辱有关的障碍，难以从事护理工作。该提案的独特优势在于 重点是服务不足的人口（包括有针对性地征聘妇女和少数种族/族裔） 退伍军人），利用移动的技术进行干预，以克服护理障碍，并使用 针对AUD和失眠的新型综合干预。这项研究旨在产生一种可行的， 基于证据的，易于获得的治疗，可以对物质使用的结果产生重大影响。