Evaluating the Efficacy of Telehealth-Delivered Brief Family Involved Treatment (B-FIT) for Alcohol Use Disorder among Veterans

评估远程医疗提供的短期家庭参与治疗 (B-FIT) 对退伍军人酒精使用障碍的疗效

• 批准号: 10705831
• 负责人: JULIANNE Christina Flanagan
• 金额: $ 67.03万
• 依托单位: MEDICAL UNIVERSITY OF SOUTH CAROLINA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-16 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10705831
• 关键词: Abstinence; Acceleration; Adherence; Age; Alcohol consumption; Alcohols; Appointment; Area; Back; Behavior; Behavioral; Characteristics; Clinic; Clinical; Cognitive Therapy; Collaborations; Communication; Complex; Couples; Couples Therapy; Cues; Data; Diagnosis; Economics; Effectiveness; Enrollment; Etiology; Exclusion; Family; Family Characteristics; Family member; Family psychotherapy; General Population; Goals; Health; Health Expenditures; Health Services Accessibility; Health Technology; Healthcare Systems; Home; Individual; Infrastructure; Intervention; Literature; Manuals; Measures; Mediating; Mediator; Medical Records; Mental Depression; Mental Health; Methods; Mission; Modality; Modeling; National Institute on Alcohol Abuse and Alcoholism; Outcome; Participant; Patients; Persons; Play; Population; Post-Traumatic Stress Disorders; Prevalence; Procedures; Provider; Psychological reinforcement; Public Health; Qualifying; Randomized; Randomized, Controlled Trials; Recovery; Relapse; Research; Rewards; Role; Rural; Rural Community; Schedule; Science; Standardization; Strategic Planning; Symptoms; System; Time; Translating; Treatment Protocols; Treatment outcome; Veterans; Videoconferencing; Woman; acceptability and feasibility; alcohol abuse therapy; alcohol availability; alcohol effect; alcohol reinforcement; alcohol use disorder; clinical practice; comparative efficacy; cost; design; diagnostic criteria; drinking; eHealth; efficacy evaluation; evidence base; family support; health disparity populations; high risk; improved; innovation; meetings; member; pilot trial; prevent; programs; public health priorities; randomized controlled design; satisfaction; sex; telehealth; therapy design; treatment as usual; treatment program; underserved community

ABSTRACT Improving alcohol use disorder (AUD) treatment access and outcomes among Veterans is an urgent public health priority. The lifetime prevalence of AUD among Veterans is twice that of civilians. Veterans also incur more severe and persistent AUD symptoms with more lengthy and complex treatment courses and negative outcomes compared to the general population. Despite the critical role that family members play in the etiology, course, and treatment of AUD, and the robust evidence base supporting the efficacy of several existing family AUD treatments, family treatment protocols are lengthy and burdensome for patients and clinicians. Thus, there is a critical need to develop efficacious family AUD treatments that are both brief and highly accessible to Veterans. Members of our team developed and refined the Brief Family Involved Treatment (B-FIT) protocol in an NIAAA-sponsored pilot trial among civilians. B-FIT is a 3-session cognitive behavioral therapy designed to be implemented in combination with any existing alcohol treatment program. The goals of B-FIT are to 1) increase reinforcement of treatment-facilitating behaviors, 2) increase the perceived reinforcement value of abstinence by increasing anticipated positive rewards from abstinence, and 3) reduce drinking cues by decreasing negative communication and increasing positive communication with family members. This study resulted in findings that support feasibility, acceptability, and preliminary efficacy of B-FIT. In a separate study, our team has demonstrated excellent feasibility and acceptability of delivering dyadic AUD treatment via home-based telehealth. Thus, the primary objective of this Stage II trial is to examine the efficacy of B-FIT in combination with treatment as usual (TAU; VA Substance Treatment and Recovery [STAR]) versus TAU alone in 1) reducing alcohol consumption, 2) improving family functioning, and 3) improving STAR treatment satisfaction, adherence, and retention among Veterans. To accomplish this, we will employ an open randomized controlled design and examine standardized, repeated, dependent measures of change at multiple time points. We will also leverage our team’s standard operating procedures for fully remote study implementation, close collaboration with regional VA STAR clinics, and a robust national VA telehealth infrastructure which is prepared to efficiently translate positive findings into treatment. The proposed study is directly aligned with NIAAA’s mission and Strategic Plan in that it will 1) employ electronic health technology to improve the effectiveness and accessibility of AUD treatment for Veterans, 2) will advance AUD treatment access among rural and underserved Veterans, who are a health disparity population, 3) focuses on Veterans in a real-world treatment setting (i.e., VA STAR clinics), 4) examines B-FIT for home-based telehealth delivery, and 4) will identify characteristics of Veterans and family members most likely to benefit from the addition of B-FIT to their recovery program. Our findings will directly inform clinical practice and accelerate treatment in this important but understudied area.

摘要 改善退伍军人的酒精使用障碍(AUD)治疗途径和结果是一个紧迫的公众问题 健康优先。退伍军人的澳门氏症终生患病率是平民的两倍。退伍军人也会招致 AUD症状更严重、更持久，疗程更长、更复杂，且阴性 结果与普通人群相比。尽管家庭成员在病因学中起着关键作用， AUD的病程和治疗，以及支持几个现有家族疗效的强有力的证据基础 AUD治疗和家庭治疗方案对患者和临床医生来说既冗长又繁重。因此，在那里 是开发有效的家庭AUD治疗方法的迫切需要，这些治疗方法既简单又易于获得 退伍军人。我们团队的成员开发和完善了简明家庭参与治疗(B-FIT)方案 一项由NIAAA赞助的平民试点试验。B-Fit是一种为期3个疗程的认知行为疗法，旨在 与任何现有的酒精治疗计划相结合实施。B-Fit的目标是1)增加 促进治疗行为的强化，2)通过以下方式增加对戒酒的感知强化价值 从禁欲中增加预期的积极回报，以及3)通过减少负面因素来减少饮酒暗示 沟通和增加与家庭成员的积极沟通。这项研究的结果是 支持B-Fit的可行性、可接受性和初步效果。在另一项研究中，我们的团队 证明了通过基于家庭的方式提供二元AUD治疗的极好的可行性和可接受性 远程医疗。因此，这项II阶段试验的主要目标是检查B-Fit与 照常治疗(TAU；VA物质治疗和恢复[STAR])与单独使用TAU相比，1)减少 酒精消费，2)改善家庭功能，以及3)提高明星治疗满意度，坚持， 以及在退伍军人中的留任。为了实现这一目标，我们将采用开放的随机对照设计和 在多个时间点检查标准化的、重复的、依赖的变化测量。我们还将利用 我们团队为完全远程学习实施的标准操作程序，与区域组织密切合作 退伍军人事务部星级诊所，以及强大的国家退伍军人事务部远程医疗基础设施，该基础设施准备高效地 治疗中发现阳性结果。拟议的研究直接与NIAAA的使命和战略计划保持一致 因为它将1)使用电子健康技术来提高AUD的有效性和可及性 对退伍军人的治疗，2)将促进农村和服务不足的退伍军人获得AUD治疗，这些退伍军人 健康差距人群，3)专注于现实世界治疗环境中的退伍军人(即退伍军人明星诊所)，4) 检查B-适合于基于家庭的远程医疗服务，以及4)将确定退伍军人和家庭的特征 最有可能从B-Fit增加到他们的恢复计划中受益的成员。我们的发现将直接 告知临床实践，并加快这一重要但未被研究的领域的治疗。