Integrated CBT for Co-Occurring PTSD and Substance Use Disorders

针对同时发生的 PTSD 和药物滥用障碍的综合 CBT

• 批准号: 8282721
• 负责人: Mark P McGovern
• 金额: $ 34.53万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8282721
• 关键词: Address; Alcohol or Other Drugs use; Analgesics; Behavior Therapy; Behavioral; Caring; Clinic; Clinical; Cocaine Dependence; Cognitive; Cognitive Therapy; Commit; Communities; Comorbidity; DA10; Data; Diagnosis; Disease; Dose; Elements; Exposure to; Family; Feasibility Studies; Female; Freedom; Funding; Goals; Group Therapy; Individual; Intervention; Measures; Medical center; Mental Health; Military Personnel; Modality; Modeling; Modification; National Institute of Drug Abuse; Outcome; Outpatients; Pain; Patients; Phase; Population; Positioning Attribute; Post-Traumatic Stress Disorders; Prevalence; Protocols documentation; Randomized; Randomized Controlled Trials; Recruitment Activity; Research; Research Personnel; Resources; Risk; Safety; Sampling; Series; Services; Severities; Specialist; Staging; Stimulus; Substance Use Disorder; Substance abuse problem; Symptoms; System; Testing; Translating; Translations; Trauma; Universities; Veterans; Woman; addiction; base; community setting; experience; follow-up; improved; male; men; operation; phase 2 study; pilot trial; prescription drug abuse; programs; public health relevance; response; standard care; substance abuse treatment; therapy development; treatment program; trial comparing

DESCRIPTION (provided by applicant): Prevalence data indicate that military service men and women returning from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) suffer high rates of PTSD and substance use disorders. With these numbers expected to rise, the co-occurrence of these disorders presents added challenges to the Veterans Affairs treatment delivery system, presently in need of effective integrated treatments. This RO1 proposal is a direct response to NIDA RFA DA-10-001 "Substance use and abuse among U.S. military personnel, Veterans and their families." The overarching goal of the this application is to evaluate an integrated cognitive behavioral therapy (I-CBT) for co-occurring PTSD and substance use disorders among OEF/OIF Veterans. I-CBT has been found efficacious in community samples of men and women with this comorbidity, but needs testing for its application to Veterans Affairs (VA) patient samples and settings. To enhance potential translation to VA clinical settings, the intervention has been adapted for delivery in combined individual and group therapy formats. Within the framework of the NIDA stage model of behavioral therapy development, we propose to execute three specific aims within this Stage I research: 1) To evaluate the feasibility of I-CBT with a sample of 16 patients with co-occurring PTSD and substance use disorders, recruited from VA PTSD and substance abuse treatment program (SATP) clinics; and assessed on PTSD and substance use severity at baseline, 3- and 6-month follow-up (Phase I); 2) To make modifications and improvements to the I-CBT based on feasibility study outcomes and qualitative study (Phase II); and 3) To conduct a randomized controlled pilot trial (n=64) comparing I-CBT plus standard care (n=32) versus standard care only (n=32) on measures of PTSD and substance use severity at baseline, 3-month and 6-month follow-up (Phase III). Although there have been two other behavioral therapies for co-occurring PTSD and substance use developed and tested, these treatments have not been found effective versus comparison conditions, have moderate to poor retention rates, have been studied with female civilians only, and have not been integrated within existing treatment services. The present proposal builds upon a series of successfully completed studies by the PI, implementing a cognitive behavioral therapy (CBT) for co-occurring PTSD and substance use disorders in community clinics. The research team is uniquely experienced and well-positioned to execute the research as proposed. It consists of investigators from Dartmouth, the National VA Center for PTSD, Brown University, and the Providence VA Medical Center. The findings from this research have the potential for immediate and broad impact by providing an effective and readily translated behavioral therapy option for OEF/OIF Veterans with co- occurring substance use and posttraumatic stress disorders. PUBLIC HEALTH RELEVANCE: Among Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) Veterans, co-occurring substance use and posttraumatic stress disorders are common and associated with negative outcomes. The specific aims of the present research are to evaluate an integrated cognitive behavioral group therapy (I-CBT) for co-occurring PTSD and substance use disorders. The overarching goal is to test I-CBT in Veterans Affairs (VA) clinical settings, with the eventual impact of improving outcomes for OEF/OIF Veterans with this co-morbidity.

描述（由申请人提供）：患病率数据表明，从伊拉克自由行动（OIF）和持久自由行动（OEF）返回的军人男女患创伤后应激障碍和物质使用障碍的比例很高。随着这些数字预计将上升，这些疾病的共同发生给退伍军人事务部的治疗提供系统带来了额外的挑战，目前需要有效的综合治疗。该RO 1提案是对NIDA RFA DA-10-001“美国军事人员、退伍军人及其家属的药物使用和滥用”的直接回应。“该应用程序的首要目标是评估针对OEF/OIF退伍军人中同时发生的创伤后应激障碍和药物使用障碍的综合认知行为疗法（I-CBT）。 I-CBT已被发现有效的男性和女性的社区样本与此合并症，但需要测试其应用于退伍军人事务部（VA）的患者样本和设置。 为了增强VA临床环境的潜在转化，干预措施已被调整为以组合的个体和团体治疗形式提供。在NIDA行为治疗发展阶段模型的框架内，我们提出在第一阶段研究中执行三个具体目标：1）评估I-CBT的可行性，样本为16例患有PTSD和物质使用障碍的患者，招募自VA PTSD和物质滥用治疗计划（SATP）诊所;并在基线、3个月和6个月随访（I期）时评估PTSD和物质使用严重程度; 2）根据可行性研究结果和定性研究对I-CBT进行修改和改进（II期）;和3）进行随机对照试验（n=64），比较I-CBT加标准治疗（n=32）与仅标准治疗（n=32）在基线、3个月和6个月随访时PTSD和物质使用严重程度的测量（III期）。 虽然已经开发和测试了另外两种用于共同发生的PTSD和物质使用的行为疗法，但这些治疗方法与对照条件相比并不有效，保留率中等至较差，仅对女性平民进行了研究，并且尚未整合到现有的治疗服务中。 本提案建立在PI成功完成的一系列研究的基础上，在社区诊所实施认知行为疗法（CBT），用于共同发生的PTSD和物质使用障碍。 研究团队具有独特的经验和良好的定位，可以按照建议执行研究。它由来自达特茅斯、国家创伤后应激障碍退伍军人管理中心、布朗大学和普罗维登斯退伍军人管理医疗中心的调查人员组成。这项研究的结果有可能产生直接和广泛的影响，为OEF/OIF退伍军人提供有效和易于翻译的行为治疗选择，同时发生物质使用和创伤后应激障碍。 公共卫生相关性：在伊拉克自由组织（OIF）和持久自由行动（OEF）退伍军人中，同时发生的物质使用和创伤后应激障碍是常见的，并与负面结果有关。本研究的具体目的是评估一个综合认知行为团体治疗（I-CBT）的共同发生的创伤后应激障碍和物质使用障碍。总体目标是在退伍军人事务部（VA）的临床环境中测试I-CBT，最终影响是改善OEF/OIF退伍军人的结局。