A Female-Specific Cognitive Behavioral Therapy Group for Alcohol Use Disorder in VA Primary Care Settings

退伍军人事务部初级保健机构针对酒精使用障碍的女性特定认知行为治疗小组

• 批准号: 10116903
• 负责人: Elizabeth Ellen Epstein
• 金额: $ 61.28万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-02-05 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10116903
• 关键词: Abstinence; Address; Aftercare; Alcohol abuse; Alcohol consumption; Alcohols; Bacterial Artificial Chromosomes; Behavior; Behavior Therapy; Caring; Clinic; Clinical; Cognitive Therapy; Complex; Consolidated Framework for Implementation Research; Coping Skills; Counseling; Data; Development; Distress; Drug usage; Enrollment; Ensure; Evidence based treatment; Female; Funding; Gender; Grant; Group Therapy; Health Sciences; Health Services; Health Services Accessibility; Healthcare; Healthcare Systems; Heavy Drinking; Human Resources; Hybrids; Intervention; Interview; Mediating; Mental Health; Modality; Modeling; Moods; Motivation; National Institute on Alcohol Abuse and Alcoholism; New York; Outcome; Outpatients; Patient Care; Persons; Pharmaceutical Preparations; Primary Health Care; Process; Provider; Randomized Controlled Trials; Reporting; Research; Research Priority; Resources; Self Care; Services; Site; Sleep; Smoking; Social support; Special Population; Strategic Planning; Substance Use Disorder; Testing; Time; Trauma; Treatment outcome; United States National Institutes of Health; Veterans; Veterans Health Administration; Woman; Women' s Group; Women' s Health; alcohol abuse therapy; alcohol seeking behavior; alcohol use disorder; behavioral health; brief intervention; care providers; chronic pain; community setting; comorbidity; disorder later incidence prevention; drinking; effectiveness implementation study; efficacy outcomes; emotion regulation; evidence base; fitness; formative assessment; implementation barriers; implementation facilitators; implementation framework; improved; interest; medical specialties; military veteran; mobile application; novel; nutrition; patient oriented; preference; primary care setting; primary outcome; programs; research and development; response; screening, brief intervention, referral, and treatment; secondary outcome; support network; therapy development; transgender women; treatment as usual; treatment group; trial comparing; virtual

Project Summary: Women comprise 10% of the U.S. Veteran population, expected to rise to 35% by 2035.1, 2 37% of female Veterans report risky or problem alcohol use4, and many have complex comorbidity requiring specialized treatment5 but only 2% of women Veterans receive treatment in VA Substance Use Disorder (SUD) clinics. There is currently no evidence-based, Veteran-centric, female segregated treatment with female-specific programming for AUD or SUD at the VA. The vast majority of women at the V.A. are limited to gender- neutral treatments for AUD in Specialty SUD clinics, which is a mixed gender setting and is unappealing to women Veterans6. Only 19%7 to 30%8 of VAs offer female-only SUD treatments, and these are offered in Specialty SUD clinics, and do not contain women-specific content shown to be crucial for efficacy9. Since women are likely to seek AUD care with their Primary Care (PC) Providers10, 11, and women Veterans report preference for PC colocation of AUD services12, PC is a promising setting to reduce treatment entry barriers, increase access to care and outcome efficacy for AUD among women Veterans. This R01 resubmission, “A Female-Specific Cognitive Behavioral Therapy (CBT) Group for Alcohol Use Disorder in VA Primary Care Settings,” in response to PA-19-055, and NOT-AA-19-010, proposes a Hybrid Type 118 study to adapt a single-gender group modality Female-Specific CBT developed for civilian females with AUD19-22, 41, and to test the new Veteran-Centric female-specific CBT group (FS-CBT) in VA PC at New York Harbor Healthcare System (NYHHS) VA, compared to Usual Care (UC) for AUD in PC. FS-CBT is a unique 12-session weekly group CBT treatment for AUD, providing: 1. AUD interventions; 2. general female specific content; 3. female-Veteran content; 4. wellness and self-care; and 5. a novel 24/7 social support for abstinence discussion mobile app. Aim 1. RCT (n=162) testing FS-CBT+UC for AUD in PC compared to UC only in PC for women Veterans, with baseline and 3-, 9-, 15- month assessments. UC will be delivered by grant-funded PCP staff to ensure fidelity. H.1a.Women VA PC patients in FS-CBT+UC for AUD at a PC site will be more likely to access and engage in treatment for AUD than women in UC. H.1b. Women in FS-CBT+UC will have better drinking and secondary outcomes than women in UC only. H.1c. Outcomes in FS-CBT+UC vs UC will be mediated by social support, AUD medication, coping skills, and subjective distress. Aim 2. Formative evaluation of FS-CBT with 20 women Veterans in FS-CBT, 20 in UC, 15 who did not enroll, and 16 PC providers, using “Consolidated Framework for Implementation Research” will be done. This project is consistent with NIAAA priorities for behavioral and health services, and Advancing Science for the Health of Women: Trans-NIH Strategic Plan24, and the VA Strategic Plan25 to focus resources more efficiently and improve timeliness of services. The long-term objective is to produce an “off the shelf” treatment to fill a gap in evidence-based, accessible, patient-centered AUD treatment for women Veterans.

项目摘要： 妇女占美国退伍军人人口的10％，预计到2035年1月将增长到35％，2 37％的女性 退伍军人报告风险或饮酒的问题4，许多人的合并症需要专业的合并症 治疗5，但只有2％的女性退伍军人接受VA药物使用障碍（SUD）诊所的治疗。 目前尚无基于循证的，以退伍军人为中心的，女性特异性的女性隔离治疗 VA的AUD或SUD编程。 V.A.的绝大多数妇女仅限于性别 在专业SUD诊所中的AUD中性治疗方法，这是一种混合性别环境，没有吸引力 妇女退伍军人6。只有19％的7％至30％的VA提供仅女性的SUD治疗，这些提供了 专业SUD诊所，不包含针对效率至关重要的特定女性含量。9。自从 妇女可能会通过其初级保健（PC）提供者10、11和妇女退伍军人报告寻求AUD护理。 PC偏爱AUD Services12的PC托管，PC是减少治疗障碍的承诺环境， 提高女性退伍军人中AUD的护理和结果效率的机会。此R01重新提交“ 女性特异性认知行为疗法（CBT）针对VA初级保健中的酒精使用障碍 设置，“响应PA-19-055和NOT-AA-19-010，提出了一项混合型118研究以适应A 单个性别群体模式为女性特定于AD19-22、41的民用女性开发的女性CBT和 测试纽约港Healthcare的VA PC中的新的以资深女性特异性CBT小组（FS-CBT） 与PC中AUD的常规护理（UC）相比，系统（NYHHS）VA。 FS-CBT是每周一次独特的12条。 AUD组CBT治疗，提供：1。AUD干预措施； 2。一般女性特定内容； 3。 女性兽医内容； 4。健康和自我保健；和5。一本小说的24/7社会支持戒酒 讨论移动应用程序。 AIM1。RCT（n = 162）测试PC中AUD的FS-CBT+UC与PC中的UC相比 对于女性退伍军人，基线和3个，9个，15个月的评估。 UC将由赠款资助 PCP员工以确保忠诚。 H.1A。在PC网站的FS-CBT+UC中的Women VA PC患者将更多 可能比UC中的女性获得和接受AUD的治疗。 H.1b。 FS-CBT+UC中的女性 仅比UC中的女性更好的饮酒和次要结果。 H.1c。 FS-CBT+UC与UC的结果 将由社会支持，AUD药物，应对技巧和主观困扰来调节。目标2。 在FS-CBT中对FS-CBT进行FS-CBT的形成性评估，UC中的20名，15名未入学的FS-CBT和 将完成16个PC提供商，使用“实施研究的合并框架”。 该项目与行为和卫生服务的NIAAA优先事项一致，并推进科学 对于妇女的健康：Trans-NIH战略计划24和VA战略计划25更多地集中资源 有效并改善服务的及时性。长期目标是生产一个“货架上的” 治疗以填补女性退伍军人的基于证据，可访问，以患者为中心的AUD治疗的空白。