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

项目摘要： 女性占美国退伍军人人口的10%，预计到2035年将上升到35%。 退伍军人报告危险或问题酒精使用4，许多人有复杂的并发症，需要专门的 治疗5，但只有2%的女性退伍军人在VA物质使用障碍（SUD）诊所接受治疗。 目前还没有基于证据的，以退伍军人为中心的，女性隔离治疗与女性特异性 在VA为AUD或SUD编程。退伍军人管理局的绝大多数女性仅限于性别- 专科SUD诊所中的AUD中性治疗，这是一种混合性别环境，对 女退伍军人6.只有19%7至30%8的VA提供仅限女性的SUD治疗，这些治疗在 专业SUD诊所，不包含女性特定的内容，显示出对疗效至关重要9。以来 女性可能会向其初级保健（PC）提供者寻求AUD护理10，11，女性退伍军人报告 优先选择个人电脑托管AUD服务12，个人电脑是一种有前途的设置，以减少治疗进入壁垒， 在退伍军人中增加获得治疗的机会，提高AUD的疗效。此次R 01重新提交，“A VA初级保健中酒精使用障碍的女性特定认知行为治疗（CBT）组 根据PA-19-055和NOT-AA-19-010，建议进行118型混合动力研究， 为AUD 19 -22，41的平民女性开发的单一性别组模式女性特定CBT， 在纽约港医疗中心的VA PC中测试新的以退伍军人为中心的女性特定CBT组（FS-CBT） 系统（NYHHS）VA，与患者护理（UC）相比，PC中AUD。FS-CBT是一个独特的12节每周 CBT组治疗AUD，提供：1.澳元干预; 2.一般女性的具体内容; 3. 女性-退伍军人内容; 4.健康和自我护理; 5。一个新颖的24/7禁欲社会支持 讨论移动的应用。目标1. RCT（n=162）测试FS-CBT+UC治疗PC中AUD与PC中仅UC相比 为女性退伍军人，基线和3，9，15个月的评估。UC将由赠款资助的 PCP工作人员确保忠诚度。H.1a.在PC研究中心接受FS-CBT+UC治疗AUD的女性VA PC患者将更多 更有可能获得和参与AUD治疗。H.1b.参加FS-CBT+UC的妇女将有 更好的饮酒和次要结果比女性在UC。H.1c. FS-CBT+UC与UC的结局 社会支持、AUD药物、应对技能和主观痛苦将起到中介作用。目标二。 FS-CBT的形成性评价，20名女性退伍军人参加FS-CBT，20名UC，15名未参加， 16个PC供应商，使用“实施研究的综合框架”将完成。 该项目符合NIAAA行为和健康服务的优先事项， 妇女健康：跨NIH战略计划24和VA战略计划25，以更加集中资源 提高服务效率和及时性。长期目标是生产一种“现成的” 治疗以填补女性退伍军人循证，可获得，以患者为中心的AUD治疗的空白。

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.