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.

项目概要： 女性占美国退伍军人人口的 10%，预计到 2035 年将上升至 35%.1，2 女性退伍军人的 37% 退伍军人报告存在饮酒风险或问题4，许多人患有复杂的合并症，需要专门的治疗 治疗 5 但只有 2% 的女性退伍军人在 VA 药物使用障碍 (SUD) 诊所接受治疗。 目前尚无基于证据的、以退伍军人为中心的、针对女性特定的女性隔离治疗 在 VA 进行 AUD 或 SUD 编程。退伍军人管理局的绝大多数女性仅限于性别—— SUD 专科诊所对 AUD 采取中性治疗，这是一种混合性别的环境，对患者没有吸引力 女性退伍军人 6.只有 19%7 到 30%8 的 VA 提供仅限女性的 SUD 治疗，并且这些治疗是在 专业 SUD 诊所，不包含被证明对疗效至关重要的女性特定内容 9。自从 女性可能会向初级保健 (PC) 提供者寻求 AUD 护理10、11，并且女性退伍军人报告 偏好 PC 托管 AUD 服务12，PC 是减少治疗进入壁垒的有前景的环境， 增加女性退伍军人获得 AUD 护理的机会和疗效。此 R01 重新提交，“A 退伍军人事务部初级保健中针对酒精使用障碍的女性特定认知行为治疗 (CBT) 小组 设置”，针对 PA-19-055 和 NOT-AA-19-010，提出了一项混合型 118 研究，以适应 单性别群体模式 为平民女性开发的女性特定 CBT，价格为 AUD19-22、41 和 在 New York Harbor Healthcare 的 VA PC 中测试新的以退伍军人为中心的女性特定 CBT 小组 (FS-CBT) VA 系统 (NYHHS) 与 PC 中 AUD 的普通护理 (UC) 相比。 FS-CBT 是一个独特的每周 12 节课程 针对 AUD 的团体 CBT 治疗，提供： 1. AUD 干预； 2.一般女性具体内容； 3. 女性退伍军人内容； 4. 健康和自我保健； 5. 新颖的 24/7 禁欲社会支持 讨论移动应用程序。目标 1. RCT (n=162) 测试 FS-CBT+UC 在 PC 中的 AUD 与仅在 PC 中的 UC 的比较 针对女性退伍军人，进行基线评估和 3、9、15 个月评估。 UC 将通过赠款资助提供 PCP 工作人员确保忠诚度。 H.1a.在 PC 站点进行 FS-CBT+UC 进行 AUD 治疗的女性 VA PC 患者会更多 与 UC 女性相比，更有可能获得并参与 AUD 治疗。 H.1b。参加 FS-CBT+UC 的女性将有 与仅患有 UC 的女性相比，饮酒和次要结果更好。 H.1c。 FS-CBT+UC 与 UC 的结果 将通过社会支持、AUD 药物、应对技巧和主观痛苦来调节。目标2。 对 20 名参加 FS-CBT 的女性退伍军人、20 名参加 UC 的女性退伍军人、15 名未参加的女性退伍军人进行 FS-CBT 的形成性评估 16 家 PC 提供商将使用“实施研究综合框架”来完成。 该项目符合 NIAAA 行为和健康服务优先事项以及推进科学 促进妇女健康：跨 NIH 战略计划24 和 VA 战略计划25，以更加集中资源 高效并提高服务的及时性。长期目标是生产“现成的” 旨在填补针对女性退伍军人的循证、可及、以患者为中心的 AUD 治疗方面的空白。