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

项目总结： 女性占美国退伍军人总数的10%，预计到2035.1将增至35%，女性占237% 退伍军人报告说，饮酒有风险或有问题，许多人患有复杂的合并症，需要专门的 治疗5但只有2%的女性退伍军人在退伍军人物质使用障碍(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、针对女性的女性隔离治疗 在退伍军人事务部进行澳元或南元编程。退伍军人管理局的绝大多数女性都只限于性别-- 在Sud专科诊所对AUD进行中性治疗，这是一个混合的性别环境，对 女退伍军人6.只有19%7%到30%8的VAS提供仅限女性使用的SUD治疗，这些治疗在#年提供 专门的SUD诊所，不包含被证明对疗效至关重要的妇女专用内容9。自.以来 10、11和女性退伍军人报告称，女性可能会向初级保健(PC)提供者寻求澳大利亚的医疗服务 对AUD服务的PC代管位置的偏好12，PC是降低治疗进入障碍的有前景的设置， 增加女性退伍军人获得AUD治疗的机会和疗效。此R01重新提交，“A 退伍军人初级保健中酒精使用障碍的女性特定认知行为疗法(CBT)小组 根据PA-19-055，而不是-AA-19-010，提出了一项混合型118研究，以适应 为患有AUD19-22、41和TO的平民女性开发的针对女性的单一性别群体形态 在纽约港医疗保健的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) 系统(NYHHS)VA，与PC中AUD的常规护理(UC)进行比较。FS-CBT是一份独特的12节课周刊 CBT组针对AUD的治疗，提供：1.AUD干预；2.一般女性特有内容； 女性-退伍军人的内容；4.健康和自我照顾；5.一种新的全天候社会支持节欲 讨论移动应用程序。目的1.随机对照试验(n=162)在PC中测试FS-CBT+UC的AUD，与仅在PC中的UC进行比较 对于女性退伍军人，有基线和3个月、9个月、15个月的评估。UC将通过赠款资助的方式交付 PCP工作人员以确保忠诚度。H.1a.在FS-CBT+UC中的VA PC女性患者在PC站点的AUD将更多 与UC中的女性相比，更有可能获得和参与AUD的治疗。H.1b。FS-CBT+UC的女性将拥有 仅在UC中，饮酒和次要结果比女性更好。H.1c.FS-CBT+UC与UC的结果 将通过社会支持、AUD药物、应对技能和主观痛苦来调节。目标2. FS-CBT的形成性评估：FS-CBT组20名女性退伍军人，UC组20名，未注册的15名女性退伍军人 将利用“实施研究综合框架”，对16家个人电脑供应商进行培训。 该项目与NIAAA在行为和健康服务以及先进科学方面的优先事项一致 妇女健康：跨国立卫生研究院战略计划24和退伍军人管理局战略计划25，以更多地集中资源 提高服务的效率和及时性。其长期目标是生产出一种“现成的” 治疗以填补以证据为基础的、可获得的、以患者为中心的女性退伍军人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.