Evaluating the Impact of Supplementing Residential Substance Use Treatment with Written Exposure Therapy for Veterans with Co-Occurring PTSD and Substance Use Disorders

评估用书面暴露疗法补充住宅药物使用治疗对同时患有 PTSD 和药物使用障碍的退伍军人的影响

• 批准号: 10588809
• 负责人: Dana Holohan
• 金额: --
• 依托单位: SALEM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-12-01 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10588809
• 关键词: Address; Aftercare; Age; Attention; Back; Behavior Therapy; Behavioral; Behavioral Model; Caring; Clinic; Clinical; Communities; Control Groups; DSM-V; Data; Diagnosis; Dropout; Effectiveness; Enrollment; Ensure; Equity; Ethnic Origin; Evidence based treatment; Family; Feedback; Financial cost; Focus Groups; Future; Gender; Goals; Grant; Health; Health Services Accessibility; Homelessness; Individual; Intervention; Interview; Investigation; Knowledge; Length; Measures; Medical Care Costs; Mental Depression; Minority; Modeling; Monitor; Morbidity - disease rate; Outcome; Participant; Patient Representative; Patient Selection; Patients; Persons; Pilot Projects; Population; Post-Traumatic Stress Disorders; Provider; Quality of life; Randomized; Relapse; Research; Risk; Rural; Safety; Sampling; Severities; Shapes; Site; Social Workers; Substance Use Disorder; Suicide; Suicide attempt; Surveys; Symptoms; Telephone; Trauma; Treatment outcome; United States National Institutes of Health; Veterans; Woman; World Health Organization Disability Assessment Schedule; Writing; acceptability and feasibility; alcohol use disorder; behavioral outcome; brief intervention; clinical practice; community engagement; comorbidity; cost; craving; depressive symptoms; design; disability; effective therapy; effectiveness study; effectiveness testing; efficacy evaluation; experience; follow-up; functional outcomes; health care delivery; high risk; implementation barriers; improved; insight; patient population; primary outcome; programs; recruit; reduce symptoms; response; satisfaction; screening; standard care; study population; substance use; substance use treatment; success; suicidal; suicide rate; symptomatic improvement; treatment arm; treatment as usual; treatment effect; treatment program; trend; uptake

Posttraumatic Stress Disorder (PTSD) and Substance Use Disorder (SUD) are highly comorbid, and comorbidity increases risk for poor functional outcomes. SUDs are associated with poor functional outcomes such as quality of life, community engagement, and suicide (Teeters, Lancaster, Brown & Back, 2017). Risks for poor quality of life and suicide increase further for those with co-occurring PTSD and SUD diagnoses as compared to either condition alone, with suicide attempt rates three times higher for Veterans with alcohol use disorder and PTSD (Norman, Haller, Hamblen, Southwick & Pietrzak, 2018). For patients with PTSD-SUD, there is evidence of greater PTSD symptom severity and poorer SUD treatment outcomes (e.g., Back et al., 2000), as well as higher rates of homelessness and disability (Bowe & Rosenheck, 2015). PTSD-SUD treatments have shown promising reductions in PTSD and SUD symptoms (Flanagan, Korte, Killeen & Back, 2016). Yet, there are still major challenges in widely implementing concurrent or single-target gold-standard treatments for this population, especially with rural veterans where care access may be limited (e.g., Flanagan et al., 2016). Written Exposure Therapy (WET) is a front-line, brief and effective treatment for PTSD that addresses some of the challenges posed by other gold-standard treatments. This project is designed to examine the feasibility and acceptability of Written Exposure Therapy (WET) delivered to Veterans with comorbid PTSD-SUD while they are completing a 28 day-residential SUD program (DOM SUD). The preliminary effects of the treatment during the program, and at one month and 3 month follow-up periods will also be examined, with particular attention to rates of substance use, homelessness, treatment attendance, treatment completion, quality of life, suicidality, and PTSD and depression symptoms. Veterans enrolled in the DOM SUD with PTSD Checklist-5 (PCL-5) scores over 33 will be recruited for further screening into the study. Those that meet criteria for PTSD through confirmation using the Clinician Administered PTSD Scale for DSM- 5 (CAPS-5) will be randomized into one of two treatment arms: Treatment as Usual (DOM SUD) and Written Exposure Therapy in a residential SUD program (resWET). Randomization will be stratified by gender and oversampling for women and minority participants will be used. Those in the TAU control group will participate in the DOM SUD treatment program, while those in the resWET group will also have five individual treatment sessions of WET. Participants will complete weekly measures of symptoms, in addition to rating cravings for substance use. Treatment completion rates will also be compiled for both DOM SUD and resWET. Participants will complete pre-treatment, post-treatment, 1 month, and 3 month follow-up measures in person, over video, or by phone, and these measures, along with data available from the treatment record, will be examined using descriptive analyses to look for important trends regarding both symptom responses (e.g., PTSD, depression) to treatment, as well as behavioral and functional outcomes (such as suicide attempts, homelessness, treatment attendance, treatment completion, substance use, disability). This preliminary data will be used to inform future studies using this treatment approach. Additionally, providers in the DOM SUD will complete treatment feasibility and acceptability measures and focus groups to provide essential information about implementation barriers that need to be addressed for the uptake of the treatment approach and to enhance the accessibility of the treatment. All Veterans will also provide feedback about their treatment, through survey when the treatment is complete, and focus group participation. Findings from both qualitative and quantitative data will be used to improve the treatment and assessment approach and to determine effect sizes of key measures (WHO-DAS, PCL, PHQ-9) to prepare for a fully powered RCT to systematically evaluate resWET.

创伤后应激障碍(PTSD)和物质使用障碍(SUD)高度并存， 合并症增加了不良功能结局的风险。肥胖症与不良的功能结局有关。 例如生活质量、社区参与和自杀(Teeters，Lancaster，Brown&Back，2017)。风险 对于生活质量差和自杀的人来说，同时患有创伤后应激障碍和SUD诊断为 与任何一种情况相比，饮酒的退伍军人自杀未遂率高出三倍 精神障碍和创伤后应激障碍(Norman，Haller，Hamblen，Southwick&Pietrzak，2018)。对于患有创伤后应激障碍的患者， 有证据表明创伤后应激障碍症状更严重而SUD治疗结果更差(例如，Back等人， 以及更高的无家可归率和残障率(Bowe&Roseneck，2015)。创伤后应激障碍-SUD 治疗显示PTSD和SUD症状有希望减少(Flanagan，Korte，Killeen&Back， 2016)。然而，在广泛实施同时或单一目标黄金标准方面仍存在重大挑战 对这一群体的治疗，特别是农村退伍军人，那里的护理机会可能有限(例如弗拉纳根 等人，2016)。书面暴露疗法(WEW)是一种针对创伤后应激障碍的一线、简短和有效的治疗方法 解决了其他黄金标准治疗带来的一些挑战。该项目旨在 检查向退伍军人提供书面暴露疗法(WEW)的可行性和可接受性 当他们正在完成为期28天的住院SUD计划(DOM SUD)时，他们同时患有创伤后应激障碍-SUD。这个 治疗期间的初步效果，并在1个月和3个月的随访期将 也要进行检查，特别注意药物使用率、无家可归者、治疗就诊率、 治疗完成率、生活质量、自杀倾向、创伤后应激障碍和抑郁症状。退伍军人参加了 创伤后应激障碍检查表-5(PCL-5)得分超过33分的DOM SUD将被招募用于进一步筛查这项研究。 那些符合创伤后应激障碍标准的人，通过使用DSM的临床医生管理的创伤后应激障碍量表进行确认- 5(CAPS-5)将被随机分成两个治疗组之一：照常治疗(DOM SUD)和书面治疗 住宅区SUD项目中的暴露疗法(ResWET)。随机化将按性别和 将对妇女和少数族裔参与者进行过度抽样。TAU控制组的人员将参加 在DOMSUD治疗方案中，resWET组也将有5个单独治疗 湿润的会议。参与者将完成每周一次的症状测量，除了对 物质使用。还将编制DOM SUD和resWET的治疗完成率。参与者 将亲自完成治疗前、治疗后、1个月和3个月的随访措施，通过视频， 或通过电话，这些措施以及治疗记录中的数据将使用以下方法进行检查 描述性分析，寻找有关两种症状反应的重要趋势(例如，创伤后应激障碍、抑郁) 治疗以及行为和功能结果(如自杀未遂、无家可归、 治疗出勤率、治疗完成率、药物使用、残疾)。这一初步数据将用于 使用这种治疗方法通知未来的研究。此外，DOM SUD中的提供程序将完成 治疗可行性和可接受性措施和重点小组提供有关的基本信息 需要克服的实施障碍，以便采用治疗方法，并加强 治疗的可及性。所有退伍军人也将通过调查提供关于他们治疗的反馈 治疗结束后，由焦点小组参与。定性和定量的研究结果 数据将用于改进治疗和评估方法，并确定关键因素的效果大小 采取措施(WHO-DAS、PCL、PHQ-9)，为全面开展随机对照试验做准备，以便对ResWET进行系统评估。