Testing a PTSD m-Health Intervention to Improve Alcohol Treatment Outcomes

项目摘要/摘要 创伤后应激障碍(PTSD)通常与酒精使用障碍(AUD)并存，影响30%-60% 在那些寻求澳门氏症治疗的人中，这一点可能对患有澳门氏症的女性尤为突出。患有AUD的患者 合并创伤后应激障碍在治疗后的预后较差，包括更早复发，更多药物使用， 与那些没有创伤后应激障碍的人相比，他们的心理社会功能更差。虽然有一小部分 可能减少创伤后应激障碍症状的循证心理疗法，AUD治疗中的男性和女性 很少收到它们，即使在住宅澳元环境中也是如此。与成本、时间和临床医生专业知识相关的障碍 严重限制了创伤后应激障碍干预在AUD治疗环境中的可用性。因此，有很大的 需要低成本、主要是自我指导的、可扩展的、可在现有时间内提供的创伤后应激障碍治疗 和治疗结构。PTSD Coach是一款前景看好的移动健康(m-Health)应用程序(APP)，它可以 解决患有AUD和共患创伤后应激障碍的男性和女性的治疗差距。最近的初步数据来自 有创伤后应激障碍症状的社区样本，没有与酒精使用有关的纳入标准， 结果显示，被随机分配使用该应用程序的那组人在创伤后应激障碍方面的改善明显更大 与等待名单对照组(科恩的d=0.41)相关的症状，以及另一名飞行员显示，短暂的临床 APP支持/促进(即，4、20分钟的疗程)可能会增强这些治疗效果。尽管它有可能 改善创伤后应激障碍和酒精相关预后，具有短暂临床支持的创伤后应激障碍教练尚未接受测试 作为对AUD治疗环境中合并创伤后应激障碍患者的治疗。因此，这一次的目标是 项目是测试创伤后应激障碍教练应用程序干预包(创伤后应激障碍应用程序+简要支持)在 家庭AUD治疗环境可以改善创伤后应激障碍症状，并有助于维持AUD治疗成果 在康复期间。鉴于先前的研究已经发现男性之间存在AUD、PTSD和治疗方面的差异 这项拟议的研究还将评估男性和女性在治疗效果方面的潜在差异 女人。为了实现这些目标，我们将随机选择150名男性和150名女性(总计n=300)进行AUD和 在家庭成瘾治疗中共发生的创伤后应激障碍教练干预方案或 加强日常护理(EUC)控制。所有参与者将在1：00完成基线评估和后续工作- (治疗后)、随机化后3、6和12个月。实施创伤后应激障碍教练干预 住宅AUD治疗为患者在一段时间内受益于APP提供了理想的机会 相对稳定性。这个项目意义重大，因为它的目标是一种并存的、高需求的AUD治疗 人口，改善获得护理的机会，并利用易于扩展的移动健康干预方法。 将一款前景看好的、公开可用的创伤后应激障碍应用程序整合到AUD治疗中，以解决 AUD患者具有很高的创新性。这项研究的发现可能会对公共健康产生重大影响， 改善AUD合并创伤后应激障碍患者的治疗结果。

Project Summary/Abstract Posttraumatic stress disorder (PTSD) commonly co-occurs with alcohol use disorder (AUD), affecting 30-60% of those seeking AUD treatment, and may be especially salient for women with AUD. AUD patients with comorbid PTSD have poorer outcomes following treatment, including earlier relapse, greater substance use, and poorer psychosocial functioning, compared with those without PTSD. Although there are a small number of evidence-based psychotherapies that may reduce PTSD symptoms, men and women in AUD treatment rarely receive them, even in residential AUD settings. Barriers related to cost, time, and clinician expertise severely limit the availability of PTSD interventions in AUD treatment settings. Consequently, there is great need for low-cost, primarily self-guided, and scalable PTSD treatments that can be delivered within existing AUD treatment structures. PTSD Coach is a promising mobile health (m-Health) application (app) that could address treatment gaps for men and women with AUD and comorbid PTSD. Recent preliminary data from a community sample of individuals with PTSD symptoms, without inclusion criteria related to alcohol use, showed that the group randomly assigned to use the app had significantly greater improvements in PTSD symptoms relative to those in a waitlist control (Cohen’s d=0.41), and a further pilot showed that brief clinical app support/facilitation (i.e., 4, 20-minute sessions) may boost these treatment effects. Despite its potential to improve both PTSD and alcohol-related outcomes, PTSD Coach with brief clinical support has not been tested as a treatment for patients with comorbid PTSD in the AUD treatment setting. Therefore, the objectives of this project are to test whether the use of the PTSD Coach app intervention package (PTSD app + brief support) in the residential AUD treatment setting can improve PTSD symptoms, and help sustain AUD treatment gains during recovery. Given that prior research has found AUD-, PTSD-, and treatment-differences between men and women, the proposed study will also evaluate potential differences in treatment effects between men and women. To accomplish these goals, we will randomize 150 men and 150 women (total n=300) with AUD and co-occurring PTSD in residential addictions treatment to either the PTSD Coach intervention package or the enhanced usual care (EUC) control. All participants will complete a baseline assessment and follow-ups at 1- (post-treatment),3-, 6-, and 12-months post-randomization. Delivering the PTSD Coach intervention during residential AUD treatment provides an ideal opportunity for patients to benefit from the app during a period of relative stability. This project is significant because it targets a comorbid, high-needs AUD treatment population, improves access to care, and utilizes an m-Health intervention approach that is readily scalable. Incorporating a promising, publicly available PTSD app into AUD treatment to address co-morbidity among AUD patients is highly innovative. The findings from this study could have substantial public health impact by improving treatment outcomes for patients with AUD and comorbid PTSD.