Integrated CBT for Co-Occurring PTSD and Substance Use Disorders

描述(由申请人提供)：流行率数据表明，从伊拉克自由行动(OIF)和持久自由行动(OEF)返回的军人患创伤后应激障碍和药物使用障碍的比例很高。随着这些数字预计将上升，这些疾病的共同出现给退伍军人事务部治疗提供系统带来了额外的挑战，目前需要有效的综合治疗。该RO1提案是对NIDA RFA DA-10-001《美国军事人员、退伍军人及其家人中的物质使用和滥用》的直接回应。这项应用的首要目标是评估一种综合认知行为疗法(I-CBT)，用于治疗OEF/OIF退伍军人中同时发生的PTSD和物质使用障碍。I-CBT在患有这种共病的男性和女性的社区样本中被发现是有效的，但需要进行测试才能将其应用于退伍军人事务部(VA)患者样本和环境。为了加强对VA临床环境的潜在转化，干预措施已被调整为以个人和集体治疗相结合的形式提供。在行为疗法发展的NIDA阶段模式的框架内，我们建议在这一阶段的研究中执行三个具体目标：1)评估I-CBT的可行性，从VA创伤后应激障碍和药物滥用治疗计划(SATP)诊所招募16名合并PTSD和药物使用障碍的患者；并在基线、3个月和6个月的随访(阶段I)评估创伤后应激障碍和物质使用严重程度；2)根据可行性研究结果和定性研究(阶段II)对I-CBT进行修改和改进；3)进行一项随机对照试验(n=)，比较I-CBT+标准护理(n=32)和单纯标准护理(n=32)在基线、3个月和6个月随访(III期)时的创伤后应激障碍和药物使用严重程度。虽然已经开发和测试了另外两种针对创伤后应激障碍和药物使用的行为疗法，但与比较条件相比，这些疗法尚未被发现有效，保留率中等到很低，仅在女性平民中进行过研究，并未纳入现有的治疗服务。本建议建立在PI成功完成的一系列研究的基础上，这些研究针对社区诊所中共发生的创伤后应激障碍和物质使用障碍实施认知行为疗法(CBT)。研究团队具有独特的经验和良好的地位，可以执行建议的研究。它由来自达特茅斯大学、国家退伍军人事务部创伤后应激障碍中心、布朗大学和普罗维登斯退伍军人医学中心的研究人员组成。这项研究的发现有可能产生直接和广泛的影响，为患有药物使用和创伤后应激障碍的OEF/OIF退伍军人提供有效和容易翻译的行为治疗选择。 公共卫生相关性：在伊拉克自由行动(OIF)和持久自由行动(OEF)退伍军人中，共同发生的药物使用和创伤后应激障碍是常见的，并与负面结果相关。本研究的具体目的是评估一种综合认知行为团体疗法(I-CBT)，用于治疗共发生的创伤后应激障碍和物质使用障碍。首要目标是在退伍军人事务部(VA)的临床环境中测试I-CBT，并最终影响患有这种共同发病率的OEF/OIF退伍军人的预后。

DESCRIPTION (provided by applicant): Prevalence data indicate that military service men and women returning from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) suffer high rates of PTSD and substance use disorders. With these numbers expected to rise, the co-occurrence of these disorders presents added challenges to the Veterans Affairs treatment delivery system, presently in need of effective integrated treatments. This RO1 proposal is a direct response to NIDA RFA DA-10-001 "Substance use and abuse among U.S. military personnel, Veterans and their families." The overarching goal of the this application is to evaluate an integrated cognitive behavioral therapy (I-CBT) for co-occurring PTSD and substance use disorders among OEF/OIF Veterans. I-CBT has been found efficacious in community samples of men and women with this comorbidity, but needs testing for its application to Veterans Affairs (VA) patient samples and settings. To enhance potential translation to VA clinical settings, the intervention has been adapted for delivery in combined individual and group therapy formats. Within the framework of the NIDA stage model of behavioral therapy development, we propose to execute three specific aims within this Stage I research: 1) To evaluate the feasibility of I-CBT with a sample of 16 patients with co-occurring PTSD and substance use disorders, recruited from VA PTSD and substance abuse treatment program (SATP) clinics; and assessed on PTSD and substance use severity at baseline, 3- and 6-month follow-up (Phase I); 2) To make modifications and improvements to the I-CBT based on feasibility study outcomes and qualitative study (Phase II); and 3) To conduct a randomized controlled pilot trial (n=64) comparing I-CBT plus standard care (n=32) versus standard care only (n=32) on measures of PTSD and substance use severity at baseline, 3-month and 6-month follow-up (Phase III). Although there have been two other behavioral therapies for co-occurring PTSD and substance use developed and tested, these treatments have not been found effective versus comparison conditions, have moderate to poor retention rates, have been studied with female civilians only, and have not been integrated within existing treatment services. The present proposal builds upon a series of successfully completed studies by the PI, implementing a cognitive behavioral therapy (CBT) for co-occurring PTSD and substance use disorders in community clinics. The research team is uniquely experienced and well-positioned to execute the research as proposed. It consists of investigators from Dartmouth, the National VA Center for PTSD, Brown University, and the Providence VA Medical Center. The findings from this research have the potential for immediate and broad impact by providing an effective and readily translated behavioral therapy option for OEF/OIF Veterans with co- occurring substance use and posttraumatic stress disorders. PUBLIC HEALTH RELEVANCE: Among Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) Veterans, co-occurring substance use and posttraumatic stress disorders are common and associated with negative outcomes. The specific aims of the present research are to evaluate an integrated cognitive behavioral group therapy (I-CBT) for co-occurring PTSD and substance use disorders. The overarching goal is to test I-CBT in Veterans Affairs (VA) clinical settings, with the eventual impact of improving outcomes for OEF/OIF Veterans with this co-morbidity.