Integrated CBT for Co-Occurring PTSD and Substance Use Disorders

描述（由申请人提供）：流行数据表明，从伊拉克自由行动（OIF）和持久自由行动（OEF）返回的军人男女患创伤后应激障碍和物质使用障碍的比例很高。随着这些数字预计会上升，这些疾病的同时发生给退伍军人事务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。这份RO1提案是对NIDA RFA DA-10-001《美国军人、退伍军人及其家属的药物使用和滥用》的直接回应。本应用程序的总体目标是评估综合认知行为疗法（I-CBT）在OEF/OIF退伍军人中共同发生的PTSD和物质使用障碍。I-CBT已被发现在患有这种共病的男性和女性的社区样本中有效，但它在退伍军人事务部（VA）患者样本和环境中的应用还需要测试。为了加强对VA临床环境的潜在转化，该干预措施已被调整为以个人和团体联合治疗形式提供。在NIDA行为治疗发展阶段模型的框架内，我们建议在第一阶段研究中实现三个具体目标：1)从VA PTSD和药物滥用治疗项目（SATP）诊所招募16名PTSD和物质使用障碍共存的患者，评估I- cbt的可行性；并在基线、3个月和6个月随访时评估PTSD和物质使用严重程度（I期）；2)根据可行性研究结果和定性研究对I-CBT进行修改和改进（第二期）；3)进行一项随机对照先导试验（n=64），比较I-CBT加标准治疗（n=32）与仅标准治疗（n=32）在基线、3个月和6个月随访（III期）时PTSD和物质使用严重程度的测量。虽然已经开发和测试了另外两种治疗同时发生的PTSD和物质使用的行为疗法，但这些疗法与比较条件相比没有发现有效，保留率中等至较低，仅在女性平民中进行了研究，并且没有纳入现有的治疗服务。目前的建议建立在PI成功完成的一系列研究的基础上，在社区诊所实施认知行为疗法（CBT）来治疗共同发生的创伤后应激障碍和物质使用障碍。研究团队具有独特的经验和良好的定位来执行所提出的研究。它由来自达特茅斯、国家退伍军人创伤后应激障碍中心、布朗大学和普罗维登斯退伍军人医疗中心的调查人员组成。这项研究的发现通过为同时发生物质使用和创伤后应激障碍的OEF/OIF退伍军人提供有效且易于翻译的行为治疗选择，具有直接和广泛的影响。

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.