A Stage II Efficacy Study of CBT for PTSD in Community Addiction Treatment

描述（由申请人提供）：本申请是对NIDA PA-07-111行为与综合治疗发展计划（RO1）最初提出的研究的重新提交，目前提交给NIH-RO1-FOA。同时发生的药物使用和精神障碍在一般人群中很常见，在临床环境中更为普遍，并与负面治疗和生活结果有关。创伤后应激障碍（PTSD）是最普遍的共发性疾病之一，困扰着临床医生，也是消耗、药物和酒精复发以及精神症状恶化的危险因素。已经开发和测试了几种针对共同发生的PTSD的行为疗法，但这些治疗方法与比较条件相比没有发现有效，保留率中等到较低，并且没有整合到现有的成瘾治疗服务中或由典型的社区成瘾咨询师提供。目前的建议建立在一系列由首席研究员完成的第一阶段研究的基础上，在成瘾治疗项目中实施认知行为疗法（CBT）治疗创伤后应激障碍。到目前为止，第一阶段研究的累积结果表明，CBT治疗PTSD对PTSD症状、药物使用和良好的保留率（65- 70%）有很好的效果。本研究提出了一项II期疗效研究，从7个典型的社区成瘾治疗项目中招募了228名参与者，并随机分为：a) PTSD的CBT治疗+常规治疗；b)个人成瘾咨询(IAC) +常规治疗；还是c)照旧治疗。社区成瘾咨询师将提供所有治疗。基线、3个月和6个月评估的主要结局是：PTSD症状严重程度、药物使用严重程度和滞留。拟议的研究有可能通过推进一种行为疗法产生重大影响，这种疗法可以减少药物和酒精的使用，关注共病精神疾病，并考虑先验地转化为常规社区环境和提供者。这个第二阶段的研究利用了研究小组的经验，在第一阶段的研究活动中发现了一个有希望的治疗方法。此外，研究团队与典型的社区成瘾治疗项目（由常规成瘾咨询师和患者组成）有着富有成效的研究关系。在这些环境中的研究应有助于提高外部有效性，并促进将基于研究的有效治疗方法转化为社区。

DESCRIPTION (provided by applicant): This application is a resubmission of research originally proposed in response to NIDA PA-07-111 Behavioral & Integrative Treatment Development Program (RO1), and presently to the NIH-RO1-FOA. Co-occurring substance use and psychiatric disorders are common in the general population, even more prevalent in clinical settings, and associated with negative treatment and life outcomes. Posttraumatic stress disorder (PTSD) is among the most widespread of co-occurring disorders, vexing to clinicians, and a risk factor for attrition, relapse to drugs and alcohol, and deterioration in psychiatric symptoms. There have been several behavioral therapies for co-occurring PTSD developed and tested, but these treatments have not been found effective versus comparison conditions, have moderate to poor retention rates, and have not been integrated within existing addiction treatment services or delivered by typical community addiction counselors. The present proposal builds upon a series of completed Stage I studies by the principal investigator, implementing a cognitive behavioral therapy (CBT) for PTSD in addiction treatment programs. The cumulative findings of the Stage I studies thus far demonstrate the CBT for PTSD to have promising effects on PTSD symptoms, substance use, and good retention rates (65-70 percent). This present research proposes a Stage II efficacy study of 228 participants recruited across seven typical community addiction treatment programs, and randomized to: a) CBT for PTSD + treatment-as-usual; b) Individual Addiction Counseling (IAC) + treatment-as-usual; or c) Treatment-as-usual alone. Community addiction counselors will deliver all treatments. Primary outcomes assessed at baseline, 3- and 6-months are: PTSD symptom severity, substance use severity and retention. The proposed research has the potential for significant impact by advancing a behavioral therapy that can reduce drug and alcohol use, attend to comorbid psychiatric conditions, and consider, a priori, translation to routine community settings and providers. This Stage II research capitalizes on the experience of the research team with a promising treatment, as found in the Stage I research activities. In addition, the research team has a track record of productive research relationships with typical community addiction treatment programs composed of routine addiction counselors and patients. Research within these settings should serve to enhance external validity and facilitate the translation of effective research-based treatments into the community. PUBLIC HEALTH RELEVANCE: Drug abuse is a major public health concern both in direct disease burden and societal sequelae. Effective treatments for addiction exist, but are not accessible to most individuals and families. The overarching goal of the present research is to improve addiction treatment for patients with posttraumatic stress disorder, as persons with this comorbidity are significantly less likely to access and benefit from standard care.