PTSD and Addiction Disorder Screening and Treatment for Incarcerated Men

描述（由申请人提供）：州监狱中至少有五分之一的男子有精神健康问题，一半以上的人在成长期和成年后经历过身体、性或情感虐待（称为“人际创伤”），大多数人有酗酒或吸毒问题。人际创伤与健康、行为健康问题和犯罪密切相关。很少有男性囚犯在监禁期间接受与人际创伤有关的行为健康障碍的治疗，尽管这些问题是释放后重返监狱的危险因素。虽然卫生局局长的报告和总统的新自由委员会的报告强调了创伤信息服务和护理系统的重要性，但在被监禁的男性中，与创伤相关的行为健康问题却很少受到关注。该应用程序解决了在成年男性矫正设置中筛查和治疗创伤后应激障碍（PTSD）和物质使用障碍（SUD）的问题。这项拟议中的研究将在新泽西州一所中等安全级别的成人监狱进行，该监狱关押着约1900名年龄在18至25岁之间的男性囚犯。我们提出了一项两阶段的研究：(1)测试PTSD和SUD计算机筛查与临床筛查的可靠性（测试-再测试）(目的：(2)进行一项随机对照试验（RCT），其中240名男性囚犯被分配到两种基于证据的、手动的第一阶段创伤干预措施（寻求安全（SS）和针对有物质使用问题的男性的创伤恢复和赋权模型（M-TREM））（目标：确定有效的干预措施）。RCT将以两种方式增强：(1)拒绝参与治疗的受试者将观看一段10分钟的创伤后应激障碍和SUD教育视频，并在观看视频后再次被邀请参加RCT；(2)随机分配，三分之二的参与者（n=160）将被随机分配到治疗组，另外三分之一（n=80）将根据他们对一种干预措施的偏好选择治疗。我们将测试筛查和治疗干预措施的总体有效性，以及教育强化和偏好对结果的边际影响。

DESCRIPTION (provided by applicant): At least one-fifth of men inside state prisons have mental health problems, over half have experienced physical, sexual, or emotional abuse (referred to as "interpersonal trauma") during their formative years and often in adulthood, and the majority has alcohol or drug use problems. Interpersonal trauma is highly correlated with health and behavioral health problems and criminality. Few male inmates receive treatment for behavioral health disorders related to interpersonal trauma while incarcerated even though these problems are risk factors for returning to prison after release. While the Surgeon General's Report and the President's New Freedom Commission Report highlighted the importance of trauma-informed services and systems of care, trauma- related behavioral health problems among incarcerated men have received little attention. This application addresses both screening for and treatment of Post-Traumatic Stress Disorder (PTSD) and substance use disorders (SUD) within an adult male correctional setting. The proposed study will be conducted at an adult medium security prison in New Jersey that houses ~1900 male inmates primarily aged 18 to 25. We propose a two-phase study that: (1) tests the reliability (test-retest) of computer-administered screening for PTSD and SUD compared to clinician-administered screening (goal: to develop a cost-effective population- based screening procedure for PTSD and SUD within incarcerated settings) and (2) conduct a randomized controlled trial (RCT) in which 240 male inmates are assigned to two evidence-based, manualized first stage trauma interventions (Seeking Safety (SS) and Trauma Recovery and Empowerment Model version for men with substance use problems (M-TREM) (goal: to identify effective interventions for PTSD and SUD among incarcerated men). The RCT will be enhanced in two ways: (1) those who decline treatment participation will be shown a 10-minute educational video on PTSD and SUD and after viewing the video invited a second time to participate in the RCT and (2) determined by random assignment, two-thirds of participating subjects (n=160) will be randomly assigned to treatment and the other one-third (n=80) will choose treatment based on their preference for one intervention over the other. We will be testing overall effectiveness of screening and treatment interventions and the marginal impact of educational-enhancement and preferences on outcomes. PUBLIC HEALTH RELEVANCE: This study has the potential to identify cost-effective methods for screening PTSD and SUD among incarcerated men and effective interventions for treating these conjoint behavioral health problems. The importance of focusing on PTSD screening and trauma-informed treatment was highlighted in the Surgeon General's Report, the President's New Freedom Commission on Mental Health and a variety of reports by The Institute of Medicine. This application is responsive to the current NIMH Strategic Plan, specifically Objectives #3 (Develop New and Better Interventions that Incorporate the Diverse Needs and Circumstances of People with Mental Illnesses) and #4 (Strengthen the Public Health Impact of NIMH-Supported Research).