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

项目总结/摘要 创伤后应激障碍（PTSD）通常与酒精使用障碍（AUD）同时发生，影响30-60% 对于寻求AUD治疗的人来说，这一点可能对AUD女性尤为突出。AUD患者， 共病的PTSD在治疗后的结果较差，包括早期复发，更多的物质使用， 与没有PTSD的人相比，心理社会功能更差。虽然有少数 基于证据的心理疗法，可以减少创伤后应激障碍症状，男性和女性在AUD治疗 很少收到他们，即使在住宅澳元设置。与成本、时间和临床医生专业知识相关的障碍 严重限制了AUD治疗环境中PTSD干预的可用性。因此， 需要低成本，主要是自我指导，可扩展的PTSD治疗，可以在现有的 AUD治疗结构。PTSD教练是一个有前途的移动的健康（m-Health）应用程序（app），可以 解决患有AUD和共病PTSD的男性和女性的治疗差距。最近的初步数据来自a 有PTSD症状的个人的社区样本，没有与酒精使用相关的纳入标准， 结果显示，随机分配使用该应用程序的一组人在创伤后应激障碍方面的改善明显更大， 症状相对于候补名单对照组（Cohen的d=0.41），进一步的试点表明，短暂的临床症状 应用程序支持/便利（即，4，20分钟的会议）可能会提高这些治疗效果。尽管它有潜力 改善PTSD和酒精相关的结果，PTSD教练与简短的临床支持尚未得到测试 作为AUD治疗环境中合并PTSD患者的治疗。因此，这一目标 项目是测试是否使用PTSD教练应用程序干预包（PTSD应用程序+简短的支持）， 住宅AUD治疗环境可以改善PTSD症状，并有助于维持AUD治疗收益 在恢复过程中。鉴于先前的研究已经发现，男性之间的AUD，PTSD和治疗差异 这项研究还将评估男性和女性之间治疗效果的潜在差异， 妇女为了实现这些目标，我们将随机分配150名男性和150名女性（共n=300）， 同时发生的创伤后应激障碍的住宅成瘾治疗，无论是创伤后应激障碍教练干预包或 加强日常护理（EUC）控制。所有参与者将在1- 10点完成基线评估和随访。 （治疗后）、随机化后3个月、6个月和12个月。在创伤后应激障碍治疗期间提供创伤后应激障碍教练干预 住院AUD治疗为患者提供了一个理想的机会，使他们在一段时间内从应用程序中受益， 相对稳定性该项目意义重大，因为它针对的是合并症、高需求的AUD治疗 人口，改善获得护理的机会，并利用移动健康干预方法，是容易扩展。 将一个有前途的、公开可用的PTSD应用程序应用于AUD治疗，以解决 AUD患者具有高度创新性。这项研究的结果可能会对公共卫生产生重大影响， 改善AUD和共病PTSD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.