GROUP COGNITIVE BEHAVIOR THERAPY--DUAL DIAGNOSIS WOMEN

这项拟议的研究是因为需要开发有效的治疗方法 合并创伤后应激障碍(PTSD)和药物使用的女性 精神障碍(SUD)。据估计，患有创伤后应激障碍的女性占29%至39% SUD治疗样本，记录显示其病程比 独自患有萎缩症的女性。到目前为止，还没有有效的治疗方法。 已经确定了相当数量的人口。为了解决这个问题， 申请者开发了一份治疗手册，解释了一种新的、认知的 行为团体疗法特别适合他们的临床需求，如 NIDA行为疗法第一阶段治疗项目的一部分 发展计划。这一24节课程的高度结构化计划提供了 认知行为和人际应对的密集排练 技能，使用在教育中经过经验验证的技术 使治疗变得容易获得并为此吸引人的文献 人口。它对成本敏感(即，分组格式)，已修订 根据其影响的实际经验和实证结果，以及 针对被认为对这类妇女最重要的主题(例如，艾滋病毒风险)。它的 首要目标是戒除所有物质。初步经验结果 它的影响，基于17名患者，显示出统计上的显著和 在几个领域有临床意义的改进：(A)物质使用方面 最早治疗一个月，并持续3个月的随访- (B)创伤后应激障碍症状；(C)在理论上最相关的领域 对治疗、认知。上座率很高(67%的有空人员 会议)，联盟和对治疗的满意度评级为 非常结实。 这项拟议的研究旨在将这种有前景的治疗方法带到下一步 阶段1评价的逻辑水平，即对照“照常对待” 对照组。要最大限度地发挥此类控制组的作用， 测试CB治疗的效果，所有患者将被限制在 他们在参加治疗期间可能参加的治疗数量和类型 这项研究。目标样本为治疗中和治疗中的患者各25人 控制条件。这项研究将会：(A)估计 治疗与对照相比，使用减少物质使用作为 主要结果衡量标准；(B)使用预期的“消费者”测试手册 IT(独立于调查人员的四名治疗师)；(C)评价 患者每月通过9个月的治疗后随访期 评估收益的维持情况；以及(D)心理测量学验证两个新的 理论上源自这种治疗的器械(治疗师 依从性量表和患者“治疗的核心组成部分”量表 试图衡量治疗的假说作用机制)。

The proposed study arises from the need to develop effective treatment for women with comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD). Women with PTSD are estimated to comprise 29% to 39% of SUD treatment samples, and are documented to show a more severe course than women with wither disorder alone. As yet, no effective treatment for this substantial population has been identified. To attend to this problem, the applicant has developed a treatment manual explicating a new, cognitive behavioral group therapy specifically adapted to their clinical needs as part of a Stage 1 treatment project of the NIDA Behavioral Therapies Development Program. This 24-session, highly structured program offers an intensive rehearsal of cognitive behavioral, and interpersonal coping skills, using techniques empirically validated in the educational literature to make the treatment accessible and engaging for this population. It is cost-sensitive (i.e., a group format), has been revised on the basis of actual experience and empirical results of its impact, and targets topics believed most central for such women (e.g., HIV risk). Its primary goal is abstinence from all substances. Initial empirical results of its impact, based on 17 patients, show statistically significant and clinically meaningful improvements in several areas: (a) in substance use as early as one month into treatment and lasting through a 3-month follow- up, (b) in PTSD symptoms; and (c) in the domain most theoretically relevant to the treatment, cognitions. Attendance was high (67% of available sessions), and ratings of alliance and satisfaction with the treatment were very strong. The proposed study is designed to take this promising treatment to the next logical level of Stage 1 evaluation that is, against a "treatment-as-usual" control group. To maximize the usefulness of such as control group in testing the effects of the CB treatment, all patients will be restricted in the amount and types of treatments they may attend while participating in this study. The target sample is 25 patients each in the treatment and control conditions. The study will: (a) estimate the effect size of the treatment compared to the control, using reduction in substance use as the primary outcome measure; (b) test the manual using expected "consumers of it (four therapists independent of the investigators); (c) evaluate patients monthly through a 9-month post-treatment follow-up period to assess maintenance of gains; and (d) psychometrically validate two new instruments that are theoretically derived from this treatment (a therapist adherence scale, and a patient "core components of treatment" scale that attempts to measure hypothesize mechanisms of action of the treatment).