NALTREXONE AND CBT FOR PATIENTS WITH ALCOHOLISM AND PTSD

申请人摘要：这项拟议的调查扩展了先前的研究 埃德娜·福阿和约瑟夫·沃尔皮切利在药理学评价中的努力 以及对酒精依赖(AD)和酒精依赖后的认知行为治疗 创伤应激障碍(PTSD)，并利用他们的综合专业知识 在评估为慢性阻塞性肺疾病患者开发的综合治疗计划时 AD和创伤后应激障碍并存。 阿尔茨海默病和创伤后应激障碍的共病是一个重大的公共心理健康问题 因为有创伤的人患阿尔茨海默病的风险大大增加 病史或创伤后应激障碍，反之亦然。这两种疾病被认为形成了一种 创伤后应激障碍导致酗酒的恶性循环；酗酒阻碍 从创伤经历中恢复，从而有助于维持 创伤后应激障碍；而创伤后应激障碍反过来又进一步加剧和巩固酒精滥用。 尽管已经确定了治疗AD和PTSD的有希望的治疗方法， 同时解决这两种疾病的综合计划并没有 经过了经验的检验。具体来说，阿片类拮抗剂纳曲酮 已被公认为治疗阿尔茨海默病的有效方法，但研究尚未 具体阐述了它在创伤后应激障碍专利中的有效性，他们特别是 容易出现治疗磨损和不依从的情况。同样，认知- 通过长时间暴露(PE)对创伤后应激障碍的行为治疗是最有效的 心理社会治疗创伤后应激障碍；然而，它对滥用药物的患者有效 酒精是未知的，因为AD通常是此类疾病的排除标准 研究。在拟议的研究中，我们将评估联合 这些经验性验证的治疗方法适用于一组表现为 AD和创伤后应激障碍并存。 这项拟议的研究比较了两组患者的四个月、六个月的治疗条件。 (纳曲酮与安慰剂)×2(PE与非PE)研究设计。四个 条件为：1)100 mg。纳曲酮配伍PE；2)单用纳曲酮；3)丸剂 安慰剂联合PE；4)单独服用安慰剂。加强用药管理 干预将伴随着所有的治疗条件。PE将由以下人员提供 经验丰富的心理学家接受了手工操作规程的培训。该研究将包括 诊断为AD合并PTSD的患者200例(50例/组)。症状会是 在治疗前、治疗中、治疗结束时、治疗9个月和12个月时进行评估 在研究进入之后。我们的主要研究目标是比较短小的 和长期效果的联合治疗的每一种治疗 隔离AD和创伤后应激障碍的症状。这项研究提供了一种模型 结合和评估不同治疗方式的干预措施 解决阿尔茨海默病的共病，这是朝着发展 理论驱动和经验验证的治疗方法 治疗人群。

APPLICANT'S ABSTRACT: This proposed investigation extends prior research efforts by Edna Foa and Joseph Volpicelli in the evaluation of pharmacological and cognitive-behavioral treatments for alcohol dependence (AD) and post- traumatic stress disorder (PTSD), and capitalizes on their combined expertise in evaluating a comprehensive treatment program developed for patients with comorbid AD and PTSD. The comorbidity of AD and PTSD is a significant public mental health problem because the risk for AD dramatically increases among individuals with trauma history or PTSD and vice versa. The two disorders are thought to form a vicious cycle in which PTSD leads to abuse of alcohol; alcohol abuse impedes recovery from the traumatic experience thus contributing to the maintenance of PTSD; and PTSD in turn further escalates and entrenches alcohol abuse. Although promising treatments for AD and PTSD have been identified, comprehensive programs that address both disorders simultaneously have not been empirically tested. Specifically, the opiate antagonist naltrexone has been well established as an efficacious treatment for AD, but research has not specifically addressed its efficacy in patents with PTSD, who are especially prone to treatment attrition and noncompliance. Similarly, cognitive- behavioral treatment of PTSD by prolonged exposure (PE) is the most validated psychosocial treatment for PTSD; however, its efficacy in patients who abuse alcohol is unknown because AD is typically an exclusion criterion in such research. In the proposed study we will evaluate the efficacy of combining these empirically validated treatments for a group of patients who exhibit comorbid AD and PTSD. The proposed study compares four, 6-month treatment conditions in a 2 (naltrexone vs. placebo) by 2 (PE vs. No PE) research design. The four conditions are: 1) 100mg. naltrexone with PE; 2) naltrexone alone; 3) pill placebo with PE; 4) pill placebo alone. An enhanced medication management intervention will accompany all treatment conditions. PE will be provided by experienced psychologists trained in manual protocols. The study will include 200 patients (50/group) diagnosed with AD and comorbid PTSD. Symptoms will be evaluated before, during, and at the end of treatment, and at 9 and 12 months following study entry. Our primary study objective is to compare the short and long term effects of the combined treatments to those of each treatment in isolation on symptoms of AD and of PTSD. This study offers a model for combining and evaluating interventions in diverse treatment modalities for addressing comorbidity in AD, in a major step toward the development of theoretically driven and empirically validated treatments for difficult to treat populations.