NALTREXONE AND CBT FOR PATIENTS WITH ALCOHOLISM AND PTSD

申请人摘要：这项研究扩展了先前的研究 Edna Foa和Joseph Volpicelli在药理学评价方面的努力 以及酒精依赖（AD）的认知行为治疗和 创伤后应激障碍（PTSD），并利用他们的综合专业知识 在评估一个全面的治疗方案开发的患者， AD和创伤后应激障碍并存 AD和PTSD的共病是一个重要的公共精神卫生问题 因为AD的风险在有创伤的个体中显著增加， 或者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升级和巩固酗酒。 虽然已经确定了AD和PTSD的有希望的治疗方法， 同时解决这两种疾病的综合方案， 经过了实证检验。 具体而言，阿片拮抗剂纳洛酮具有 作为AD的有效治疗方法已得到公认，但研究尚未 特别强调了它在PTSD患者中的疗效， 倾向于治疗损耗和不依从。 同样，认知- 通过长期暴露（PE）进行PTSD的行为治疗是最有效的 PTSD的心理社会治疗;然而，它在滥用药物的患者中的疗效 酒精是未知的，因为AD通常是此类患者的排除标准。 research. 在拟议的研究中，我们将评估联合 这些经过经验验证的治疗方法， AD和创伤后应激障碍并存 这项研究比较了4个6个月的治疗条件， （纳洛酮与安慰剂）× 2（PE与无PE）研究设计。 四 条件为：1）100 mg.纳洛酮+PE; 2）纳洛酮单药; 3）丸剂 安慰剂+PE; 4）单独服用安慰剂。 加强药物管理 干预将伴随所有治疗条件。 PE将由 经验丰富的心理学家接受过手工操作训练 研究将包括 200例患者（50例/组）诊断为AD和共病PTSD。 症状会 在治疗前、治疗期间和治疗结束时以及9个月和12个月时进行评价 研究进入后。 我们的主要研究目标是比较短 联合治疗的长期效果与单独治疗的长期效果相比， AD和PTSD症状的隔离。 这项研究提供了一个模型， 综合和评估各种治疗方式的干预措施， 解决科摩罗在AD，在朝着发展的重要一步， 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.