A Stage II Efficacy Study of CBT for PTSD in Community Addiction Treatment

描述（由申请人提供）：本申请是最初响应NIDA PA-07-111行为和综合治疗开发计划（RO 1）提出的研究的重新提交，目前已提交给NIH-RO 1-FOA。同时发生的物质使用和精神障碍在一般人群中很常见，在临床环境中甚至更普遍，并与负面的治疗和生活结果有关。创伤后应激障碍（PTSD）是最普遍的并发症之一，令临床医生烦恼，也是自然减员、药物和酒精复发以及精神症状恶化的风险因素。已经开发和测试了几种用于共同发生的PTSD的行为疗法，但这些治疗方法与比较条件相比并不有效，保留率中等至较差，并且尚未整合到现有的成瘾治疗服务中或由典型的社区成瘾辅导员提供。本提案建立在主要研究者完成的一系列第一阶段研究的基础上，在成瘾治疗计划中实施PTSD的认知行为疗法（CBT）。迄今为止，第一阶段研究的累积结果表明，PTSD的CBT对PTSD症状、物质使用和良好的保留率（65- 70%）有很好的效果。本研究提出了一个第二阶段的疗效研究，228名参与者招募了七个典型的社区成瘾治疗计划，并随机分配到：a）CBT的PTSD +治疗照常; B）个人成瘾咨询（IAC）+治疗照常;或c）治疗照常单独。社区成瘾咨询师将提供所有治疗。在基线、3个月和6个月时评估的主要结局是：PTSD症状严重程度、物质使用严重程度和保留。拟议的研究有可能通过推进行为疗法产生重大影响，该疗法可以减少药物和酒精的使用，治疗共病精神疾病，并先验地考虑将其转化为常规社区环境和提供者。第二阶段研究利用了研究团队的经验，在第一阶段研究活动中发现了一种有前途的治疗方法。此外，该研究小组与由常规成瘾咨询师和患者组成的典型社区成瘾治疗计划建立了富有成效的研究关系。在这些环境中的研究应有助于提高外部有效性，并促进有效的研究为基础的治疗转化为社区。

DESCRIPTION (provided by applicant): This application is a resubmission of research originally proposed in response to NIDA PA-07-111 Behavioral & Integrative Treatment Development Program (RO1), and presently to the NIH-RO1-FOA. Co-occurring substance use and psychiatric disorders are common in the general population, even more prevalent in clinical settings, and associated with negative treatment and life outcomes. Posttraumatic stress disorder (PTSD) is among the most widespread of co-occurring disorders, vexing to clinicians, and a risk factor for attrition, relapse to drugs and alcohol, and deterioration in psychiatric symptoms. There have been several behavioral therapies for co-occurring PTSD developed and tested, but these treatments have not been found effective versus comparison conditions, have moderate to poor retention rates, and have not been integrated within existing addiction treatment services or delivered by typical community addiction counselors. The present proposal builds upon a series of completed Stage I studies by the principal investigator, implementing a cognitive behavioral therapy (CBT) for PTSD in addiction treatment programs. The cumulative findings of the Stage I studies thus far demonstrate the CBT for PTSD to have promising effects on PTSD symptoms, substance use, and good retention rates (65-70 percent). This present research proposes a Stage II efficacy study of 228 participants recruited across seven typical community addiction treatment programs, and randomized to: a) CBT for PTSD + treatment-as-usual; b) Individual Addiction Counseling (IAC) + treatment-as-usual; or c) Treatment-as-usual alone. Community addiction counselors will deliver all treatments. Primary outcomes assessed at baseline, 3- and 6-months are: PTSD symptom severity, substance use severity and retention. The proposed research has the potential for significant impact by advancing a behavioral therapy that can reduce drug and alcohol use, attend to comorbid psychiatric conditions, and consider, a priori, translation to routine community settings and providers. This Stage II research capitalizes on the experience of the research team with a promising treatment, as found in the Stage I research activities. In addition, the research team has a track record of productive research relationships with typical community addiction treatment programs composed of routine addiction counselors and patients. Research within these settings should serve to enhance external validity and facilitate the translation of effective research-based treatments into the community.