Motivating Substance Abusing Veterans, via Family to Seek Treatment

描述（由申请人提供）： 根据VHA统一精神卫生服务规范制定的指导方针和重点，本研究的第三次提交是一项II期随机临床试验，旨在评估两种干预措施对相关显著性抑郁症的疗效。 OEF/OIF/OND退伍军人药物滥用障碍（SUD）。社区强化和家庭培训（CRAFT）已在平民中证明有效，并将与标准的社区治疗方案Al-Anon Facilitation进行比较。近年来获得的数据越来越明显，饮酒和药物滥用的有害水平在OEF/OIF/OND退伍军人中非常普遍，他们已经加入了退伍军人事务部医疗保健系统（无论接受的医疗服务类型如何），以及在58%的合格OEF/OIF/OND退伍军人中没有在VA寻求治疗。SUD在家庭中的后果是深远的，VA热衷于提供有用的干预措施，帮助OEF/OIF/OND退伍军人的家庭成员（参见，2008年110-387号《退伍军人精神健康和其他护理改善法》（Public Law 110-387 Veterans' Mental Health and Other Care Improvements Act of 2008）家庭干预的次要结果可能是退伍军人寻求治疗。持久自由行动/法语国家组织/全国民主联盟退伍军人获得心理健康服务的意愿低得惊人，尽管这会给他们的家庭和他们自己带来负面后果（例如健康、经济、法律的）。该方案的总体目标是确定针对退伍军人CSO的干预措施是否会改善CSO与退伍军人的互动，从而增加现有循证治疗的使用。共有104名CSO（配偶或亲密伴侣）报告了他们对OEF/OIF/OND退伍军人药物滥用的担忧，他们将被随机分配到治疗师指导的CRAFT（n=52）或治疗师指导的Al-Anon促进（例如12步; n=52）。这两种治疗将在门诊的基础上进行12周的单独治疗。将在基线、治疗结束时以及治疗完成后24、36和48周评估主要和次要结局指标。治疗结束后，将每周评估预测变量。拟议的研究是创新的，因为它将教会民间社会组织应对退伍军人饮酒的不同方式，以及如何激励他们的OEF/OIF/OND退伍军人谁是治疗抵抗寻求治疗他们的SUD。我们希望这项研究能够成功地改善CSO和退伍军人的关系功能。这项研究的主要影响将是通过测试和改进一种方法来解决知识库中的空白，以鼓励逃避治疗的退伍军人参与现有的循证治疗。 公共卫生相关性： 从目前的持久自由行动（OEF），伊拉克自由行动（OIF）和新黎明行动（OND）冲突中返回的退伍军人家庭面临药物滥用障碍（SUD）后果的风险增加，包括家庭酒精滥用。虽然已经制定了一些有效的治疗方案，这些人很容易获得，但返回的“持久自由行动”/“伊拉克自由行动”/“国防部”退伍军人往往特别不愿意寻求治疗。在平民群体中，社区强化和家庭培训（CRAFT）干预措施已被证明是有效的，可以提高相关重要他人在激励SUD合作伙伴接受治疗方面的成功率。当前研究的目标是确定这种治疗是否可以应用于OEF/OIF/OND退伍军人的相关重要其他伴侣，以改善治疗寻求。这一目标符合VHA统一精神卫生服务守则。

DESCRIPTION (provided by applicant): In keeping with the guidelines and points of emphasis established by the VHA Uniform Mental Health Services Code, the third submission of this research study is a Phase II randomized clinical trial designed to evaluate the efficacy of two interventions for the concerned significant others (CSOs) of OEF/OIF/OND veterans with substance abuse disorders (SUD). Community Reinforcement and Family Training (CRAFT) has demonstrated efficacy in civilian populations, and will be compared to a standard community treatment option, Al-Anon Facilitation. Data obtained in recent years has made it increasingly evident that harmful levels of alcohol drinking and substance abuse are extremely prevalent amongst OEF/OIF/OND veterans who have enrolled with Veterans Affairs Health Care System (regardless of the type of health services received), as well as within the 58% of eligible OEF/OIF/OND veterans who have not pursued treatment at the VA. The consequences of SUD in families are profound, and VA is keen to offer useful interventions aiding family members of OEF/OIF/OND veterans (cf., Public Law 110-387 Veterans' Mental Health and Other Care Improvements Act of 2008). A secondary outcome of family intervention can be veteran treatment seeking. The willingness of OEF/OIF/OND veterans to access mental health services is alarmingly low, despite the negative consequences (e.g. health, financial, legal) to their families and to themselves. The overall goal of this propoal is to determine whether an intervention designed to target the CSOs of veterans will improve CSO interactions with veterans, subsequently resulting in increased use of existing evidence-based treatment for their SUD. A total of 104 CSOs (the spouse or intimate partner) who report concern about their OEF/OIF/OND veterans substance abuse will be randomly assigned to therapist-guided CRAFT (n=52) or therapist-guided Al-Anon Facilitation (e.g. 12-Step; n=52). Both treatments will be delivered in individual sessions on an outpatient basis for 12- weeks. Primary and secondary outcome measures will be assessed at baseline, at the end of treatment, and 24, 36 and 48 weeks after treatment completion. Predictive variables will be assessed weekly, following therapy sessions. The proposed research is innovative because it will teach CSOs different styles of coping with veteran's drinking and how to motivate their OEF/OIF/OND veterans who are treatment resistant to seek treatment for their SUD. We expect that this research will prove successful at improving the relationship functioning of the CSO and the veteran. The major impact of this research will be to address a gap in the knowledge-base by testing and refining a method to encourage treatment-avoidant veterans to participate in existing evidence-based treatments. PUBLIC HEALTH RELEVANCE: Families of veterans returning from the current Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF) and Operation New Dawn (OND) conflicts are at increased risk for consequences of Substance Abuse Disorder (SUD) including familial alcohol misuse. Whereas several effective treatment programs have been developed and are readily accessible to these individuals, returning OEF/OIF/OND veterans are often particularly reluctant to seek treatment. Within civilian populations, the Community Reinforcement and Family Training (CRAFT) intervention has been proven to be effective at increasing the success of concerned significant others in motivating SUD partners to treatment. The goal of the current study is to determine whether this treatment can be applied to the concerned significant other partners of OEF/OIF/OND veterans in order to improve treatment seeking. This objective is consistent with the VHA Uniform Mental Health Services Codes.