Preventing Alcohol Misuse among Young Adult Veterans through Brief Online Intervention

项目摘要/摘要 伊拉克和阿富汗战争中的年轻成年退伍军人代表着酗酒的风险人群 以及因使用而产生的长期问题。不幸的是，很少有人因酗酒而寻求治疗。这个 这项计划中的研究的目的是更全面地测试非常短、廉价、单疗程、 以及由我们的团队开发和评估的网络交付的个性化规范反馈(PNF)干预 在一项成功的R34试验性研究中，防止酒精滥用和相关的负面后果，以及 增加行为健康就医行为难及难治人群 退伍军人。我们通过(1)建立一个可供公众使用的大型数据库来扩展我们成功的试点工作 年轻退伍军人饮酒和治疗寻求规范，(2)专注于接触到最近 与军队分离，酗酒，但最近没有寻求任何行为健康 治疗，(3)评估提供PNF内容的增强干预如何与治疗具体相关 寻求影响准备行为和实际治疗启动，以及(4)检验假想中介 以及与这一人群相关的干预、饮酒和治疗启动结果的主持人。在目标1中， 我们通过收集饮酒和寻求治疗来增加我们庞大的人群饮酒规范数据库 试点中代表人数不足的退伍军人的信息，如女退伍军人(总样本N=2,500)。在……里面 目标2，然后我们将这些标准用于PNF干预的随机对照试验，旨在达到 目前没有接受行为健康护理的酗酒年轻退伍军人(N=800)，并测试是否 关于寻求治疗的其他反馈可以帮助促进该治疗中的治疗启动 抗性组。对接受增强PNF的参与者在3、6、9和12个月的结果进行比较 状态(N=400)转变为只注意控制状态(N=400)。在目标3中，我们测试了干预的介体 对饮酒结果的疗效(即，感知标准的改变，治疗开始的增加)和探索 结果的主持人，以确定短暂的干预是否对经验丰富的参与者更有效 年龄、性别、饮酒原因(社交和应对)、感觉到的耻辱、创伤后应激障碍和抑郁症状， 和独自饮酒。拟议的研究为当前的PNF提供了重大的方法学进步 通过以行为健康需求未得到满足的共病人群为目标的方法。对公众健康的影响 这种方法很有希望，因为干预完全在互联网上进行，可以接触到退伍军人 在治疗环境之外。自给自足的计划使用有限的时间和人员，并可在 手机和平板电脑。这种干预措施可以接触到对传统疗法产生抗药性的大量人群。 并作为预防饮酒后果和促进治疗启动的独立方法发挥作用 早些时候，在酒精滥用和共病问题成为慢性问题之前。

Project Summary/Abstract Young adult veterans from the wars in Iraq and Afghanistan represent a population at risk for heavy drinking and resulting long-term problems from use. Unfortunately, few seek treatment for alcohol concerns. The objective of this planned research is to more fully test the efficacy of a very brief, inexpensive, single-session, and web-delivered personalized normative feedback (PNF) intervention developed by our team and evaluated in a successful pilot R34 study to prevent alcohol misuse and associated negative consequences, as well as increase behavioral health treatment seeking behaviors among a difficult to reach and treatment resistant veteran population. We expand on our successful pilot work by (1) building a large publicly available database of young veteran drinking and treatment seeking norms, (2) focusing on reaching veterans who have recently separated from the military and drink heavily but who have not recently sought any behavioral health treatment, (3) evaluating how an enhanced intervention offering PNF content specifically related to treatment seeking affects preparatory behaviors and actual treatment initiation, and (4) testing hypothesized mediators and moderators of intervention drinking and treatment initiation outcomes relevant for this population. In Aim 1, we add to our large database of drinking norms for the population by collecting drinking and treatment seeking information from veterans underrepresented in the pilot, such as female veterans (total sample N = 2,500). In Aim 2, we then use these norms in a randomized controlled trial of the PNF intervention designed to reach heavy drinking young veterans who are not currently receiving behavioral health care (N = 800) and test if additional feedback about treatment seeking can help promote treatment initiation among this treatment resistant group. Outcomes at 3, 6, 9, and 12 months are compared for participants receiving an enhanced PNF condition (N = 400) to an attention-only control condition (N = 400). In Aim 3, we test mediators of intervention efficacy on drinking outcomes (i.e., changes in perceived norms, increases in treatment initiation) and explore moderators of outcomes to determine if the brief intervention works better for veteran participants based on age, gender, reasons for drinking (social versus coping), perceived stigma, PTSD and depression symptoms, and solitary drinking. The proposed research offers significant methodological advancements to current PNF approaches by targeting a comorbid population with unmet behavioral health needs. The public health impact of the approach is promising as the intervention is hosted entirely on the Internet and can reach veterans outside of treatment settings. The self-sustaining program uses limited time and personnel and is available on mobile phones and tablets. The intervention can reach a large population resistant to conventional therapies and functions as a stand-alone approach to prevent drinking consequences and promote treatment initiation early, before alcohol misuse and comorbid problems become chronic.