Evaluating the Efficacy of Telehealth-Delivered Brief Family Involved Treatment (B-FIT) for Alcohol Use Disorder among Veterans

摘要 改善酒精使用障碍（AUD）的治疗途径和退伍军人的结果是一个紧迫的公众 健康优先。退伍军人中AUD的终生患病率是平民的两倍。退伍军人还承担 更严重和持续的AUD症状，疗程更长和更复杂， 与一般人群相比。尽管家庭成员在病因学中起着关键作用， 过程和治疗AUD，以及支持几个现有家族疗效的强大证据基础 AUD治疗、家庭治疗方案对于患者和临床医生来说是冗长和繁重的。因此 是开发有效的家庭AUD治疗的关键需求，这些治疗既简短又易于接受， 老兵我们的团队成员制定并完善了简短的家庭参与治疗（B-FIT）协议， 一项由NIAAA赞助的平民试点试验B-FIT是一种3节认知行为疗法，旨在 与任何现有的酒精治疗计划相结合。B-FIT的目标是：1）增加 强化治疗促进行为，2）增加禁欲的感知强化值， 增加预期的积极奖励，从禁欲，和3）减少饮酒线索，减少负面影响， 沟通，增加与家人的积极沟通。这项研究的结果是， 支持B-FIT可行性、可接受性和初步疗效。在另一项研究中，我们的团队 证明了通过家庭提供二元AUD治疗的良好可行性和可接受性 远程保健因此，本II期试验的主要目的是检查B-FIT与以下药物联合治疗的疗效： 常规治疗（TAU; VA物质治疗和恢复[星星]）与TAU单独治疗相比：1）减少 饮酒，2）改善家庭功能，和3）改善星星治疗满意度，依从性， 和退伍军人之间的保留。为了实现这一点，我们将采用开放随机对照设计， 在多个时间点检查标准化的、重复的、依赖性的变化测量。我们还将利用 我们的团队的标准操作程序，完全远程研究的实施，密切合作，与区域 VA星星诊所，以及一个强大的国家VA远程医疗基础设施，准备有效地翻译 积极的发现进行治疗。拟议的研究与NIAAA的使命和战略计划直接一致 因为它将1）采用电子健康技术来提高AUD的有效性和可及性 治疗退伍军人，2）将推进农村和服务不足的退伍军人，谁是AUD治疗的访问 健康差异人群，3）关注现实世界治疗环境中的退伍军人（即，VA星星诊所），4） 检查家庭远程医疗服务的B-FIT，以及4）将识别退伍军人和家庭的特征 会员最有可能受益于B-FIT添加到他们的恢复计划。我们的发现将直接 为临床实践提供信息，并加速这一重要但研究不足领域的治疗。

ABSTRACT Improving alcohol use disorder (AUD) treatment access and outcomes among Veterans is an urgent public health priority. The lifetime prevalence of AUD among Veterans is twice that of civilians. Veterans also incur more severe and persistent AUD symptoms with more lengthy and complex treatment courses and negative outcomes compared to the general population. Despite the critical role that family members play in the etiology, course, and treatment of AUD, and the robust evidence base supporting the efficacy of several existing family AUD treatments, family treatment protocols are lengthy and burdensome for patients and clinicians. Thus, there is a critical need to develop efficacious family AUD treatments that are both brief and highly accessible to Veterans. Members of our team developed and refined the Brief Family Involved Treatment (B-FIT) protocol in an NIAAA-sponsored pilot trial among civilians. B-FIT is a 3-session cognitive behavioral therapy designed to be implemented in combination with any existing alcohol treatment program. The goals of B-FIT are to 1) increase reinforcement of treatment-facilitating behaviors, 2) increase the perceived reinforcement value of abstinence by increasing anticipated positive rewards from abstinence, and 3) reduce drinking cues by decreasing negative communication and increasing positive communication with family members. This study resulted in findings that support feasibility, acceptability, and preliminary efficacy of B-FIT. In a separate study, our team has demonstrated excellent feasibility and acceptability of delivering dyadic AUD treatment via home-based telehealth. Thus, the primary objective of this Stage II trial is to examine the efficacy of B-FIT in combination with treatment as usual (TAU; VA Substance Treatment and Recovery [STAR]) versus TAU alone in 1) reducing alcohol consumption, 2) improving family functioning, and 3) improving STAR treatment satisfaction, adherence, and retention among Veterans. To accomplish this, we will employ an open randomized controlled design and examine standardized, repeated, dependent measures of change at multiple time points. We will also leverage our team’s standard operating procedures for fully remote study implementation, close collaboration with regional VA STAR clinics, and a robust national VA telehealth infrastructure which is prepared to efficiently translate positive findings into treatment. The proposed study is directly aligned with NIAAA’s mission and Strategic Plan in that it will 1) employ electronic health technology to improve the effectiveness and accessibility of AUD treatment for Veterans, 2) will advance AUD treatment access among rural and underserved Veterans, who are a health disparity population, 3) focuses on Veterans in a real-world treatment setting (i.e., VA STAR clinics), 4) examines B-FIT for home-based telehealth delivery, and 4) will identify characteristics of Veterans and family members most likely to benefit from the addition of B-FIT to their recovery program. Our findings will directly inform clinical practice and accelerate treatment in this important but understudied area.