Integrated Treatment of OEF/OIF Veterans with PTSD and Substance Use Disorders

描述（由申请人提供）：由于在阿富汗和伊拉克的持续行动，有越来越多的美国军事人员和退伍军人面临物质使用障碍（sud）和创伤后应激障碍（PTSD）的风险。如果不及时治疗，患有sud和/或PTSD的人有可能出现其他精神健康问题（如抑郁症）、自杀意念和企图、身体健康问题、恢复能力下降、生产力下降以及家庭/关系受损。虽然美国军人的心理健康服务已经到位，但在同时发生的sud和PTSD的治疗方面存在巨大差距，而且几乎没有科学证据可以指导护理的提供。该研究通过测试一种综合行为干预的可行性和初步效果，直接解决了这一知识差距，该干预用于治疗同时发生的sud和PTSD，该干预适用于在持久自由行动和/或伊拉克自由行动（OEF/OIF）中服役的美国军事人员（包括国民警卫队和预备役人员）。这种干预被称为“长时间暴露的同时治疗”或“COPE”，它代表了一种新的治疗方法，将治疗sud的认知行为疗法与治疗PTSD的长时间暴露疗法结合起来。在对平民进行的早期研究中，COPE已证明在减少酒精和药物使用严重程度、创伤后应激障碍症状和相关精神健康问题（如抑郁、焦虑）方面有效。在这项Ib/ II期混合研究中，我们将(1)对sud和PTSD （COPE）使用手动的、耐受性良好的行为治疗；(2)采用双臂随机组间实验设计（COPE vs .改良的照旧治疗（TAU））；(3)在5个时间点（治疗前、治疗中、治疗后；随访3个月和6个月）检查临床结果和过程变量的标准化、重复依赖测量。拟议的项目直接响应国家药物滥用研究所（NIDA）和国家酒精滥用和酒精中毒研究所（NIAAA）的使命，因为它寻求加强和加速关于预防和治疗酒精和药物使用障碍（包括非法和处方药）和合并症（例如创伤后应激障碍、抑郁症、睡眠障碍、艾滋病毒风险行为）的研究。这项研究的结果将为政策和项目提供经验证据，以更好地满足美国军事人员、退伍军人及其家属的需求。

DESCRIPTION (provided by applicant): As a result of sustained operations in Afghanistan and Iraq, there are an increasing number of U.S. military personnel and Veterans at risk of developing both substance use disorders (SUDs) and Post Traumatic Stress Disorder (PTSD). If left untreated, individuals with SUDs and/or PTSD are at risk for other mental health problems (e.g., depression), suicidal ideation and attempts, physical health problems, reduced resiliency, lost productivity, and family/relationship impairment. While mental health services are in place for U.S. military personnel, substantial gaps in the treatment of co-occurring SUDs and PTSD exist and there is little scientific evidence available to guide the provision of care. The proposed study directly addresses this knowledge gap by testing the feasibility and preliminary efficacy of an integrative behavioral intervention for the treatment of co-occurring SUDs and PTSD modified for use among U.S. military personnel (including National Guard and Reservists) who have served in Operation Enduring Freedom and/or Operation Iraqi Freedom (OEF/OIF). The intervention, called "Concurrent Treatment with Prolonged Exposure" or "COPE," represents a novel treatment that integrates cognitive-behavioral therapy for SUDs with prolonged exposure therapy for PTSD. In earlier studies with civilians, COPE has demonstrated efficacy in reducing alcohol and drug use severity, PTSD symptoms, and associated mental health problems (e.g., depression, anxiety). In this hybrid Stage Ib/Stage II study, we will (1) use a manualized, well-tolerated behavioral treatment for SUDs and PTSD (COPE); (2) employ a two-arm randomized between-groups experimental design (COPE versus a modified treatment-as- usual (TAU); and (3) examine standardized, repeated dependent measures of clinical outcomes and process variables at 5 time points (pre-, mid-, and post-treatment; 3 and 6 month follow-up). The proposed project is directly responsive to the mission of the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) in that it seeks to enhance and accelerate research on the prevention and treatment of alcohol and drug use disorders (including illicit and prescription drugs) and comorbid conditions (e.g., PTSD, depression, sleep disturbances, HIV risk behaviors). The findings of this study will provide empirical evidence to inform policies and programs to better serve the needs of U.S. military personnel, Veterans, and their families. PUBLIC HEALTH RELEVANCE: Substance use disorders and Post Traumatic Stress Disorder (PTSD) are debilitating and chronic disorders that frequently co-occur and affect a substantial proportion of OEF/OIF Veterans and their families. The current services offered do not adequately address co-occurring substance use disorders and PTSD, and there is an immediate need for the development of theory-grounded, evidence-based treatments. The proposed study has the potential to significantly improve the standard of patient care, advance the comorbidity science in this area, decrease public health expenditures, and improve the military readiness and overall health of our U.S. military families.