Adapting and Piloting Behavioral Activation for Veterans with Co-Occurring AUD and Posttraumatic Stress Disorder

在美国，酒精使用障碍(AUD)经常与创伤后应激障碍(PTSD)并存。 退伍军人。与仅患有AUD的退伍军人相比，患有AUD/PTSD的退伍军人症状更严重 严重程度、更多的心理社会功能障碍和更高的自杀风险。许多患有澳大利亚/创伤后应激障碍的人 采取旨在避免不愉快情绪的行为(例如，饮酒以避免与创伤有关的噩梦， 跳过社交活动，以避免引发焦虑的人群)。这些“回避行为”提供了暂时的 缓解不愉快的情绪，但它们维持澳元/创伤后应激障碍，并干扰长期功能。 尽管存在AUD/PTSD的治疗方法，但它们侧重于减轻症状(而不是改善功能)和 辍学率高达50%。行为激活(BA)最初是为治疗抑郁症而开发的，是一种 增加日常参与奖励的、与患者社交相关的戒酒活动的干预措施， 职业价值观和与健康相关的价值观。将BA用于其他疾病的随机对照试验(RCT) 已表明BA对有酒精/药物使用障碍的成年人有效，退伍军人也可以接受 创伤后应激障碍，但BA尚未被用于治疗AUD/PTSD共病。此外，由于澳大利亚/创伤后应激障碍的随机对照试验 治疗通常强调AUD/PTSD结果的显著平均组差异，鲜为人知 这些治疗在多大程度上在个体水平上产生了临床上的显著改善。 AUD/PTSD的个体水平的改善不仅应该在主观的临床评估中明显，而且 在客观衡量地理空间活动方面也是如此。具体地说，患者每天的地理空间活动可能会 随着他们减少回避行为，增加对各种社交活动的参与度， 职业和健康促进活动。地理空间方法的进展，加上谨慎和 便携式全球定位系统(GPS)跟踪器使客观测量人们的 在他们社区内的空间运动。然而，尽管地理空间方法已被用来识别社会 关于酒精使用的决定因素，它们尚未被用来衡量对AUD或AUD/PTSD治疗的反应。 由于这项工作的长期目标是确定更可接受的AUD/PTSD治疗方案，以及 为了改进澳元/创伤后应激障碍恢复的衡量标准，该R34项目将实现以下具体目标： (1)使BA适用于患有AUD/PTSD的退伍军人；(2)评估其可行性、可接受性和初步 在一项试验性随机对照试验中，BA(相对于复发预防)对患有AUD/PTSD的退伍军人的影响；以及(3)探索 对GPS收集的数据进行地理空间分析，作为衡量AUD/PTSD治疗反应的一种新方法。 这项研究将通过试点BA的新应用和一种新的措施来推进研究和实践 澳大利亚/创伤后应激障碍的恢复。该项目与国家酒精滥用和酒精中毒研究所的特别项目相一致 对研究AUD患者的治疗和共发病障碍、功能维度的兴趣 以及与康复相关的幸福感，以及评估AUD治疗和康复的创新方法。

Alcohol use disorder (AUD) frequently co-occurs with posttraumatic stress disorder (PTSD) among U.S. military veterans. Compared to veterans with AUD only, veterans with AUD/PTSD have greater symptom severity, more psychosocial functioning difficulties, and higher risk of suicide. Many people with AUD/PTSD perform behaviors aimed at avoiding unpleasant emotions (e.g., drinking to avoid trauma-related nightmares, skipping social events to avoid anxiety-provoking crowds). These “avoidance behaviors” provide temporary relief from unpleasant emotions, but they maintain AUD/PTSD and interfere with long-term functioning. Although treatments for AUD/PTSD exist, they focus on reducing symptoms (not improving functioning) and have dropout rates as high as 50%. Originally developed to treat depression, Behavioral Activation (BA) is an intervention that increases daily participation in rewarding, alcohol-free activities relevant to patients’ social, vocational, and health-related values. Randomized controlled trials (RCTs) adapting BA for other disorders have shown that BA is efficacious for adults with alcohol/drug use disorders and acceptable to veterans with PTSD, but BA has not been used to treat co-occurring AUD/PTSD. Additionally, because RCTs of AUD/PTSD treatments typically emphasize significant mean group differences in AUD/PTSD outcomes, less is known about the degree to which these treatments yield clinically significant improvements at the individual level. Individual-level improvements in AUD/PTSD should be evident not only in subjective clinical assessments, but also in objective measures of geospatial activity. Specifically, patients’ daily geospatial activity is likely to change as they decrease their avoidance behaviors and increase their engagement in various social, vocational, and health-promoting activities. Advances in geospatial methods, coupled with discreet and portable Global Positioning System (GPS) trackers, have made it possible to objectively measure people’s spatial movement within their communities. Yet although geospatial methods have been used to identify social determinants of alcohol use, they have not been used to measure response to AUD or AUD/PTSD treatment. As the long-term objectives of this work are to identify a more acceptable AUD/PTSD treatment option and improve the measurement of AUD/PTSD recovery, this R34 project will address the following specific aims: (1) adapt BA for use with veterans with AUD/PTSD; (2) evaluate the feasibility, acceptability, and preliminary effects of BA (relative to Relapse Prevention) for veterans with AUD/PTSD in a pilot RCT; and (3) explore geospatial analysis of GPS-collected data as a new approach to measuring AUD/PTSD treatment response. This study will advance research and practice by piloting a novel application of BA and a novel measure of AUD/PTSD recovery. This project aligns with the National Institute on Alcohol Abuse and Alcoholism’s special interest in investigating treatments for patients with AUD and co-occurring disorders, dimensions of functioning and well-being associated with recovery, and innovative methods for evaluating AUD treatment and recovery.