Web-based Behavioral Intervention for Returning Veterans with Risky Alcohol Use

描述（由申请人提供）：本申请涉及广泛的挑战领域：（05）比较有效性研究和具体挑战主题05- aa -103*：在酒精治疗研究中使用创新技术。在伊拉克（“伊拉克自由行动”）和阿富汗（“持久自由行动”）服役的相当数量的军事人员报告说，他们在回国后滥用酒精并出现创伤后应激障碍（PTSD）的症状，与以前战争的退伍军人类似。然而，许多退伍军人不愿寻求酒精或其他精神健康问题的治疗，他们经常提到治疗的障碍，包括对耻辱和治疗不便的担忧。基于网络的技术提供了一个潜在的省时、低成本和保密的场所，可以向可能得不到护理的退伍军人以及有酒精问题的非退伍军人群体提供循证治疗。本研究的具体目的是：1)为OIF/OEF退伍军人开发一种基于网络的干预措施，重点关注饮酒问题；2)进行一项对照临床试验，评估这种专门的基于网络的干预措施在减少酒精使用、酒精问题和创伤后应激障碍症状方面的效果。干预将利用基于证据的方法来解决饮酒问题和创伤后应激障碍，并为OIF/OEF退伍军人量身定制。对于报告饮酒问题和与军事经历相关的创伤后应激障碍症状的退伍军人，将提供减少饮酒和管理创伤后应激障碍症状的策略。我们将招募200名退伍军人参与这项研究。在初步网络筛选后，符合条件的参与者将被随机分配到初始干预组（IIG）或延迟干预组（DIG）。IIG的参与者将在随机分组后立即进入干预，并允许最多8周的时间来完成干预。DIG组的参与者将在第九周开始干预。所有参与者将完成至少三项评估：1)随机化前的基线，2)干预结束，3)干预后三个月。DIG组的参与者将在第8周开始干预时完成第二次基线评估。这将作为IIG干预后评估的一个比较点。主要结局包括从干预前到干预后酒精使用、酒精问题和创伤症状的变化。我们假设IIG组在初始阶段比DIG组在酒精使用、酒精问题和创伤症状方面表现出更大的减少。组内分析从前期到后期到3个月随访的变化将确定短期持久性效果。我们将进行探索性分析，以检查战斗暴露、创伤症状严重程度、性别、种族/民族、年龄和服务部门对饮酒结果的影响。这一研究的长期目标是为经历过各种创伤性事件的酒精问题患者开发低成本、可获得的干预措施。虽然这项研究是针对退伍军人的，但研究结果应该提高我们对干预有其他类型创伤史的问题饮酒者上网的一般认识。该项目将建立一个基于网络的治疗方案，针对有酗酒问题和与战斗有关的创伤后应激障碍症状的退伍军人。这一点很重要，因为一些退伍军人由于距离或其他因素难以获得治疗。创建一个计算机化的程序也保证了程序按照设计的方式交付，并且可以被更多的人使用，而不是治疗师可以看到的。

DESCRIPTION (provided by applicant): This application addresses the Broad Challenge Area: (05) Comparative Effectiveness Research and the Specific Challenge Topic 05-AA-103*: Use of Innovative Technologies in Alcohol Treatment Research. A substantial number of military personnel who have served in Iraq (Operation Iraqi Freedom; OIF) and Afghanistan (Operating Enduring Freedom; OEF) report alcohol misuse and symptoms of posttraumatic stress disorder (PTSD) following their return home, similar to veterans of previous wars. However, many returning veterans are reluctant to seek treatment for alcohol or other mental health problems, often citing barriers to care that include concerns about stigma and the inconvenience of treatment. Web-based technologies offer a potentially time-efficient, low cost and confidential venue for delivery of evidence-based therapies to veterans who might otherwise not receive care, and to a larger community of non-veterans with alcohol problems. The specific aims of this study are: 1) to develop a Web-based intervention for OIF/OEF veterans focused on problem drinking and 2) to conduct a controlled clinical trial that evaluates the efficacy of this specialized Web- based intervention to reduce alcohol use, alcohol problems and PTSD symptoms. The intervention will utilize evidence-based approaches for problem drinking and PTSD and be tailored to OIF/OEF veterans. For veterans who report problem drinking and symptoms of PTSD related to their military experience, strategies will be offered to reduce drinking as well as manage PTSD symptoms. We will recruit 200 veterans for the study. Following an initial web screening, eligible participants will be randomly assigned to either an Initial Intervention group (IIG) or a Delayed Intervention group (DIG). Participants in IIG will have access to the intervention immediately following randomization and allowed up to eight weeks to complete the intervention. Participants in DIG group will begin the intervention in Week nine. All participants will complete at least three assessments: 1) baseline prior to randomization, 2) end of the intervention, and 3) three months post- intervention. Participants in DIG group will complete a second baseline assessment in Week eight at time they begin the intervention. This will serve as a comparison point to the IIG post-intervention assessment. Primary outcomes include changes in alcohol use, alcohol problems and trauma symptoms from pre-intervention to post-intervention. We hypothesize that the IIG group will show a greater decrease in alcohol use, alcohol problems and trauma symptoms than the DIG group during the initial period. Within-group analyses of changes from pre- to post- to 3 month follow up will determine short-term durability effects. We will conduct exploratory analyses to examine the impact of combat exposure, trauma symptom severity, gender, race/ethnicity, age, and service branch on drinking outcomes. The long-term objective of this line of research is to develop low cost, accessible interventions for individuals with alcohol problems who have been exposed to all types of traumatic events. Although this study is specific to veterans, the results should improve our general knowledge about intervening on the web with problem drinkers who report a history of other types of trauma. This project will build a Web-based treatment program for returning veterans with alcohol problems and symptoms of combat-related symptoms of post-traumatic stress disorder. This is important because some veterans have difficulty accessing treatment because of distance or other factors. Creating a computerized program also guarantees that the program is delivered as it is designed, and can be used by many more people than can be seen by a therapist.