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

描述(申请人提供)：由于在阿富汗和伊拉克的持续行动，越来越多的美国军事人员和退伍军人面临患上物质使用障碍(SODS)和创伤后应激障碍(PTSD)的风险。如果不治疗，患有肥皂泡和/或创伤后应激障碍的人有可能出现其他精神健康问题(如抑郁症)、自杀念头和企图、身体健康问题、复原力降低、生产力丧失和家庭/关系损害。虽然为美国军事人员提供了心理健康服务，但在治疗同时发生的肥皂泡和创伤后应激障碍方面存在很大差距，而且几乎没有科学证据来指导提供护理。这项拟议的研究通过测试综合行为干预的可行性和初步疗效，直接解决了这一知识差距，该综合行为干预治疗为在持久自由行动和/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)使用而改装的共生肥皂泡和创伤后应激障碍。这一干预措施被称为“长期暴露的同时治疗”或“应对”，代表了一种新的治疗方法，它将肥皂泡的认知行为疗法与创伤后应激障碍的长期暴露疗法结合在一起。在早期对平民的研究中，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的精神健康问题(如抑郁、焦虑)方面有效。在这项混合的Ib期/II期研究中，我们将(1)对肥胖症和创伤后应激障碍(COPE)使用手动的、耐受性良好的行为治疗；(2)采用两组间随机试验设计(COPE与改进的照常治疗(TAU))；以及(3)在5个时间点(治疗前、治疗中和治疗后；3和6个月随访)检查标准化的、重复的临床结果和过程变量的相关测量。拟议的项目直接响应了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，旨在加强和加快关于预防和治疗酒精和药物使用障碍(包括非法和处方药)以及共病(例如创伤后应激障碍、抑郁症、睡眠障碍、艾滋病毒危险行为)的研究。这项研究的结果将提供经验证据，为更好地满足美国军事人员、退伍军人及其家属的需求的政策和计划提供参考。 公共卫生相关性：物质使用障碍和创伤后应激障碍(PTSD)是经常并存并影响相当大比例的OEF/OIF退伍军人及其家人的衰弱和慢性疾病。目前提供的服务不足以解决共生物质使用障碍和创伤后应激障碍，迫切需要开发以理论为基础、以证据为基础的治疗方法。这项拟议的研究有可能显著提高患者护理标准，推进这一领域的共病科学，减少公共卫生支出，并改善我们美国军人家属的军事准备和整体健康。

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.