Web-based CBT for Substance Misusing and PTSD Symptomatic OEF/OIF Veterans

针对药物滥用和 PTSD 症状 OEF/OIF 退伍军人的基于网络的 CBT

• 批准号: 8527631
• 负责人: STEPHEN A MAISTO
• 金额: $ 58.97万
• 依托单位: NATIONAL DEVELOPMENT AND RESEARCH INSTITUTES, INC.
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8527631
• 关键词: Abstinence; Address; Adoption; Affect; Afghanistan; Alcohol or Other Drugs use; Behavior Therapy; Behavioral; Caring; Clinic; Clinical; Cognitive; Cognitive Therapy; Comorbidity; Complex; Computers; Costs and Benefits; Data; Development; Diagnosis; Diffusion; Disease; Drug usage; Economics; Education; Evidence based treatment; Feedback; Focus Groups; Freedom; Future; Health Services Accessibility; Healthcare; Heavy Drinking; High Prevalence; Illicit Drugs; Individual; Intervention; Iraq; Knowledge; Medical center; Mental Depression; Mental Health; Military Personnel; Minority; Modeling; Online Systems; Outcome; Participant; Patients; Population; Post-Traumatic Stress Disorders; Primary Health Care; Problem behavior; Provider; Public Health; Quality of life; Quality-Adjusted Life Years; Randomized; Relative (related person); Reporting; Research; Science; Series; Substance Use Disorder; Symptoms; System; Technology; Therapeutic; Time; Tobacco use; Training; Travel; Treatment Efficacy; United States Department of Veterans Affairs; Veterans; Work; base; behavioral health; binge drinking; chronic pain; control trial; cost; cost effective; cost effectiveness; economic cost; evidence base; experience; hazardous drinking; improved; innovation; medical specialties; meetings; operation; primary care setting; primary outcome; programs; psychosocial; public health relevance; secondary outcome; skills; social stigma; stressor; treatment as usual; treatment center

DESCRIPTION (provided by applicant): Over 2/3 (69%) of veterans from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) at Veterans' Administration (VA) medical centers screen positive for mental health problems. The most prevalent is post-traumatic stress disorder (PTSD). Substance use problems are also prevalent, particularly among veterans with PTSD symptoms. Despite their mental health needs, OEF/OIF veterans with PTSD are more likely to seek treatment for physical complaints than for mental health concerns. Although behavioral health care has been integrated into primary care in VA medical centers, veterans encounter significant barriers accessing this care. Although, psychosocial interventions such as cognitive-behavioral therapy (CBT) have been found to be efficacious for the treatment of problematic substance use and PTSD, providers in non- specialty care are unlikely to have the time or proper training to deliver this complex intervention. To address this public health concern, we propose to modify the content of an efficacious web-based CBT intervention for individuals with substance use disorders (Therapeutic Education System; TES), to target substance use, PTSD and other problems common among OEF/OIF veterans. The specific aims are: AIM 1. Develop an interactive, web-based psychosocial treatment for OEF/OIF veterans with hazardous or problematic substance use and PTSD symptoms. The planned intervention will be theoretically grounded in a CBT approach and will be delivered via an interactive system that employs informational technologies which are effective in promoting knowledge and skills. Development will be informed by expert collaborators, focus groups of OEF/OIF veterans, and feedback sessions in which experts and a 2nd group of veterans are asked to evaluate a beta-version of the program. AIM 2. Evaluate the efficacy of the web-based intervention with OEF/OIF veterans with hazardous or problematic substance use and PTSD symptoms. We plan to conduct a controlled trial in two primary care VA treatment centers. Participants will be randomized to: (1) Treatment as Usual (TAU) reflecting the model of treatment provided to most OEF/OIF veterans (n=81) or (2) TAU plus the web-based CBT intervention (n=81). Primary outcomes will be: a) number of heavy drinking days and/or number of days of illicit or non-prescribed drug use in the past 30 days; b) Quality of Life; and c) PTSD symptoms. AIM 3. Evaluate the cost and cost-effectiveness of the web-based intervention plus TAU relative to TAU alone. Cost-effectiveness ratios will be estimated to identify the incremental costs of the web-based intervention per increased quality adjusted life years (QALYs) and increased abstinence. Analysis will consider costs and cost effectiveness from a societal perspective, as well as from the VA system perspective to inform the adoption decision at a program level. Results of this study have the potential to markedly improve psychosocial treatment for substance use and related disorders among OEF/OIF veterans and enable rapid and widespread diffusion of a science-based intervention to this population. PUBLIC HEALTH RELEVANCE: Although a significant minority of veterans from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) in VA primary care centers present with co-occurring PTSD and substance use problems, most do not receive adequate treatment. To address this public health concern, we propose to modify the content of an efficacious web-based CBT intervention that will target substance use, PTSD and other problems common among OEF/OIF veterans, and will conduct an economic analysis that will compare costs & benefits of our web-based intervention with usual treatment at VA primary care settings. Results of this study have the potential to markedly improve psychosocial treatment for substance use and related disorders among OEF/OIF veterans and enable rapid and widespread diffusion of a science-based intervention to this population.

描述（由申请人提供）：在退伍军人管理局 (VA) 医疗中心，超过 2/3 (69%) 参加过持久自由行动 (OEF) 和伊拉克自由行动 (OIF) 的退伍军人的心理健康问题筛查呈阳性。最普遍的是创伤后应激障碍（PTSD）。药物滥用问题也很普遍，尤其是在患有创伤后应激障碍（PTSD）症状的退伍军人中。尽管有心理健康需求，但患有 PTSD 的 OEF/OIF 退伍军人更有可能因身体不适而不是心理健康问题寻求治疗。尽管行为健康护理已被纳入退伍军人管理局医疗中心的初级保健，但退伍军人在获得这种护理方面遇到了重大障碍。尽管认知行为疗法 (CBT) 等心理社会干预措施已被发现对于治疗有问题的物质使用和创伤后应激障碍 (PTSD) 有效，但非专业护理的提供者不太可能有时间或适当的培训来提供这种复杂的干预措施。为了解决这一公共卫生问题，我们建议修改针对药物使用障碍患者的有效的基于网络的 CBT 干预（治疗教育系统；TES）的内容，以针对 OEF/OIF 退伍军人中常见的药物使用、PTSD 和其他问题。具体目标是： AIM 1. 为有危险或有问题的物质使用和 PTSD 症状的 OEF/OIF 退伍军人开发一种交互式、基于网络的心理社会治疗。计划中的干预措施在理论上将以 CBT 方法为基础，并将通过采用信息技术的交互式系统进行，该系统可有效促进知识和技能的发展。开发工作将由专家合作者、OEF/OIF 退伍军人焦点小组以及反馈会议提供信息，其中要求专家和第二组退伍军人评估该计划的测试版。目标 2. 评估基于网络的干预措施对有危险或问题药物使用和 PTSD 症状的 OEF/OIF 退伍军人的效果。我们计划在两个初级保健 VA 治疗中心进行对照试验。参与者将被随机分配到：(1) 照常治疗 (TAU)，反映向大多数 OEF/OIF 退伍军人提供的治疗模式 (n=81) 或 (2) TAU 加上基于网络的 CBT 干预 (n=81)。主要结果是： a) 过去 30 天内酗酒天数和/或使用非法或非处方药物的天数； b) 生活质量； c) 创伤后应激障碍症状。目标 3. 评估基于网络的干预加上 TAU 相对于单独 TAU 的成本和成本效益。将估算成本效益比，以确定每增加质量调整生命年 (QALY) 和增加戒欲，基于网络的干预措施的增量成本。分析将从社会角度以及 VA 系统角度考虑成本和成本效益，以便为计划层面的采用决策提供信息。这项研究的结果有可能显着改善 OEF/OIF 退伍军人对药物滥用和相关疾病的心理社会治疗，并使基于科学的干预措施能够快速广泛地传播到这一人群。 公共健康相关性：尽管退伍军人事务部初级保健中心参加持久自由行动 (OEF) 和伊拉克自由行动 (OIF) 的退伍军人中有相当一部分同时存在创伤后应激障碍 (PTSD) 和药物滥用问题，但大多数人没有得到充分的治疗。为了解决这一公共卫生问题，我们建议修改有效的基于网络的 CBT 干预措施的内容，该干预措施将针对药物使用、创伤后应激障碍 (PTSD) 和 OEF/OIF 退伍军人中常见的其他问题，并将进行经济分析，比较成本和收益我们基于网络的干预措施以及退伍军人事务部初级保健机构的常规治疗。这项研究的结果有可能显着改善 OEF/OIF 退伍军人对药物滥用和相关疾病的心理社会治疗，并使基于科学的干预措施能够快速广泛地传播到这一人群。