The Impact of CBT for Insomnia on Alcohol Treatment Outcomes among Veterans

CBT 治疗失眠对退伍军人酒精治疗结果的影响

• 批准号: 9753816
• 负责人: JOHN E MCGEARY
• 金额: $ 18.22万
• 依托单位: UNIVERSITY OF MISSOURI-COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-01 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9753816
• 关键词: Aftercare; Alcohol consumption; Alcohol dependence; Alcohol or Other Drugs use; Alcohols; Attention; Behavioral; Cognitive; Cognitive Therapy; Comorbidity; Computational algorithm; DSM-V; Data Analyses; Education; Effectiveness; Emotional; Emotions; Enrollment; Family; Goals; Health; Heavy Drinking; Individual; Intervention; Investigation; Lead; Long-Term Effects; Medical center; Mental Depression; Military Personnel; Outcome; Outpatients; Participant; Patients; Post-Traumatic Stress Disorders; Process; Productivity; Quality of life; Randomized; Randomized Controlled Trials; Relapse; Reporting; Research; Risk Factors; Safety; Severities; Short-Term Memory; Sleep; Sleep Disorders; Sleep disturbances; Sleeplessness; Stimulus; Symptoms; Testing; Treatment Efficacy; Treatment outcome; United States National Institutes of Health; Veterans; Work; alcohol abuse therapy; alcohol related consequences; alcohol related problem; alcohol response; alcohol use disorder; base; cognitive benefits; cost effectiveness; craving; drinking; effective therapy; emotion regulation; evidence base; falls; follow up assessment; follow-up; improved; innovation; interest; intervention effect; negative affect; pilot trial; post intervention; prevent; psychologic; public health relevance; recruit; reduce symptoms; relapse prediction; retention rate; satisfaction; service member; skills; sleep health; substance abuse treatment; sustained attention; tool; treatment as usual; treatment effect

PROJECT SUMMARY / ABSTRACT Alcohol use disorders (AUDs) are prevalent among Veterans and result in significant physical and psychological burden. Among those who receive treatment for AUDs, 1 in 3 relapses to problematic drinking within one year of treatment. Thus, additional strategies are needed to enhance alcohol treatment outcomes. One promising approach involves providing concurrent treatment for a common complaint – difficulty falling or staying asleep. As many as 63% of Veterans with AUDs report co-occurring symptoms of insomnia. Given the negative impact of insomnia on attention and emotion regulation, insomnia symptoms may decrease patients’ abilities to attend to alcohol treatment and manage negative emotions that lead to craving and relapse. Moreover, approximately 50% of individuals with AUDs report using alcohol to help them sleep, making relapse more likely for those with no other tools or skills to help them sleep. Indeed, sleep disturbance has been identified as a risk factor for relapse among individuals in alcohol treatment. Thus, effective treatment of sleep problems may enhance alcohol treatment for a substantial number of individuals with AUDs. Cognitive Behavioral Therapy for Insomnia (CBTi) has been effective in reducing insomnia severity in individuals with AUDs; however, no investigations have examined the efficacy of CBTi delivered concurrently with AUD treatment to determine its impact on treatment engagement. This R21 aims to examine the feasibility, acceptability, and initial efficacy of a CBTi supplement to ongoing outpatient alcohol treatment at the VA. We will conduct a randomized pilot trial with 80 Veterans who meet DSM-5 criteria for AUD and the episodic criterion for Insomnia Disorder. Participants will be randomly assigned to a minimal-treatment (education) control involving sleep hygiene education in addition to treatment as usual (eTAU; n = 40) or TAU+CBTi (n = 40). Outcomes will be assessed at the end of the active intervention period (6 weeks) and 6 weeks post- intervention. Outcomes of interest include recruitment and retention rates, treatment satisfaction, percentage of abstinent days, percentage of heavy drinking days, alcohol-related consequences, use of alcohol as a sleep aid, sleep efficiency, ability to sustain attention, working memory, negative affect, and emotion regulation. Data analyses will focus on size of treatment effects. Results will inform an R01 application to examine the efficacy, cost-effectiveness, and potential mechanisms of CBTi in preventing or delaying relapse to problematic drinking among Veterans with insomnia and AUDs. This study will provide initial evidence that treatment of insomnia not only improves sleep but also allows participants to derive greater benefit from intensive outpatient alcohol treatment.

项目摘要 /摘要 饮酒障碍（AUD）在退伍军人中普遍存在，并导致重要的物理 心理负担。 在提升的一年内，这里的其他策略可以增强酒精治疗结果。 一种有前途的方法涉及提供并发的信任 在有63％的退伍军人中，有63％的退伍军人报告了失眠的症状 失眠对注意力和情绪调节的负面影响，失眠症状可能会降低患者 接受酒精治疗并管理导致渴望和复发的负面情绪的能力。 此外，大约50％的酒精患者可以帮助他们入睡 对于那些没有其他工具或技能的人来说，更有可能帮助他们睡眠障碍。 被确定为在酒精治疗中个人复发的危险因素。 问题可能会增强大量aud的人的酒精治疗 失眠（CBTI）的行为疗法已有效减少失眠严重程度 但是，没有投资检查CBTI的功效 确定其对治疗参与的影响。 CBTI补充剂在VA中对饮酒的可接受性和初始功效 将与80名符合DSM-5 AUD标准的退伍军人进行随机试验试验 失眠症的标准将随机分配给最小的治疗（教育） 控制相关睡眠卫生教育除了往常（etau; n = 40）或tau+cbti（n = 40）将在主动干预期结束时进行评估（6周） 干涉。 节制的日子，大量饮酒日的百分比，与酒精相关的共和国，将酒精用作啤酒 援助，睡眠效率，维持及格的能力，工作记忆，负面影响和情绪调节。 分析将集中于治疗效果的大小。 成本效益和CBTI生产中CBTI的潜在机制或延迟饮酒的复发 在失眠和auds的退伍军人中。 不仅可以改善睡眠 治疗。