The Impact of Insomnia Treatment on Heavy Alcohol Use among Returning Veterans

失眠治疗对退伍军人酗酒的影响

• 批准号: 10224837
• 负责人: Mary Elizabeth Miller
• 金额: $ 17.91万
• 依托单位: UNIVERSITY OF MISSOURI-COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-05 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10224837
• 关键词: Afghanistan; Aftercare; Alcohol abuse; Alcohol consumption; Alcohol dependence; Alcohols; Animals; Area; Behavior; Behavior Therapy; Behavioral; Behavioral trial; Belief; Clinical; Clinical Trials; Cognitive Therapy; DSM-V; Decision Making; Development Plans; Diagnostics Research; Emotional; Etiology; Evaluation; Evidence based treatment; Feedback; Foundations; Frequencies; Funding; Future; Goals; Health Care Costs; Heavy Drinking; Impairment; Individual; Intervention; Intervention Studies; Iraq; Lead; Measures; Mediator of activation protein; Mental Health; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methodology; Modeling; National Institute on Alcohol Abuse and Alcoholism; Outcome; Participant; Pathway interactions; Pharmacological Treatment; Placebos; Population; Population Heterogeneity; Prevention Research; Public Health; Randomized; Relapse; Reporting; Research; Risk; Severities; Short-Term Memory; Sleep; Sleep Disorders; Sleeplessness; Solid; Strategic Planning; Symptoms; Testing; Time; Training; United States; Update; Veterans; Vulnerable Populations; Woman; acceptability and feasibility; actigraphy; alcohol comorbidity; alcohol craving; alcohol related consequences; alcohol related problem; alcohol risk; alcohol use disorder; base; brief alcohol intervention; brief intervention; career; career development; clinical practice; clinically significant; college; coping; craving; diaries; discounting; drinking; efficacious treatment; efficacy testing; emotion regulation; evidence base; executive function; experience; feasibility testing; follow-up; hazardous drinking; improved; innovation; interest; men; military veteran; negative affect; novel; pilot trial; poor sleep; post intervention; prevent; psychologic; public health relevance; recruit; reduce symptoms; reduced alcohol use; response; satisfaction; sedative; skills; sleep health; sleep quality; social stigma; treatment research; trial design; university student

PROJECT SUMMARY / ABSTRACT Heavy alcohol use is prevalent among returning Veterans and results in significant physical and psychological burden. One in five returning Veterans screens positive for probable past-year alcohol use disorder (AUD), and few hold positive beliefs about mental health treatment. Moreover, brief interventions for alcohol use demonstrate limited efficacy within this population. Thus, additional strategies are needed to engage and treat returning Veterans who may be at risk for AUD. More than half of returning Veterans who screen positive for hazardous drinking report clinically significant symptoms of insomnia. In turn, insomnia symptoms have been associated with increased risk of alcohol-related problems, perhaps due to insomnia-related impairments in executive functioning, negative emotionality, craving for alcohol, and use of alcohol as a sleep aid. The proposed K23 aims to determine the utility of the first line of treatment for insomnia (Cognitive Behavioral Therapy for Insomnia or CBT-I) in reducing alcohol use and related problems among returning Veterans. Forty- four returning Veterans who indicate risk for problem drinking on the Alcohol Use Disorders Identification Test (AUDIT-C scores ≥4/5 for women/men) and have insomnia based on DSM-5 and research diagnostic criteria will participate in a randomized pilot trial. Participants will be randomly assigned to receive personalized normative alcohol feedback in the context of one of two treatment conditions: CBT-I (n = 22) or a time- matched Behavioral Placebo Treatment (BPT; n = 22). Outcomes will be assessed at the end of the active intervention period (6 weeks), mid-treatment (after 3 sessions), and at 3 months post-intervention. Outcomes of interest include insomnia severity, total wake time, sleep quality, drinking quantity/frequency, alcohol-related consequences, executive functioning, negative affect, emotion regulation, craving for alcohol, and use of alcohol as a sleep aid. This research will provide Dr. Miller with mentored training in (1) the methodology of multi-session insomnia treatment research, including daily assessment and mechanistic behavioral trial design; (2) the interplay of sleep and alcohol use disorders; (3) assessment of executive functioning; and (4) longitudinal mixed effects modeling. Training will take place under the mentorship of an impressive team with complimentary areas of expertise. The proposed 5-year career development plan will facilitate Dr. Miller’s transition to independent research by providing her the skills to (a) compete successfully for federal funding to conduct high-quality research, (b) advance our understanding of the etiology of AUD, and (c) contribute uniquely to alcohol addiction prevention and treatment research. The proposed research aims to reduce the harms associated with heavy alcohol use among Veterans by improving the availability of efficacious treatment. It will impact our understanding of the benefits of CBT-I, and it is innovative because it evaluates improvement in insomnia as a mechanism for improvements in AUD. This research is consistent with NIAAA’s initiative to evaluate and promote interventions that prevent the progression of AUD in diverse populations.

项目摘要 /摘要 返回的退伍军人中，大量的饮酒是普遍的，并导致了大量的身体和心理 伯恩。五分之一的返回退伍军人筛选了可能过去一年的饮酒障碍（AUD）和 很少有关于心理健康治疗的积极信念。此外，简短的饮酒干预措施 在该人群中证明效率有限。那需要其他策略来参与和治疗 退回可能有AUD风险的退伍军人。超过一半的退休退伍军人，他们的阳性阳性 危险饮酒报告临床上重要的失眠症状。反过来，失眠症状已经 与与酒精有关的问题的风险增加相关，这可能是由于与失眠有关的障碍 执行功能，负面情绪，渴望酒精以及将酒精用作睡眠援助。这 拟议的K23旨在确定失眠的第一线治疗的实用性（认知行为 用于减少退伍军人中饮酒和相关问题的失眠或CBT-I的治疗。四十- 四名返回的退伍军人表明在酒精使用障碍识别测试中饮酒的风险 （女性/男性审核-C分数≥4/5），并且基于DSM-5和研究诊断标准有失眠 将参加一项随机试验试验。参与者将被随机分配接受个性化 在两个治疗条件之一的背景下，正常酒精反馈：CBT-I（n = 22）或时间 - 匹配的行为安慰剂治疗（BPT; n = 22）。结果将在活动结束时进行评估 干预期（6周），中期治疗（3个课程后）和干预后3个月。结果 感兴趣的包括失眠严重程度，总唤醒时间，睡眠质量，饮酒量/频率，与酒精有关 后果，执行功能，负面影响，情绪调节，渴望酒精以及使用 酒精作为睡眠援助。这项研究将为米勒博士提供（1）的指导培训 多课程失眠治疗研究，包括日常评估和机械行为试验设计； （2）睡眠和酒精使用障碍的相互作用； （3）评估执行功能； （4） 纵向混合效应建模。培训将在一个令人印象深刻的团队的指导下进行 免费专业领域。拟议的5年职业发展计划将促进米勒博士的 通过为她提供（a）成功竞争联邦资金的技能来过渡到独立研究 进行高质量的研究，（b）提高我们对AUD病因的理解，（c）贡献 独特地预防酒精成瘾和治疗研究。拟议的研究旨在减少 通过提高有效的可用性，与退伍军人之间的大量酒精相关的危害 治疗。它将影响我们对CBT-I的好处的理解，并且具有创新性，因为它评估了 改善失眠症，作为改善AUD的机制。这项研究与NIAAA一致 评估和促进干预措施的倡议，以防止在潜水员人群中AUD的发展。