A Mobile App to Address Co-Occurring Sleep Problems and Heavy Alcohol Use among Veterans Outside of Care Settings

一款解决退伍军人在护理机构之外同时发生的睡眠问题和酗酒问题的移动应用程序

• 批准号: 10647530
• 负责人: Eric Roland Kuhn
• 金额: $ 25.98万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-15 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10647530
• 关键词: Address; Affect; Aftercare; Alcohol consumption; Alcohols; American; Behavior; Behavioral; Caring; Cognitive Therapy; Data; Disease; Ethnic Origin; Exclusion; Exclusion Criteria; Frequencies; Goals; Health Services Accessibility; Healthcare; Healthcare Systems; Heavy Drinking; Individual; Intervention; Interview; Learning; Link; Mediating; Mental Depression; Mental Health; Military Personnel; Motivation; Occupational; Outcome; Participant; Persons; Phase; Population; Post-Traumatic Stress Disorders; Prevalence; Prevention strategy; Public Health; Race; Randomized, Controlled Trials; Reporting; Research; Risk; Sampling; Schedule; Self Direction; Sleep; Sleep Disorders; Sleeplessness; Stigmatization; Surveys; Symptoms; Technology; Testing; Transportation; Treatment outcome; Underserved Population; Veterans; Veterans Health Administration; Woman; Work; alcohol consequences; alcohol misuse; alcohol use disorder; barrier to care; behavioral health; brief alcohol intervention; care seeking; comparison control; drinking; drinking behavior; dual diagnosis; efficacy evaluation; efficacy testing; ethnic minority; evidence base; follow-up; health communication; high risk; improved; improvement on sleep; interest; intervention delivery; intervention effect; marijuana use disorder; meetings; military veteran; mobile application; mobile computing; normative feedback; novel; physical conditioning; post 9/11; preference; primary outcome; racial minority; recruit; relapse prevention; secondary outcome; sex; sleep health; sleep quality; social media; social stigma; standard care; substance use; telehealth; treatment as usual; usability; willingness

PROJECT SUMMARY/ABSTRACT The long-term goal of this proposal is to improve treatment outcomes for post 9/11 veterans with alcohol use disorder (AUD) and insomnia who are not currently accessing care through the Veterans Affairs Healthcare System (VA) or other settings. Many post-9/11 veterans struggle with AUD and this can be especially pronounced with the co-occurrence of insomnia. With upwards of 50% of veterans who have behavioral health needs not seeking treatment, it is imperative to utilize advances in technology to develop and test interventions that can reach non-treatment seeking veterans and target both symptoms of insomnia and AUD. CBT-I is the first line of treatment for insomnia, and it has been found to improve insomnia symptoms among veterans and other populations across a number of studies. However, very little research has examined the efficacy of CBT-I in addressing AUD symptoms; indeed, AUD is often a criterion excluding individuals from CBT-I trials. CBT-I is often delivered individually, in groups, or face-to-face over telehealth, yet these formats do little to reach veterans with insomnia and AUD that do not seek behavioral health care. Therefore, we propose to beta test and conduct a pilot randomized controlled trial of a promising mobile app for addressing insomnia among veterans (Insomnia Coach), enhanced with evidence-based brief alcohol intervention content, among post 9/11 veterans with insomnia and AUD that are outside of treatment settings. The engaging and easy-to-use mobile app integrates aspects of CBT-I with brief alcohol intervention content (e.g., drinking normative feedback, relapse prevention strategies) to improve upon both AUD and insomnia symptoms, which often go unaddressed in treatments focused on a single disorder, but are necessary to target in integrated treatments due to the interplay of AUD and insomnia symptoms. This project contains four aims: (1) refine and add brief alcohol intervention content to the popular VA-developed Insomnia Coach mobile app and test usability, feasibility, and acceptability of the app in a beta testing phase, (2) test the efficacy of the enhanced Insomnia Coach on alcohol use and insomnia outcomes compared to control, (3) assess mechanisms of change to learn how and for whom the intervention works best, and (4) explore the intervention's potential to increase treatment initiation (willingness to seek care, preparatory behaviors) among veterans with AUD who are often difficult to engage in care due to logistical and stigma-related barriers. The unique strengths of this proposal are its focus on an underserved population (including targeted recruitment of women and racial/ethnic minority veterans), utilization of mobile technology for intervention delivery to overcome barriers to care, and use of a novel integrated intervention to target both AUD and insomnia. This study intends to produce a viable, evidence-based, and easy-to-access treatment that can have substantial impacts on substance use outcomes.

项目概要/摘要 该提案的长期目标是改善 9/11 后酗酒退伍军人的治疗结果 目前未通过退伍军人事务医疗保健机构获得护理的疾病（澳元）和失眠 系统 (VA) 或其他设置。许多 9/11 后的退伍军人都在与澳元作斗争，这尤其重要 与失眠同时发生而明显。超过 50% 的退伍军人行为健康 不需要寻求治疗，必须利用技术进步来开发和测试干预措施 可以覆盖未寻求治疗的退伍军人，并针对失眠和 AUD 症状。 CBT-I 是 失眠的一线治疗方法，已被发现可以改善退伍军人和老年人的失眠症状 多项研究中的其他人群。然而，很少有研究检验 CBT-I 的功效 解决 AUD 症状；事实上，AUD 通常是一个将个人排除在 CBT-I 试验之外的标准。 CBT-I 是 通常是单独、分组或通过远程医疗面对面提供，但这些形式几乎没有影响到 患有失眠和 AUD 且不寻求行为健康护理的退伍军人。因此，我们建议进行 beta 测试 并对一款有前途的移动应用程序进行试点随机对照试验，以解决失眠问题 9/11 事件后，退伍军人（失眠教练）通过基于证据的简短酒精干预内容得到增强 患有失眠和未接受治疗的 AUD 的退伍军人。引人入胜且易于使用的移动设备 应用程序将 CBT-I 的各个方面与简短的酒精干预内容（例如饮酒规范反馈、 复发预防策略）以改善 AUD 和失眠症状，这些症状经常会发生 在针对单一疾病的治疗中未得到解决，但在综合治疗中需要针对该问题 由于 AUD 和失眠症状的相互作用。该项目包含四个目标：（1）细化和补充概要 VA 开发的 Insomnia Coach 移动应用程序中的酒精干预内容并测试可用性， 应用程序在 Beta 测试阶段的可行性和可接受性，(2) 测试增强版 Insomnia 的功效 与对照相比，指导饮酒和失眠结果，(3) 评估学习的改变机制 干预措施如何以及对谁最有效，以及（4）探索干预措施的潜力 患有 AUD 的退伍军人的治疗开始（寻求护理的意愿、准备行为） 由于后勤和耻辱相关的障碍，难以参与护理。该提案的独特优势 其重点是否是服务不足的人群（包括有针对性地招募妇女和少数种族/族裔） 退伍军人），利用移动技术进行干预以克服护理障碍，以及使用 针对 AUD 和失眠的新型综合干预措施。这项研究旨在产生一种可行的、 基于证据且易于获得的治疗，可以对药物使用结果产生重大影响。