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.

项目摘要/摘要 该提案的长期目标是改善9/11后退伍军人使用酒精的治疗结果 障碍（AUD）和失眠，他们目前未通过退伍军人事务医疗保健获得护理 系统（VA）或其他设置。许多9/11后退伍军人与AUD斗争，尤其是 与失眠的同时发生发音。有50％的退伍军人拥有行为健康 不需要寻求治疗，必须利用技术进步来制定和测试干预措施 这可以达到未治疗的寻求退伍军人，并针对失眠和AUD的症状。 CBT-I是 失眠的第一道治疗，发现它可以改善退伍军人和 在许多研究中的其他人群。但是，很少的研究检查了CBT-I的功效 在解决AUD症状时；实际上，AUD通常是不包括CBT-I试验中的个人的标准。 CBT-I是 通常以小组或对远程医疗面对面的单独交付，但这些格式几乎没有达到 失眠和AUD的退伍军人不寻求行为医疗保健。因此，我们建议进行Beta测试 并进行了有前途的移动应用程序的飞行员随机对照试验，以解决失眠 在9/11之后，退伍军人（失眠教练）通过基于证据的简短酒精干预含量增强 失眠和AUD的退伍军人在治疗环境之外。引人入胜且易于使用的手机 应用程序将CBT-I的各个方面与短暂的酒精干预含量（例如，饮酒规范反馈， 预防复发策略）可以改善AUD和失眠症状，通常会发生 在关注单一疾病的治疗方法中未得到解决，但对于综合治疗的目标是必不可少的 由于AUD和失眠症状的相互作用。该项目包含四个目的：（1）完善并添加简短 酒精干预内容涉及流行的VA开发的失眠教练移动应用程序并测试可用性， 在Beta测试阶段的可行性和应用程序的可接受性，（2）测试增强失眠的功效 与对照相比，（3）评估学习的机制相比，饮酒和失眠结果教练 干预措施的方式和最适合谁，以及（4）探索干预措施增加的潜力 经常是AUD的退伍军人中的治疗启动（愿意寻求护理，准备行为） 由于后勤和污名相关的障碍，很难进行护理。该提议的独特优势 它的专注于服务不足的人口（包括针对妇女的目标招募和种族/族裔少数民族 退伍军人），利用移动技术来干预交付以克服护理的障碍和使用 新颖的综合干预措施以靶向AUD和失眠。这项研究打算产生可行的， 基于证据的且易于访问的治疗，可能会对物质使用结果产生重大影响。