Evaluating the Efficacy of Telehealth-Delivered Brief Family Involved Treatment (B-FIT) for Alcohol Use Disorder among Veterans

评估远程医疗提供的短期家庭参与治疗 (B-FIT) 对退伍军人酒精使用障碍的疗效

• 批准号: 10705831
• 负责人: JULIANNE Christina Flanagan
• 金额: $ 67.03万
• 依托单位: MEDICAL UNIVERSITY OF SOUTH CAROLINA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-16 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10705831
• 关键词: Abstinence; Acceleration; Adherence; Age; Alcohol consumption; Alcohols; Appointment; Area; Back; Behavior; Behavioral; Characteristics; Clinic; Clinical; Cognitive Therapy; Collaborations; Communication; Complex; Couples; Couples Therapy; Cues; Data; Diagnosis; Economics; Effectiveness; Enrollment; Etiology; Exclusion; Family; Family Characteristics; Family member; Family psychotherapy; General Population; Goals; Health; Health Expenditures; Health Services Accessibility; Health Technology; Healthcare Systems; Home; Individual; Infrastructure; Intervention; Literature; Manuals; Measures; Mediating; Mediator; Medical Records; Mental Depression; Mental Health; Methods; Mission; Modality; Modeling; National Institute on Alcohol Abuse and Alcoholism; Outcome; Participant; Patients; Persons; Play; Population; Post-Traumatic Stress Disorders; Prevalence; Procedures; Provider; Psychological reinforcement; Public Health; Qualifying; Randomized; Randomized, Controlled Trials; Recovery; Relapse; Research; Rewards; Role; Rural; Rural Community; Schedule; Science; Standardization; Strategic Planning; Symptoms; System; Time; Translating; Treatment Protocols; Treatment outcome; Veterans; Videoconferencing; Woman; acceptability and feasibility; alcohol abuse therapy; alcohol availability; alcohol effect; alcohol reinforcement; alcohol use disorder; clinical practice; comparative efficacy; cost; design; diagnostic criteria; drinking; eHealth; efficacy evaluation; evidence base; family support; health disparity populations; high risk; improved; innovation; meetings; member; pilot trial; prevent; programs; public health priorities; randomized controlled design; satisfaction; sex; telehealth; therapy design; treatment as usual; treatment program; underserved community

ABSTRACT Improving alcohol use disorder (AUD) treatment access and outcomes among Veterans is an urgent public health priority. The lifetime prevalence of AUD among Veterans is twice that of civilians. Veterans also incur more severe and persistent AUD symptoms with more lengthy and complex treatment courses and negative outcomes compared to the general population. Despite the critical role that family members play in the etiology, course, and treatment of AUD, and the robust evidence base supporting the efficacy of several existing family AUD treatments, family treatment protocols are lengthy and burdensome for patients and clinicians. Thus, there is a critical need to develop efficacious family AUD treatments that are both brief and highly accessible to Veterans. Members of our team developed and refined the Brief Family Involved Treatment (B-FIT) protocol in an NIAAA-sponsored pilot trial among civilians. B-FIT is a 3-session cognitive behavioral therapy designed to be implemented in combination with any existing alcohol treatment program. The goals of B-FIT are to 1) increase reinforcement of treatment-facilitating behaviors, 2) increase the perceived reinforcement value of abstinence by increasing anticipated positive rewards from abstinence, and 3) reduce drinking cues by decreasing negative communication and increasing positive communication with family members. This study resulted in findings that support feasibility, acceptability, and preliminary efficacy of B-FIT. In a separate study, our team has demonstrated excellent feasibility and acceptability of delivering dyadic AUD treatment via home-based telehealth. Thus, the primary objective of this Stage II trial is to examine the efficacy of B-FIT in combination with treatment as usual (TAU; VA Substance Treatment and Recovery [STAR]) versus TAU alone in 1) reducing alcohol consumption, 2) improving family functioning, and 3) improving STAR treatment satisfaction, adherence, and retention among Veterans. To accomplish this, we will employ an open randomized controlled design and examine standardized, repeated, dependent measures of change at multiple time points. We will also leverage our team’s standard operating procedures for fully remote study implementation, close collaboration with regional VA STAR clinics, and a robust national VA telehealth infrastructure which is prepared to efficiently translate positive findings into treatment. The proposed study is directly aligned with NIAAA’s mission and Strategic Plan in that it will 1) employ electronic health technology to improve the effectiveness and accessibility of AUD treatment for Veterans, 2) will advance AUD treatment access among rural and underserved Veterans, who are a health disparity population, 3) focuses on Veterans in a real-world treatment setting (i.e., VA STAR clinics), 4) examines B-FIT for home-based telehealth delivery, and 4) will identify characteristics of Veterans and family members most likely to benefit from the addition of B-FIT to their recovery program. Our findings will directly inform clinical practice and accelerate treatment in this important but understudied area.

抽象的 改善酒精使用障碍（AUD）治疗访问和退伍军人的结果是紧急公众 健康优先级。退伍军人中AUD的终身患病率是平民的两倍。退伍军人也会发生 更严重和持续的AUD症状，具有更长，更复杂的治疗课程和负面的症状 与一般人群相比，结果。尽管家庭成员在病因中起着至关重要的作用，但 AUD的课程和处理，以及支持几个现有家庭效率的强大证据基础 对于患者和临床医生而言，AUD治疗，家庭治疗方案是漫长而朴素的。那，那里 是开发有效的家庭aud治疗的迫切需要，既简短又可以使用 退伍军人。我们团队的成员开发并完善了涉及治疗的简短家庭（B-FIT）方案 NIAAA赞助的平民试点审判。 B-Fit是一种三阶段的认知行为疗法 与任何现有的酒精治疗计划结合实施。 B型的目标是1）增加 加强治疗方案行为，2）增加戒酒的增强价值 戒酒的预期积极奖励增加，3）减少负面的饮酒线索 沟通和与家人的积极沟通不断增加。这项研究导致发现 支持B拟合的可行性，可接受性和初步效率。在另一项研究中，我们的团队有 证明了通过基于家庭的二元aud处理的出色可行性和可接受性 远程医疗。这是这一阶段II试验的主要目的是检查B拟合的效率与 像往常 饮酒，2）改善家庭功能，3）提高恒星治疗满意度，依从性， 和退伍军人之间的保留。为此，我们将采用开放的随机控制设计和 检查在多个时间点上的标准化，重复的，依赖性的变化度量。我们还将利用 我们团队的标准操作程序，用于完全远程学习实施，与区域密切合作 VA星级诊所和一个强大的国家VA远程医疗基础设施，准备有效翻译 对治疗的积极发现。拟议的研究与NIAAA的使命和战略计划直接一致 这将是1）员工电子健康技术以提高AUD的有效性和可及性 对退伍军人的治疗，2）将在粗糙和服务不足的退伍军人中促进AUD治疗访问 健康差异人群，3）专注于现实世界中治疗环境中的退伍军人（即VA星诊所），4） 检查基于家庭远程医疗的B型，4）将确定退伍军人和家人的特征 成员最有可能受益于在其恢复计划中加入B-Fit。我们的发现将直接 为临床实践提供信息，并在这个重要但知识的领域加速治疗。