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.

项目概要/摘要 大量饮酒在归来的退伍军人中很普遍，会导致严重的身体和心理问题 五分之一的回国退伍军人筛查出过去一年可能存在的酒精使用障碍（AUD）呈阳性，以及 此外，很少有人对心理健康治疗抱有积极的信念。 在该人群中表现出有限的疗效，因此需要额外的策略来参与和治疗。 可能面临澳元风险的回国退伍军人 超过一半的回国退伍军人筛查结果呈阳性。 有害饮酒报告了临床上显着的失眠症状。 与酒精相关问题的风险增加有关，可能是由于失眠相关的损害 执行功能、消极情绪、对酒精的渴望以及使用酒精作为睡眠辅助剂。 提出的 K23 旨在确定一线治疗失眠的效用（认知行为 失眠疗法（CBT-I）可减少回归退伍军人的饮酒和相关问题。 四名返回的退伍军人在酒精使用障碍识别测试中表明存在饮酒问题的风险 （女性/男性 AUDIT-C 评分≥4/5）并且根据 DSM-5 和研究诊断标准存在失眠 将参加一项随机试点试验，参与者将被随机分配接受个性化治疗。 在两种治疗条件之一的背景下的规范性酒精反馈：CBT-I（n = 22）或时间- 匹配的行为安慰剂治疗（BPT；n = 22）将在活动结束时进行评估。 干预期（6 周）、治疗中期（3 个疗程后）和干预后 3 个月的结果。 感兴趣的包括失眠严重程度、总清醒时间、睡眠质量、饮酒量/频率、酒精相关 后果、执行功能、负面影响、情绪调节、对酒精的渴望以及使用 这项研究将为米勒博士提供以下方面的指导培训：(1) 方法论。 多时段失眠治疗研究，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) 执行功能评估； 纵向混合效应建模将在一支令人印象深刻的团队的指导下进行。 拟议的 5 年职业发展计划将促进米勒博士的专业领域。 向独立研究过渡，为她提供以下技能：(a) 成功竞争联邦资助 进行高质量的研究，(b) 增进我们对 AUD 病因学的理解，以及 (c) 做出贡献 独特的酒精成瘾预防和治疗研究旨在减少酒精成瘾。 通过提高有效药物的可用性，减少退伍军人中与大量饮酒相关的危害 它将影响我们对 CBT-I 益处的理解，并且它具有创新性，因为它可以评估。 改善失眠是改善 AUD 的一种机制，这项研究与 NIAAA 的研究结果一致。 旨在评估和促进预防不同人群中 AUD 进展的干预措施。