Integrated CBT for Co-Occurring PTSD and Substance Use Disorders

针对同时发生的 PTSD 和药物滥用障碍的综合 CBT

基本信息

批准号：
8282721
负责人：
Mark P McGovern
金额：
$ 34.53万
依托单位：
DARTMOUTH COLLEGE
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-09-01 至 2014-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8282721
关键词：
Address Alcohol or Other Drugs use Analgesics Behavior Therapy Behavioral Caring Clinic Clinical Cocaine Dependence Cognitive Cognitive Therapy Commit Communities Comorbidity DA10 Data Diagnosis Disease Dose Elements Exposure to Family Feasibility Studies Female Freedom Funding Goals Group Therapy Individual Intervention Measures Medical center Mental Health Military Personnel Modality Modeling Modification National Institute of Drug Abuse Outcome Outpatients Pain Patients Phase Population Positioning Attribute Post-Traumatic Stress Disorders Prevalence Protocols documentation Randomized Randomized Controlled Trials Recruitment Activity Research Research Personnel Resources Risk Safety Sampling Series Services Severities Specialist Staging Stimulus Substance Use Disorder Substance abuse problem Symptoms System Testing Translating Translations Trauma Universities Veterans Woman addiction base community setting experience follow-up improved male men operation phase 2 study pilot trial prescription drug abuse programs public health relevance response standard care substance abuse treatment therapy development treatment program trial comparing

项目摘要

DESCRIPTION (provided by applicant): Prevalence data indicate that military service men and women returning from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) suffer high rates of PTSD and substance use disorders. With these numbers expected to rise, the co-occurrence of these disorders presents added challenges to the Veterans Affairs treatment delivery system, presently in need of effective integrated treatments. This RO1 proposal is a direct response to NIDA RFA DA-10-001 "Substance use and abuse among U.S. military personnel, Veterans and their families." The overarching goal of the this application is to evaluate an integrated cognitive behavioral therapy (I-CBT) for co-occurring PTSD and substance use disorders among OEF/OIF Veterans. I-CBT has been found efficacious in community samples of men and women with this comorbidity, but needs testing for its application to Veterans Affairs (VA) patient samples and settings. To enhance potential translation to VA clinical settings, the intervention has been adapted for delivery in combined individual and group therapy formats. Within the framework of the NIDA stage model of behavioral therapy development, we propose to execute three specific aims within this Stage I research: 1) To evaluate the feasibility of I-CBT with a sample of 16 patients with co-occurring PTSD and substance use disorders, recruited from VA PTSD and substance abuse treatment program (SATP) clinics; and assessed on PTSD and substance use severity at baseline, 3- and 6-month follow-up (Phase I); 2) To make modifications and improvements to the I-CBT based on feasibility study outcomes and qualitative study (Phase II); and 3) To conduct a randomized controlled pilot trial (n=64) comparing I-CBT plus standard care (n=32) versus standard care only (n=32) on measures of PTSD and substance use severity at baseline, 3-month and 6-month follow-up (Phase III). Although there have been two other behavioral therapies for co-occurring PTSD and substance use developed and tested, these treatments have not been found effective versus comparison conditions, have moderate to poor retention rates, have been studied with female civilians only, and have not been integrated within existing treatment services. The present proposal builds upon a series of successfully completed studies by the PI, implementing a cognitive behavioral therapy (CBT) for co-occurring PTSD and substance use disorders in community clinics. The research team is uniquely experienced and well-positioned to execute the research as proposed. It consists of investigators from Dartmouth, the National VA Center for PTSD, Brown University, and the Providence VA Medical Center. The findings from this research have the potential for immediate and broad impact by providing an effective and readily translated behavioral therapy option for OEF/OIF Veterans with co- occurring substance use and posttraumatic stress disorders. PUBLIC HEALTH RELEVANCE: Among Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) Veterans, co-occurring substance use and posttraumatic stress disorders are common and associated with negative outcomes. The specific aims of the present research are to evaluate an integrated cognitive behavioral group therapy (I-CBT) for co-occurring PTSD and substance use disorders. The overarching goal is to test I-CBT in Veterans Affairs (VA) clinical settings, with the eventual impact of improving outcomes for OEF/OIF Veterans with this co-morbidity.

描述（由申请人提供）：患病率数据表明，从伊拉克自由行动 (OIF) 和持久自由行动 (OEF) 返回的军人中患有创伤后应激障碍 (PTSD) 和药物滥用障碍的比例很高。随着这些数字预计会上升，这些疾病的同时发生给退伍军人事务部的治疗提供系统带来了额外的挑战，目前需要有效的综合治疗。该 RO1 提案是对 NIDA RFA DA-10-001“美国军事人员、退伍军人及其家人的药物使用和滥用”的直接回应。该应用程序的总体目标是评估针对 OEF/OIF 退伍军人同时发生的 PTSD 和物质使用障碍的综合认知行为疗法 (I-CBT)。已发现 I-CBT 在患有这种合并症的男性和女性社区样本中有效，但需要对其在退伍军人事务部 (VA) 患者样本和环境中的应用进行测试。为了增强在 VA 临床环境中的潜在转化，该干预措施已进行了调整，以结合个人和团体治疗的形式进行。在行为治疗发展的 NIDA 阶段模型框架内，我们建议在第一阶段研究中执行三个具体目标： 1) 以 16 名同时患有 PTSD 和物质使用的患者为样本，评估 I-CBT 的可行性疾病，从 VA PTSD 和药物滥用治疗计划 (SATP) 诊所招募；并在基线、3 个月和 6 个月的随访（第一阶段）时评估 PTSD 和物质使用严重程度； 2）根据可行性研究成果和定性研究（第二阶段）对I-CBT进行修改和完善； 3) 进行一项随机对照试验（n=64），比较 I-CBT 加标准护理（n=32）与仅标准护理（n=32）在基线、3 个月时的 PTSD 和物质使用严重程度的测量和 6 个月的随访（第三阶段）。尽管已经开发和测试了另外两种针对同时发生的 PTSD 和物质使用的行为疗法，但这些疗法尚未发现与比较条件相比有效，保留率中等至较差，仅针对女性平民进行了研究，并且尚未被证实。整合到现有的治疗服务中。目前的提案建立在 PI 成功完成的一系列研究的基础上，在社区诊所针对同时发生的 PTSD 和物质使用障碍实施认知行为疗法 (CBT)。研究团队拥有独特的经验和优势，能够按照提议执行研究。它由来自达特茅斯、国家退伍军人管理局创伤后应激障碍中心、布朗大学和普罗维登斯退伍军人管理局医疗中心的研究人员组成。这项研究的结果有可能产生直接和广泛的影响，为同时患有药物滥用和创伤后应激障碍的 OEF/OIF 退伍军人提供有效且易于转化的行为治疗选择。公共卫生相关性：在伊拉克自由 (OIF) 和持久自由行动 (OEF) 退伍军人中，同时发生的药物滥用和创伤后应激障碍很常见，并且与负面结果相关。本研究的具体目的是评估针对同时发生的 PTSD 和物质使用障碍的综合认知行为团体疗法 (I-CBT)。总体目标是在退伍军人事务部 (VA) 临床环境中测试 I-CBT，最终改善患有这种共病的 OEF/OIF 退伍军人的结果。