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：
8132471
负责人：
Mark P McGovern
金额：
$ 36.35万
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/8132471
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）返回的兵役男女患有PTSD和药物使用障碍的率高。随着这些数字预计会增加，这些疾病的同时出现给退伍军人事务处理系统带来了挑战，目前需要有效的综合治疗。该RO1提案是对NIDA RFA DA-10-001的直接回应，“美国军事人员，退伍军人及其家人之间的吸毒和滥用”。该应用程序的总体目标是评估用于PTSD的共同认知行为疗法（I-CBT）和OEF/OIF退伍军人之间的物质使用障碍。 I-CBT在具有这种合并症的男性和女性的社区样本中被发现有效，但需要测试其在退伍军人事务（VA）患者样本和环境中的应用。为了增强对VA临床环境的潜在翻译，该干预措施已被调整以以组合的个体和小组治疗格式进行。在NIDA阶段开发的NIDA阶段模型的框架内，我们建议在此阶段内执行三个特定目标：1）评估I-CBT的可行性，并通过16例共发生的PTSD患者和药物使用障碍，并从VA PTSD和药物滥用治疗计划（SATP）临床招募；并在基线，3个月和6个月的随访（I阶段）时对PTSD和物质使用严重程度进行评估； 2）基于可行性研究结果和定性研究（第二阶段）对I-CBT进行修改和改进； 3）在基线，3个月和6个月的随访（III阶段）时，对I-CBT加标准护理（n = 32）的随机对照试验（n = 64）进行了比较I-CBT加标准护理（n = 32）与仅标准护理（n = 32）进行比较（n = 32）。尽管还有另外两种用于同时发生的PTSD的行为疗法和开发和测试的药物使用，但尚未发现这些治疗方法与比较条件相比有效，保留率中度至差，仅与女性平民进行了研究，并且尚未在现有治疗服务中融合。本提案建立在PI的一系列成功完成研究的基础上，在社区诊所实施了对PTSD的认知行为疗法（CBT）和同时发生的PTSD和药物使用障碍。研究团队具有独特的经验和良好的作用，可以按照提议的方式执行研究。它由达特茅斯（Dartmouth），弗吉尼亚州国家PTSD国家中心，布朗大学和普罗维登斯·弗吉尼亚州医学中心的调查人员组成。这项研究的发现有可能立即产生直接和广泛的影响，通过为OEF/OIF退伍军人提供有效的行为疗法选择，并具有同事使用的药物使用和创伤后应激障碍。公共卫生相关性：在伊拉克自由（OIF）和持久自由（OEF）的行动中，同时发生的物质使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用于同时发生的PTSD和药物使用障碍的综合认知行为群体治疗（I-CBT）。总体目标是在退伍军人事务（VA）临床环境中测试I-CBT，并最终会通过这种共同多发性改善OEF/OIF退伍军人结果的影响。