This application addresses the Broad Challenge Area: (05) Comparative Effectiveness Research and the Specific Challenge Topic 05-AA-103*: Use of Innovative Technologies in Alcohol Treatment Research. A substantial number of military personnel who have served in Iraq (Operation Iraqi Freedom;OIF) and Afghanistan (Operating Enduring Freedom;OEF) report alcohol misuse and symptoms of posttraumatic stress disorder (PTSD) following their return home, similar to veterans of previous wars. However, many returning veterans are reluctant to seek treatment for alcohol or other mental health problems, often citing barriers to care that include concerns about stigma and the inconvenience of treatment. Web-based technologies offer a potentially time-efficient, low cost and confidential venue for delivery of evidence-based therapies to veterans who might otherwise not receive care, and to a larger community of non-veterans with alcohol problems.
The specific aims of this study are: 1) to develop a Web-based intervention for OIF/OEF veterans focused on problem drinking and 2) to conduct a controlled clinical trial that evaluates the efficacy of this specialized Web- based intervention to reduce alcohol use, alcohol problems and PTSD symptoms. The intervention will utilize evidence-based approaches for problem drinking and PTSD and be tailored to OIF/OEF veterans. For veterans who report problem drinking and symptoms of PTSD related to their military experience, strategies will be offered to reduce drinking as well as manage PTSD symptoms. We will recruit 200 veterans for the study. Following an initial web screening, eligible participants will be randomly assigned to either an Initial Intervention group (IIG) or a Delayed Intervention group (DIG). Participants in IIG will have access to the intervention immediately following randomization and allowed up to eight weeks to complete the intervention. Participants in DIG group will begin the intervention in Week nine. All participants will complete at least three assessments: 1) baseline prior to randomization, 2) end of the intervention, and 3) three months post- intervention. Participants in DIG group will complete a second baseline assessment in Week eight at time they begin the intervention. This will serve as a comparison point to the IIG post-intervention assessment. Primary outcomes include changes in alcohol use, alcohol problems and trauma symptoms from pre-intervention to post-intervention. We hypothesize that the IIG group will show a greater decrease in alcohol use, alcohol problems and trauma symptoms than the DIG group during the initial period. Within-group analyses of changes from pre- to post- to 3 month follow up will determine short-term durability effects. We will conduct exploratory analyses to examine the impact of combat exposure, trauma symptom severity, gender, race/ethnicity, age, and service branch on drinking outcomes. The long-term objective of this line of research is to develop low cost, accessible interventions for individuals with alcohol problems who have been exposed to all types of traumatic events. Although this study is specific to veterans, the results should improve our general knowledge about intervening on the web with problem drinkers who report a history of other types of trauma. This project will build a Web-based treatment program for returning veterans with alcohol problems and symptoms of combat-related symptoms of post-traumatic stress disorder. This is important because some veterans have difficulty accessing treatment because of distance or other factors. Creating a computerized program also guarantees that the program is delivered as it is designed, and can be used by many more people than can be seen by a therapist.
This project will build a Web-based treatment program for returning veterans with alcohol problems and symptoms of combat-related symptoms of post-traumatic stress disorder. This is important because some veterans have difficulty accessing treatment because of distance or other factors. Creating a computerized program also guarantees that the program is delivered as it is designed, and can be used by many more people than can be seen by a therapist.
