Persons with alcohol use disorders are three times more likely to have a co-occurring psychiatric disorder than those without alcohol use diagnoses. Co-occurring alcohol and psychiatric disorders are highly prevalent in clinical settings and, relative to those with a single disorder alone, these patients have more challenging treatment and recovery experiences. Integrated treatments result in more favorable outcomes, yet these services are not widely available. This is a revised R21 application, Integrating combined therapies for persons with co-occurring disorders. We propose to evaluate an integrated adaptation of the Combined Behavioral Intervention (CBI) from NIAAA Project COMBINE. CBI features three evidence-based behavioral therapies: Motivational Enhancement Therapy (MET), Cognitive Behavioral Therapy (CBT) and Twelve Step Facilitation Therapy (TSF). We adapted CBI into a novel manual-guided intervention for co-occurring psychiatric and substance-related problems. Integrating Combined Therapies (ICT) is an individual-format treatment designed to be transferable to routine care settings and for delivery by the existing workforce. A small pilot study supported the clinical promise of ICT as well as its safety and practicality. In the research now proposed, we will randomly assign 76 eligible patients in community outpatient addiction treatment to ICT adapted standard care versus standard care only. Primary outcomes will be assessed at baseline, 3-, and 6- month follow-up periods. We hypothesize that ICT adapted standard care will demonstrate improved alcohol, drug and psychiatric outcomes, and that ICT participants will have better retention in treatment services. As found in our preliminary research, we also expect typical program counselors to be able to deliver ICT with satisfactory adherence and competence. The gap between the discovery and routine delivery of evidence-based treatments for alcohol use disorders is substantial. This problem is compounded when one considers the disparity in public access to efficacious integrated services for persons with co-occurring substance use and psychiatric disorders. The present research stands to address this issue, by rigorously evaluating a promising and community- friendly option for a broad spectrum psychosocial therapy. If found to be effective in this trial, the next logical research steps would be further efficacy study of ICT in a larger randomized controlled trial, as well as in dismantling and fractional factorial designs. The overarching goal of this research is to contribute to better treatment and recovery outcomes for individuals with co-occurring disorders.
Effective and community-friendly options to treat persons with co-occurring alcohol-related and psychiatric disorders are needed. Within a randomized controlled trial design, this R21 pilot study evaluates an integrated psychosocial therapy that combines and adapts Motivational Enhancement Therapy, Cognitive Behavioral Therapy and Twelve-Step Facilitation Therapy for a typical diagnostically heterogeneous sample with co- occurring disorders. If this innovative approach, Integrating Combined Therapies (ICT), produces clinically meaningful and observable effects on both substance use and psychiatric symptoms, it will have a substantial impact on a longstanding problem in public health care.
| Du, Juan; Zhou, Nannan; Liu, Hongxia et al. (2012) Arsenic induces functional re-expression of estrogen receptor ? by demethylation of DNA in estrogen receptor-negative human breast cancer. PLoS One 7:e35957 |
