Comorbid Disorders in Treatment of Opiate Dependence

描述：(申请人提供) 这项应用是为了研究影响治疗的共病障碍。 鸦片类药物依赖。拟议的研究方案的具体目标如下 如下：研究1将研究共病抑郁作为预测因素。 阿片类可卡因滥用的地塞帕明治疗及应急处理 使用丁丙诺啡维持依赖的受试者通过对 完成随机临床试验。研究2将评估该药的疗效 舍曲林治疗可卡因依赖患者的共病 最近开始的一项双盲随机临床试验中的抑郁症。学习 3将确定阿片类药物治疗后医疗费用的变化 退伍军人事务部利用现有医疗服务提供系统的依赖性 管理数据库。它将决定混杂因素是否， 尤其是共病的抑郁症和可卡因依赖，可能会影响 成本。该提案的总体目标是为我提供一个受监督的 以患者为中心的研究和教育经验，使我能够 成为药物滥用的独立调查员。我特定的职业生涯 发展目标是：(1)深入了解 可卡因和阿片类药物依赖以及物质诱导的神经药理学 情绪障碍。(2)培养临床研究和管理方面的专门知识 可卡因和鸦片依赖，以及目前的药物治疗。(三)发展 具备与药物滥用相关的心理健康服务研究技能。这个 提出的职业发展计划利用了托马斯·科斯滕的合作， Robert，MD在开发执行随机临床试验的专业知识方面 发展精神健康服务研究技能的医学博士罗森海克和凯文 Sevarino，医学博士，阿片依赖临床管理博士。教育性的 经验包括四年的正规课程学习 耶鲁大学医学院的跨部门神经科学项目 耶鲁大学流行病学和公共卫生学院。这个K23研究生涯 获奖将使我能够开始专注于 可卡因和阿片类药物依赖和发展临床试验之间的桥梁 和服务研究。

DESCRIPTION: (Provided by Applicant) This application is to study comorbid disorders that affect the treatment of opiate dependence. The specific aims of the proposed program of research are as follows: Study 1 will examine comorbid depression as a predictive factor in treatment with desipramine and contingency management of cocaine abusing opiate dependent subjects maintained on buprenorphine by secondary data analysis of a completed randomized clinical trial. Study 2 will evaluate the efficacy of sertraline in the treatment of cocaine dependent patients with comorbid depression in a recently started double-blind randomized clinical trial. Study 3 will determine changes of health care cost after treatment of opiate dependence in the Veterans Affairs health delivery system using existing administrative databases. It will determine whether confounding factors, especially comorbid depression and cocaine dependence, may affect changes in costs. The overall aim of the proposal is to provide me with a supervised patient oriented research and educational experience that will enable me to become an independent investigator in substance abuse. My specific career development goals are to: (1) Acquire in-depth knowledge of the neuropharmacology of cocaine and opiate dependence, and of substance induced mood disorders. (2) Develop expertise in clinical research and management of cocaine and opiate dependence, and current pharmacotherapies. (3) Develop skills in Mental Health Service research related to substance abuse. The proposed career development plan utilizes the collaboration of Thomas Kosten, MD in developing expertise executing randomized clinical trials, Robert Rosenheck, MD in developing skills in mental health services research and Kevin Sevarino, MD, PhD in clinical management of opiate dependence. The educational experience includes a four year period of formal coursework at the Interdepartmental Neuroscience Program at the Yale School of Medicine and at the Yale School of Epidemiology and Public Health. This K23 research career award will enable me to start an academic career focusing on research in cocaine and opiate dependence and to develop a bridge between clinical trials and services research.