Improving Efficacy of Drug Abuse Treatment

描述(由申请人提供)： 这是对以患者为中心的研究(K24)职业生涯中期研究人员奖的续签申请。通过解除我大量的临床和行政责任，K24使我能够更多地参与旨在改善阿片类药物和可卡因依赖治疗的有效性和可及性的研究，将我的研究扩展到国际舞台，并增加对初级调查人员的指导。目前的研究正在调查1)美沙酮维持患者持续抑郁症状的合同和行为激活疗法，2)丁丙诺啡维持治疗期间可卡因的双硫仑反应的药物遗传学，3)在初级保健环境中丁丙诺啡的维持，以及4)在马来西亚和伊朗用于治疗阿片依赖的丁丙诺啡和纳曲酮，这两个国家以穆斯林为主，面临着阿片依赖和艾滋病毒的极端问题。国际研究是拟议的K24最初几年计划的两个主要项目，并在本申请中作了更全面的描述。两者都是丁丙诺啡和纳曲酮的随机双盲比较；马来西亚的3细胞研究包括安慰剂(仅限药物咨询)组。这两个机构都提供了培训和指导初学药物滥用研究人员的机会，以及开发药物滥用临床研究基础设施的机会，这将支持这些国家未来的循证治疗研究和传播。我对初级研究人员的指导是在临床试验的背景下进行的。在目前的赠款期间，我曾担任四名初学者的研究导师，他们成功地开发了独立的研究领域，并为他们的研究获得了外部支持，目前我正在指导8名调查员。我的临床研究和指导活动得益于耶鲁大学在药物滥用方面广泛的临床研究、教学和临床计划，以及几个国际艾滋病毒和药物滥用临床研究培训计划的发展。

DESCRIPTION (provided by applicant): This is a renewal application for a Midcareer Investigator Award in Patient-Oriented Research (K24). By relieving me of substantial clinical and administrative responsibilities, the K24 has allowed me to increase the level of my involvement in research aimed at improving the efficacy and accessibility of treatments for opioid and cocaine dependence, expand my research into the international arena, and increase my mentoring of beginning investigators. Current studies are investigating 1) contracting and behavioral activation therapy for methadone maintained patients with persistent depressive symptoms, 2) the pharmacogenetics of disulfiram response to cocaine during buprenorphine maintenance treatment, 3) buprenorphine maintenance in primary care settings, and 4) buprenorphine and naltrexone for treating opioid dependence in Malaysia and Iran, predominantly Muslim countries facing extreme problems of opioid dependence and the emergence of HIV. The international studies are two of the major projects planned for the initial years of the proposed K24 and described more fully in this application. Both are randomized, double blind comparisons of buprenorphine and naltrexone; the 3-cell study in Malaysia includes a placebo (drug counseling only) group. Both provide opportunities for training and mentoring beginning drug abuse researchers and developing a drug abuse clinical research infrastructure that will support future research and dissemination of evidence-based treatments in these countries. My mentoring of beginning investigators occurs in the context of the clinical trials. During the current grant period, I have served as research mentor for four beginning investigators who have succeeded in developing independent areas of research and obtaining external support for their research, and I am currently mentoring 8 investigators. My clinical research and mentoring activities are facilitated by the extensive clinical research, teaching and clinical programs in drug abuse at Yale and by the development of several international HIV and drug abuse clinical research training programs.