Outcome of Treatment for Substance Use Disorders and HIV Risk Reduction

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DESCRIPTION (provided by applicant): This new Senior Scientist Award will free-up clinical time at the VA so I can continue my research on treatment outcome studies of persons with substance use disorders. My research career began in 1970 and since that time I have been P.I. on 17 grants and co-investigator on another 20 or more. Over the years my research activities have grown such that they conflict with clinical responsibilities that are necessary to maintain my VA salary, even though 75% of that time is for NIH and VA research. This award will allow me to reduce VA time to 5/8ths and reduce patient care and on-call responsibilities to 6 hours/week. Immediate plans are to continue projects that include 1) the Delaware Valley Node of the Clinical Trials Network (CTN) on which I am P.I. and responsible for 4 protocols: buprenorphine/naloxone for opioid dependent patients aged 14-21, motivational enhancement therapy, motivational incentives, and changes in treatment practices as a result of CTN participation; 2) studies on the long term course of HIV risk behavior among persons in and out of methadone treatment and the effect of methadone on immune function; 3) VA studies of patients who dropped out or were suspended from methadone treatment and of "Seeking Safety", a group therapy for veterans with substance use disorders and PTSD; and 4) studies in St. Petersburg, Russia comparing naltrexone with or without fluoxetine for relapse prevention and HIV risk reduction and of comorbidities between HIV, hepatitis B and C, TB and alcohol and drug dependence. Long term plans are to 1) submit a competing renewal of CTN studies in the Fall of '03; 2) implement a study of depot vs oral naltrexone in St. Petersburg; 3) help investigators in St. Petersburg and Porto Alegre, Brazil develop Centers for HIV prevention, treatment and research; and 4) submit a pilot study of buprenorphine for heroin addiction treatment of HIV+ and HIV- patients in Kiev, Ukraine. This work will be done at the University of Pennsylvania/Philadelphia VAMC Addiction Treatment Research Center, the Treatment Research Institute, and the Penn Center for AIDS Research where I have been an active participant since their beginnings.