Treatment for Complex Patients: Continuing and Extended Care

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DESCRIPTION (provided by applicant): This is a competing continuation of a currently funded Center Grant, "Treatments for Complex Patients in New Settings." In this continuation the San Francisco Treatment Research Center (hereafter, "Center") has an integrating focus on continuing and extended models of care. The Center has been productive during the past 5 years, with 190 scientific articles published or in press. The Center structure includes 4 component studies. Component 1 is a health services research study testing an intervention to bring drug abuse continuing care into medical primary care settings, while component 2 is a clinical trial testing an extended care approach to the treatment of tobacco dependence among persons receiving opiate replacement therapy. Components 3 attaches to Component 2 to investigate neurological and neurocognitive substrates of addiction and recovery. Component 4 is a cross-cutting study employing data and participants from both main components (Components 1 and 2) to study prevalence, covariance and change in multiple risk behaviors among persons in continuing care models of treatment, and a secondary analysis studies subgroups of smokers enrolled in drug abuse treatment in order to tailor tobacco dependence treatment to their specific needs. Wrapped around these component studies and providing scientific leadership and infrastructure are a Scientific and Administrative Core and a Statistics and Health Economics Core. Finally, using the Center and its resources as a platform to train and develop new and promising researchers is the Research Training Core. Building on its longstanding and successful research focused on complex patients, the Center innovates by testing continuing care models of treatment to better serve these patients, by increasing its multidisciplinary capabilities to include neurological, neurocognitive and exploratory genetics research, by integrating both treatment research and health services research into the Center's approach, and by testing continuing and extended care models in public health systems as well as in private managed health care systems. PUBLIC HEALTH RELEVANCE: Drug abuse is increasingly recognized as a chronic and relapsing condition, yet there are few practicable approaches to continuing care. This Center will test models of continuing and extended care for drug abuse treatment, including nicotine dependence, and will increase our understanding of how drug-related brain injury affects the process of treatment for, and recovery from, drug abuse. If these continuing care models are found to be effective, they will offer treatment systems practical and effective strategies for longer term and more effective drug abuse treatment. CENTER CHARACTERISTICS: