Treatment of Complex Patients: Emphasis on Nicotine

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DESCRIPTION (provided by applicant): The goal of this competing renewal K05 proposal is to continue to support my research in the treatment of nicotine dependence, to further my capacity to mentor junior scientists and train postdoctoral scholars, to allow me to continue in scientific leadership through research center administration, and to disseminate research findings to the scientific and clinical community. Since this award was last submitted, I have published, in press, or under review 62 scientific papers. I completed a clinical trial (N=322) of an innovative intervention for depressed smokers in a psychiatric outpatient clinic, studying both smoking abstinence and its impact on mental health, and the cost-effectiveness of the intervention. As proposed, I am completing two major clinical trials: (1) a study of extended behavioral relapse prevention and bupropion treatment for chronic smokers (N=407); (2) a study of extended, age-specific relapse prevention and nicotine replacement treatment for older smokers (n=403). Extended treatment conditions in these two studies have produced biologically confirmed abstinence rates from 53 to 42% at one year. Of greatest importance, these rates do not change at two year follow-up; they remain at precisely the level observed at one year. I continued to direct a P50 center grant that focuses on Treatment of Complex Patients with an emphasis on nicotine. In addition, I have developed collaborations with other scientists, who are mostly my mentees. This work includes tobacco dependence treatment studies for targeted populations and for co-morbid smokers. In addition, I collaborate with other scientists of the genetics of bupropion response in smokers, and on the effects of reduced nicotine cigarettes. If this award is funded, I will continue my work on extended treatment, studying implementation in health care settings, and developing and testing technology based adaptations of it. I will continue my leadership role in the P50 grant and in the postdoctoral training grant, and will continue to collaborate with other faculty, especially junior faculty. I have a history of mentoring junior faculty that extends back well before the receipt of this award. I will also continue my mentoring role, and increase my mentoring of junior faculty, as new faculty are recruited, and the new departmental mentoring program is implemented and enhanced. Last, I will continue my work with individual postdoctoral trainees.