Adaptive Treatment Models for the Management of Drug Use Disorders

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In this K24 renewal application, I am seeking funding to continue support for my mentoring activities in patient oriented research (POR), engage in further career development activities, conduct POR with mentees, and conduct three pilot studies that expand the aims of my current grants. My work is focused on the devel- opment, evaluation, and dissemination of adaptive, patient-oriented treatment models across the continuum of care for substance use disorders (SUD). Much of this work is concerned with identifying the treatment compo- nents and features that promote sustained participation and better outcomes, including adaptive protocols that address patient nonresponse, mobile health communication technology, and incentives. I will continue to mentor postdoctoral fellows and new clinician investigators at UPENN, the Treatment Research Institute (TRI), and other institutions, and will add additional mentees. This work will include time spent in planning, reviewing, and providing feedback on manuscripts and grant applications; giving career counseling; and providing further training in the design and evaluation of adaptive treatment interventions for substance use disorders, sequential multiple assignment randomized trial (SMART) designs, and mobile health technology. For this renewal, mentees will include a number of junior faculty members from the University of Michigan (UMICH), with interest in adaptive treatment, SMART designs, and continuing care. With regard to career development, I will obtain additional knowledge in behavioral econom- ics/incentives, new developments in adaptive treatments and SMART designs, and mobile health technology. To that end, I will attend workshops at UPENN at the Center for Health Incentives and Behavioral Economics, and consult with current collaborators at the University of Connecticut (UCONN; Dr. Nancy Petry), University of Wisconsin (UWISC; Dr. David Gustafson), UMICH (Dr. Susan Murphy), and North Shore Long Island Jewish Health System (NSLIJHS; Drs. Jon Morgenstern and Fred Muench) who are experts in these areas. I am currently the PI of a NIAAA R01 and a DoD grant equivalent to an R01, and a co-investigator on a NIDA R01 awarded to Dr. Alan Budney at Dartmouth and on a NIAAA R01 awarded to Dr. Jon Morgenstern at NSLIJHS. All of these projects are randomized clinical trials. My NIAAA R01 is testing the relative efficacy and cost-effectiveness of telephone continuing care, an automated smartphone recovery app, and an integrat- ed protocol that combines these two interventions. The DoD grant is evaluating the efficacy of an adaptive prevention intervention designed to reduce hazardous alcohol and benzodiazepine use in veterans taking opi- oid medications for pain. Funds are requested to conduct three pilot studies addressing: (1) Counselor percep- tions of use and value of mobile technology as a clinician extender in SUD treatment, (2) Patient use of differ- ent mobile heath technology functions and their contributions to SUD outcomes, and (3) Further work on tailor- ing of adaptive interventions for SUD.