IMPROVING EFFICACY OF DRUG ABUSE TREATMENT

这个应用程序是在以患者为导向的研究（K24）的职业生涯中期研究者奖，以便在未来五年内，我可以专注于临床研究，写作和指导开始调查。 我的研究旨在通过临床试验和临床流行病学研究提高药物滥用治疗的可及性、可用性和有效性。 我的研究和方法的一般主题在我的两个主要研究项目中是显而易见的，研究阿片类激动剂维持治疗的药理学和行为成分，并研究可卡因依赖孕妇和有幼儿的妇女的治疗。 药物滥用和医疗服务的协调和整合一直是本研究中探索的一个重要战略，例如目前的项目和计划在拟议的奖励期内进行的临床研究。 这些研究包括评估初级保健诊所中的丁丙诺啡维持，稳定美沙酮维持患者的医疗维持，以及产前和儿科诊所中确定的可卡因依赖妇女的行为治疗。 后一项研究是拟议授标最初几年计划的主要项目之一，在本申请中有更全面的说明。该研究是一项2X2临床试验，比较了两种手动指导的治疗方法，社区强化方法（CRA）和基于12步模型的药物咨询（DC），并比较了使用代金券程序奖励禁欲的应急管理（CM）和一个有轭的非应急控制（VC）。 近十年来，我一直在PI之间2和4外部资助的研究在任何时候。 我希望将来至少能保持这种支持水平，特别是如果我获得K24奖，从而能够免除我现在大部分的临床和行政责任。 我的临床研究和指导活动是由广泛的临床研究，教学和药物滥用在耶鲁大学的临床计划，这也提供了优秀的机会，招聘需要指导和肥沃的环境，培训他们的开始调查促进。 我有相当丰富的经验，培训和指导开始调查，我目前正在指导四个最近任命的教员和一个博士后实习生。 因此，K24奖将为我提供一个重要的机会，以提高我自己的临床研究生涯，并投入更多的时间来指导开始研究者，正如本申请中所建议的那样。

This application is for a Midcareer Investigator Award in Patient-Oriented Research (K24) so that over the next five years I can focus predominantly on clinical research, writing and mentoring beginning investigators. My research has been aimed at improving the accessibility, availability and efficacy of substance abuse treatment through clinical trials and clinical epidemiologic studies. The general themes of my research and approaches utilized are evident in my two major research programs, investigating pharmacologic and behavioral components of opioid agonist maintenance treatment and investigating treatments for cocaine dependent pregnant women and women with young children. Coordination and integration of substance abuse and medical services has been one important strategy explored in this research, as exemplified by current projects and clinical research planned for the proposed award period. These studies include evaluation of buprenorphine maintenance in a primary care clinic, medical maintenance for stabilized methadone maintained patients, and behavioral treatments for cocaine-dependent women identified in prenatal and pediatric clinics. The latter study is one of the major projects planned for the initial years of the proposed award and is described more fully in this application. The study is a 2X2 clinical trial comparing two manual-guided treatments, Community Reinforcement Approach (CRA) and Drug Counseling (DC) based on a 12-step model, and comparing Contingency Management (CM) using a voucher procedure to reward abstinence and a yoked, non-contingent Voucher Control (VC). For nearly a decade, I have been PI on between 2 and 4 externally funded studies at any time. I anticipate maintaining at least this level of support in the future, especially if I receive a K24 award and am thus able to be relieved of most of my now substantial clinical and administrative responsibilities. My clinical research and mentoring activities are facilitated by the extensive clinical research, teaching and clinical programs in drug abuse at Yale which also provide outstanding opportunities for recruitment of beginning investigators needing mentoring and a fertile environment for training them. I have had considerable experience training and mentoring beginning investigators and I am currently mentoring four recently appointed faculty members and one post-doctoral trainee. A K24 award would thus provide a critical opportunity for me to enhance my own clinical research career and devote more time to mentoring beginning investigators, as proposed in this application.