Comorbid Disorders in Treatment of Opiate Dependence

描述：（申请人提供） 本申请旨在研究影响治疗的共病疾病， 鸦片依赖拟议研究方案的具体目标如下： 研究1将检查共病抑郁症作为预测因素， 地昔帕明治疗阿片类可卡因滥用及应急管理 通过次要数据分析， 完成随机临床试验。研究2将评估 舍曲林治疗可卡因依赖患者的临床观察 抑郁症在最近开始的双盲随机临床试验。研究 3将确定阿片类药物治疗后医疗保健费用的变化 依赖退伍军人事务部的医疗服务系统， 行政数据库。它将决定是否有混杂因素， 特别是抑郁症和可卡因依赖的共病，可能会影响 成本该提案的总体目标是为我提供一个监督 以病人为导向的研究和教育经验，使我能够 成为药物滥用的独立调查员我的职业生涯 发展目标是：（1）深入了解 可卡因和阿片类药物依赖的神经药理学， 情绪障碍(2)发展临床研究和管理方面的专业知识， 可卡因和鸦片依赖，以及目前的药物治疗。(3)发展 精神卫生服务与药物滥用有关的研究技能。的 拟议的职业发展计划利用了托马斯科斯滕的合作， 医学博士在发展专业知识执行随机临床试验，罗伯特 罗森赫克，医学博士在发展技能的心理健康服务研究和凯文 Sevarino，医学博士，阿片类药物依赖的临床管理博士。教育 经验包括四年的正式课程， 耶鲁大学医学院跨部门神经科学项目， 耶鲁大学流行病学与公共卫生学院K23的研究生涯 获奖将使我能够开始学术生涯，专注于研究 可卡因和阿片类药物依赖，并建立临床试验之间的桥梁 服务研究。

DESCRIPTION: (Provided by Applicant) This application is to study comorbid disorders that affect the treatment of opiate dependence. The specific aims of the proposed program of research are as follows: Study 1 will examine comorbid depression as a predictive factor in treatment with desipramine and contingency management of cocaine abusing opiate dependent subjects maintained on buprenorphine by secondary data analysis of a completed randomized clinical trial. Study 2 will evaluate the efficacy of sertraline in the treatment of cocaine dependent patients with comorbid depression in a recently started double-blind randomized clinical trial. Study 3 will determine changes of health care cost after treatment of opiate dependence in the Veterans Affairs health delivery system using existing administrative databases. It will determine whether confounding factors, especially comorbid depression and cocaine dependence, may affect changes in costs. The overall aim of the proposal is to provide me with a supervised patient oriented research and educational experience that will enable me to become an independent investigator in substance abuse. My specific career development goals are to: (1) Acquire in-depth knowledge of the neuropharmacology of cocaine and opiate dependence, and of substance induced mood disorders. (2) Develop expertise in clinical research and management of cocaine and opiate dependence, and current pharmacotherapies. (3) Develop skills in Mental Health Service research related to substance abuse. The proposed career development plan utilizes the collaboration of Thomas Kosten, MD in developing expertise executing randomized clinical trials, Robert Rosenheck, MD in developing skills in mental health services research and Kevin Sevarino, MD, PhD in clinical management of opiate dependence. The educational experience includes a four year period of formal coursework at the Interdepartmental Neuroscience Program at the Yale School of Medicine and at the Yale School of Epidemiology and Public Health. This K23 research career award will enable me to start an academic career focusing on research in cocaine and opiate dependence and to develop a bridge between clinical trials and services research.