Improving Efficacy of Drug Abuse Treatment

描述（由申请人提供）： 这是一个以病人为导向的研究（K24）的职业中期研究者奖的续期申请。通过减轻我的大量临床和行政责任，K24使我能够提高我参与研究的水平，旨在提高阿片类药物和可卡因依赖治疗的有效性和可及性，将我的研究扩展到国际竞技场，并增加我对初学者的指导。目前的研究正在调查1）美沙酮维持治疗的持续抑郁症状患者的合同和行为激活治疗，2）丁丙诺啡维持治疗期间双硫仑对可卡因反应的药物遗传学，3）初级保健环境中的丁丙诺啡维持，以及4）马来西亚和伊朗的丁丙诺啡和纳洛酮治疗阿片类药物依赖，主要是穆斯林国家面临阿片类药物依赖和艾滋病毒出现的极端问题。国际研究是拟议K24最初几年计划的两个主要项目，在本申请中有更全面的描述。两者都是丁丙诺啡和纳洛酮的随机双盲比较;马来西亚的3细胞研究包括安慰剂（仅药物咨询）组。这两个项目都为培训和指导药物滥用初级研究人员和发展药物滥用临床研究基础设施提供了机会，以支持这些国家今后的循证治疗研究和传播。我对初级研究者的指导发生在临床试验的背景下。在目前的资助期间，我曾担任四个开始研究谁已经成功地开发研究的独立领域，并获得外部支持他们的研究，我目前指导8调查员的研究导师。我的临床研究和指导活动得到了耶鲁大学广泛的临床研究，教学和药物滥用临床项目以及几个国际艾滋病毒和药物滥用临床研究培训项目的发展的促进。

DESCRIPTION (provided by applicant): This is a renewal application for a Midcareer Investigator Award in Patient-Oriented Research (K24). By relieving me of substantial clinical and administrative responsibilities, the K24 has allowed me to increase the level of my involvement in research aimed at improving the efficacy and accessibility of treatments for opioid and cocaine dependence, expand my research into the international arena, and increase my mentoring of beginning investigators. Current studies are investigating 1) contracting and behavioral activation therapy for methadone maintained patients with persistent depressive symptoms, 2) the pharmacogenetics of disulfiram response to cocaine during buprenorphine maintenance treatment, 3) buprenorphine maintenance in primary care settings, and 4) buprenorphine and naltrexone for treating opioid dependence in Malaysia and Iran, predominantly Muslim countries facing extreme problems of opioid dependence and the emergence of HIV. The international studies are two of the major projects planned for the initial years of the proposed K24 and described more fully in this application. Both are randomized, double blind comparisons of buprenorphine and naltrexone; the 3-cell study in Malaysia includes a placebo (drug counseling only) group. Both provide opportunities for training and mentoring beginning drug abuse researchers and developing a drug abuse clinical research infrastructure that will support future research and dissemination of evidence-based treatments in these countries. My mentoring of beginning investigators occurs in the context of the clinical trials. During the current grant period, I have served as research mentor for four beginning investigators who have succeeded in developing independent areas of research and obtaining external support for their research, and I am currently mentoring 8 investigators. My clinical research and mentoring activities are facilitated by the extensive clinical research, teaching and clinical programs in drug abuse at Yale and by the development of several international HIV and drug abuse clinical research training programs.