Community Reinforcement and Family Training for Treatment Retention/HIV Risk(CDA

描述（由申请人提供）：这项K23指导的以患者为导向的研究申请将支持候选人在药物依赖治疗和长期维持康复的综合行为和药物治疗开发领域的职业发展。辛辛那提大学的Eugene Somoza博士将担任主要导师。俄亥俄州立大学的Natasha Slesnick博士和科罗拉多大学的Robert Booth博士将分别担任行为疗法发展和减少艾滋病毒风险行为的二级导师。此外，一组有成就的调查人员将担任顾问，在职业发展和研究计划的专门领域提供培训和监督。职业发展计划的目标是为候选人提供成功成为独立调查员所必需的培训和实践经验。该计划包括一系列导师监督的活动，包括：1)临床试验管理，2)出版物和提案写作，3)参加研究生课程和专业研讨会，4)进行原创性研究。计划中的研究将调整一种已知疗效的疗法，以实现对公共卫生具有重要意义的新结果。社区强化和家庭培训（CRAFT）程序将进行调整，从加强治疗进入，到加强治疗保留和减少接受丁丙诺啡逐渐戒毒的阿片类药物依赖者的艾滋病毒风险行为。研究计划包括三个阶段：1)开发手工指导疗法，2)开发治疗师培训和保真度测量，3)随机试验，52名患者接受新的CRAFT治疗或常规治疗。评估将在基线、治疗结束、3个月和6个月进行。主要结果是药物滥用治疗的持续时间，特别是阿片类药物依赖者首次连续30天停止治疗的时间。次要结果包括：减少艾滋病毒风险行为，利用现有治疗和药物滥用。依赖鸦片剂的个人对自己和公众都构成重大的健康风险。随着丁丙诺啡最近被批准用于药物滥用治疗，戒毒计划在管理阿片类药物戒断和将患者过渡到持续治疗方面变得更加有效。转入持续治疗后，留用率下降，重新使用阿片剂的人面临直接负面后果的高风险，如意外用药过量和相关的健康风险，如艾滋病毒。需要进一步改善治疗保留、维持康复和降低艾滋病毒风险。这项研究和职业发展计划将为改善治疗保留和减少艾滋病毒风险行为带来重要知识，并将为候选人作为一名独立的以患者为导向的临床研究科学家的富有成效的职业做好准备。

DESCRIPTION (provided by applicant): This K23 mentored patient-oriented research application will support the career development of the candidate in the areas of integrated behavioral and pharmacological therapies development for drug dependence treatment and long- term maintenance of recovery. Dr. Eugene Somoza of the University of Cincinnati will serve as the primary mentor. Dr. Natasha Slesnick of the Ohio State University and Dr. Robert Booth of the University of Colorado will serve as secondary mentors for behavioral therapies development and HIV risk behavior reduction respectively. In addition a team of accomplished investigators will serve as consultants to provide both training and supervision in specialized areas of the career development and research plans. The goal of the career development plan is to provide the candidate with the training and practical experience necessary to succeed as an independent investigator. The plan includes a range of mentor supervised activities including: 1) management of clinical trials, 2) publications and proposal writing, 3) attendance of graduate course work and professional seminars and, 4) the conduct of original research. The planned research will adapt a therapy of known efficacy to target a new outcome of significant importance to public health. The Community Reinforcement and Family Training (CRAFT) procedures will be adapted, from reinforcing treatment entry, to reinforcing treatment retention and HIV risk behavior reduction in persons with opioid dependence who receive a buprenorphine taper detoxification. The research plan includes three phases: 1) development of a manual guided therapy, 2) development of therapist training and fidelity measures and, 3) a randomized pilot with 52 patients receiving either the new CRAFT treatment or treatment as usual. Assessments will occur at baseline, end of treatment, 3 months and, 6 months. The primary outcome is retention in drug abuse treatment, specifically time to the opiate dependent person's first drop from services of 30 consecutive days. Secondary outcomes include: HIV risk behavior reduction, utilization of available treatment and, drug abuse. Opiate dependent individuals present a significant health risk to themselves and the public. With the recent approval of buprenorphine for drug abuse treatment, detoxification programs have become more effective at managing opioid withdrawal and transitioning patients to ongoing treatment. Following transfer to ongoing treatment retention rates decline and persons who return to opiate use are at high risk for direct negative consequences such as accidental drug over-dose and associated health risks such as HIV. Further improvements in treatment retention, maintenance of recovery and, HIV risk reduction are needed. This research and career development plan will lead to significant knowledge for improving treatment retention and reducing HIV risk behavior and, will prepare the candidate for a productive career as an independent patient-oriented clinical research scientist.