Adaptive Treatment Models for the Management of Drug Use Disorders

描述（由申请人提供）：在这个K24申请中，我正在寻求资金来支持更密集的以患者为导向的研究（POR）指导活动，并扩大我目前资助的研究项目的目标。我的工作重点是开发、评估和实施适应性的、以患者为导向的长期管理成瘾性疾病的护理模式。这项工作的大部分涉及确定促进持续参与和更好结果的治疗成分和特征，包括在可能的情况下减轻患者和家庭负担的适应性方案，在选择治疗方法时纳入患者选择，以及使用参与激励措施。我的长期职业目标是更广泛地传播和实施这些新的护理模式。关于指导，我的近期目标是投入更多的时间给我目前在宾夕法尼亚大学和治疗研究所（TRI）指导的博士后和新的临床研究人员。这项工作将包括花更多时间规划和审查手稿和拨款申请，并在设计和评估针对物质使用障碍的适应性治疗干预措施方面提供进一步培训。我还安排在宾夕法尼亚大学的其他几个部门和中心指导更多的学生和初级教师，包括公共卫生学院、临床流行病学、精神卫生政策和服务研究中心，以及跨学科烟草使用研究中心。我的长期目标是发展我在宾夕法尼亚大学的单位，成瘾持续护理中心，通过雇佣更多新的临床研究人员，并创造一个地方，让宾夕法尼亚大学其他单位和其他机构的研究人员对成瘾和适应性治疗方法感兴趣，可以寻求指导，合作和支持。我目前由一个NIDA R01、一个NIDA资助的P60的主要项目、一个NIAAA P01中心和一个NIAAA R01资助。所有这些项目都是随机临床试验。两个项目是顺序多任务随机试验（SMART），使用多重随机化来开发治疗可卡因和酒精依赖的最佳自适应算法。另外两个项目分别测试两种扩展的持续护理模式，而不是常规治疗。这些干预措施也是自适应的，随着患者的症状和状态随着时间的推移而变化，这些干预措施的算法可以使患者的治疗强度上下波动。K24寻求资金，以支持深入分析与更好地遵守适应性方案和更好的药物使用结果相关的治疗期间变化的过程和机制。在这项工作中，我们将对组合数据集进行中介分析，将各种编码系统应用于这些研究中的治疗过程内容，分析患者自我报告数据，并对研究参与者进行访谈。

DESCRIPTION (provided by applicant): In this K24 application, I am seeking funding to support more intensive mentoring activities in patient oriented research (POR) and to expand the aims of my current funded research projects. The focus of my work is on the development, evaluation, and implementation of adaptive, patient-oriented models of care for the long-term management of addictive disorders. Much of this work is concerned with identifying the treatment components and features that promote sustained participation and better outcomes, including adaptive protocols that reduce patient and family burden when possible, incorporation of patient choice in the selection of treatment approaches, and use of incentives for participation. My long-term career objectives concern the wider dissemination and implementation of these new models of care. With regard to mentoring, my immediate goal is to devote more time to the postdoctoral fellows and new clinician investigators whom I am currently mentoring at Penn and the Treatment Research Institute (TRI). This work will include more time spent in planning and reviewing manuscripts and grant applications, and providing further training in the design and evaluation of adaptive treatment interventions for substance use disorders. I have also made arrangements to mentor additional students and junior faculty in several other divisions and centers at the University of Pennsylvania, including the School of Public Health, Clinical Epidemiology, the Center for Mental Health Policy and Services Research, and the Transdisciplinary Tobacco Use Research Center. My longer term goal is to grow my unit at Penn, the Center on the Continuum of Care in the Addictions, by hiring more new clinician investigators and creating a place where investigators from other units at Penn and at other institutions who have an interest in the addictions and in adaptive approaches to treatment can seek mentoring, collaboration, and support. I am currently funded by a NIDA R01, a major project in a NIDA-funded P60, a NIAAA P01 Center, and a NIAAA R01. All of these projects are randomized clinical trials. Two projects are sequential multiple assignment randomized trials (SMART), which use multiple randomizations to develop optimal adaptive algorithms for the treatment of cocaine and alcohol dependence. The other two projects each test two extended continuing care models against treatment as usual. These interventions are also adaptive, with algorithms to step patients up and down in treatment intensity as their symptoms and status change over time. The K24 seeks funds to support an in-depth analysis of processes and mechanisms of change in the treatment sessions that are associated with better adherence to the adaptive protocols and better substance use outcomes. For this work, we will perform mediation analyses on combined data sets, apply various coding systems to the content of the treatment sessions in these studies, analyze patient self-report data, and conduct interviews with study participants. PUBLIC HEALTH RELEVANCE: The proposed grant provides support to Dr. James McKay to sustain and expand his mentoring of postdoctoral fellows and new clinical investigators conducting patient oriented research in the addictions. The grant will also support new research, which builds on Dr. McKay's current research program on the development and evaluation of adaptive approaches to continuing care. This new work seeks to identify key mechanisms of action in adaptive treatments that account for positive outcomes and adherence to the protocols.