Adaptive Treatment Models for the Management of Drug Use Disorders

在这份K24申请中，我正在寻求资金，以支持以患者为导向的研究(POR)中更密集的指导活动，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、以患者为导向的护理模式，用于成瘾障碍的长期管理。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组成部分和特点，包括尽可能减轻患者和家庭负担的适应性方案，将患者选择纳入治疗方法的选择，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，我的直接目标是把更多的时间花在我目前在宾夕法尼亚大学和治疗研究所(TRI)指导的博士后研究员和新的临床医生研究员身上。这项工作将包括将更多的时间用于规划和审查手稿和赠款申请，并在药物使用障碍的适应性治疗干预措施的设计和评估方面提供进一步的培训。我还安排在宾夕法尼亚大学的其他几个分部和中心指导更多的学生和初级教员，包括公共卫生学院、临床流行病学、心理健康政策和服务研究中心以及跨学科烟草使用研究中心。我的长期目标是扩大我在宾夕法尼亚大学的单位，通过招聘更多的临床医生调查人员，并创造一个地方，来自宾夕法尼亚大学的其他单位和其他机构的研究人员，如果他们对成瘾和适应治疗方法感兴趣，可以寻求指导、合作和支持。 我目前的资金来自NIDA R01，NIDA资助的P60中的一个主要项目，NIAAA P01中心和NIAAA R01。所有这些项目都是随机临床试验。两个项目是顺序多分配随机试验(SMART)，它使用多个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了两个延长的持续护理模式，以对照通常的治疗。这些干预措施也是自适应的，算法可以随着患者的症状和状态随着时间的推移而改变治疗强度。K24寻求资金，以支持对治疗过程中与更好地遵守适应方案和更好的药物使用结果相关的变化过程和机制的深入分析。在这项工作中，我们将对组合数据集进行调解分析，在这些研究中将各种编码系统应用于治疗过程的内容，分析患者自我报告数据，并与研究参与者进行访谈。

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.