Adaptive Treatment Models for the Management of Drug Use Disorders

在此K24更新申请中，我正在寻求资金，以继续支持我在 以患者为导向的研究（POR），参与进一步的职业发展活动，与学员进行POR， 并进行三项试点研究，以扩大我目前的赠款目标。我的工作重点是发展- 适应性的、以患者为导向的治疗模式的开发、评估和传播， 物质使用障碍（Substance Use Disorders，SUD）这项工作的大部分是关于确定治疗成分- 促进持续参与和更好结果的要素和功能，包括适应性协议， 解决病人无反应、移动的健康通信技术和激励措施。 我将继续指导博士后研究员和新的临床研究人员在宾夕法尼亚大学，治疗 研究所（TRI）和其他机构，并将增加更多的学员。这项工作将包括时间 花在规划，审查，并提供反馈意见的手稿和赠款申请;给予职业生涯 咨询;并提供进一步的培训，在设计和评估适应性治疗干预措施， 物质使用障碍、序贯多重分配随机试验（SMART）设计和移动的健康 技术.对于这次更新，学员将包括来自牛津大学的一些初级教师。 密歇根大学（UMICH），对适应性治疗，SMART设计和持续护理感兴趣。 关于职业发展，我将获得更多的知识，在行为经济学， ICS/激励措施、适应性治疗和SMART设计的新发展以及移动的医疗技术。 为此，我将参加宾夕法尼亚大学健康激励和行为经济学中心的研讨会， 并与康涅狄格大学（UCONN;南希·佩特里博士）， 威斯康星州（UWISC;大卫古斯塔夫森博士），UMICH（苏珊墨菲博士），和北岸长岛犹太人 卫生系统（NSLIJHS;乔恩·摩根斯特恩博士和弗雷德·明奇博士）是这些领域的专家。 我目前是NIAAA R 01的PI和相当于R 01的国防部补助金，以及一项 NIDA R 01授予达特茅斯的Alan Budney博士， NSLIJHS。所有这些项目都是随机临床试验。我的NIAAA R 01正在测试 电话持续护理的成本效益，自动智能手机恢复应用程序，以及集成 结合这两种干预措施的艾德方案。国防部拨款正在评估一种自适应 预防干预旨在减少服用阿片类药物的退伍军人使用危险酒精和苯二氮卓类药物， 止痛药。要求提供资金，以进行三项试点研究，涉及： 移动的技术作为SUD治疗中的临床医生扩展器的使用和价值，（2）患者使用的不同- ent移动的卫生技术功能及其对SUD结果的贡献，以及（3）进一步开展定制工作， 对SUD进行适应性干预。

In this K24 renewal application, I am seeking funding to continue support for my mentoring activities in patient oriented research (POR), engage in further career development activities, conduct POR with mentees, and conduct three pilot studies that expand the aims of my current grants. My work is focused on the devel- opment, evaluation, and dissemination of adaptive, patient-oriented treatment models across the continuum of care for substance use disorders (SUD). Much of this work is concerned with identifying the treatment compo- nents and features that promote sustained participation and better outcomes, including adaptive protocols that address patient nonresponse, mobile health communication technology, and incentives. I will continue to mentor postdoctoral fellows and new clinician investigators at UPENN, the Treatment Research Institute (TRI), and other institutions, and will add additional mentees. This work will include time spent in planning, reviewing, and providing feedback on manuscripts and grant applications; giving career counseling; and providing further training in the design and evaluation of adaptive treatment interventions for substance use disorders, sequential multiple assignment randomized trial (SMART) designs, and mobile health technology. For this renewal, mentees will include a number of junior faculty members from the University of Michigan (UMICH), with interest in adaptive treatment, SMART designs, and continuing care. With regard to career development, I will obtain additional knowledge in behavioral econom- ics/incentives, new developments in adaptive treatments and SMART designs, and mobile health technology. To that end, I will attend workshops at UPENN at the Center for Health Incentives and Behavioral Economics, and consult with current collaborators at the University of Connecticut (UCONN; Dr. Nancy Petry), University of Wisconsin (UWISC; Dr. David Gustafson), UMICH (Dr. Susan Murphy), and North Shore Long Island Jewish Health System (NSLIJHS; Drs. Jon Morgenstern and Fred Muench) who are experts in these areas. I am currently the PI of a NIAAA R01 and a DoD grant equivalent to an R01, and a co-investigator on a NIDA R01 awarded to Dr. Alan Budney at Dartmouth and on a NIAAA R01 awarded to Dr. Jon Morgenstern at NSLIJHS. All of these projects are randomized clinical trials. My NIAAA R01 is testing the relative efficacy and cost-effectiveness of telephone continuing care, an automated smartphone recovery app, and an integrat- ed protocol that combines these two interventions. The DoD grant is evaluating the efficacy of an adaptive prevention intervention designed to reduce hazardous alcohol and benzodiazepine use in veterans taking opi- oid medications for pain. Funds are requested to conduct three pilot studies addressing: (1) Counselor percep- tions of use and value of mobile technology as a clinician extender in SUD treatment, (2) Patient use of differ- ent mobile heath technology functions and their contributions to SUD outcomes, and (3) Further work on tailor- ing of adaptive interventions for SUD.