Adaptive Treatment Models for the Management of Drug Use Disorders

药物使用障碍管理的适应性治疗模型

基本信息

批准号：
7872250
负责人：
JAMES R. MCKAY
金额：
$ 12.96万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-09-01 至 2015-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7872250
关键词：
ARHGEF5 gene Abstinence Accounting Address Adherence Affect Alcohol consumption Alcohol dependence Alcohol or Other Drugs use Alcohols Algorithms Applications Grants Appointment Caring Chronic Clinical Investigator Cocaine Code Cognition Collaborations Communities Continuity of Patient Care Counseling Data Data Set Dependence Development Disease Disease Management Dropout Drops Drug Addiction Drug Use Disorder Drug usage Effectiveness Electronics Evaluation Experimental Designs Faculty Failure Family Fostering Funding Future Goals Grant HIV Health Policy Health Services Research Hobbies Horns Hour Hylobates Genus Incentives Independent Scientist Award Institution Intake Intervention Interview Lead Literature Long-Term Care Manuscripts Measures Mediating Mediation Mediator of activation protein Mental Health Mentors Methods Modeling Monitor National Institute of Drug Abuse National Institute on Alcohol Abuse and Alcoholism Outcome Outpatients Participant Patient Self-Report Patients Pennsylvania Personality Pharmaceutical Preparations Phase Pilot Projects Positioning Attribute Postdoctoral Fellow Predictive Factor Process Process Measure Protocols documentation Public Health Schools Randomized Randomized Clinical Trials Reading Recording of previous events Recovery Relapse Relative (related person)Research Research Institute Research Personnel Research Project Grants Research Support Resources Rewards Risk Risk Behaviors Sampling Schedule Selection for Treatments Self Efficacy Social support Students Study Section Substance Use Disorder Symptoms TNFRSF5 gene Talents Telephone Testing Therapeutic Time Training Transdisciplinary Tobacco Research Center Treatment Protocols Universities Work addiction alcohol use disorder alcoholism therapy alternative treatment base behavior change c new career clinical epidemiology cost design economic impact effective therapy follow-up improved innovation interest medical specialties motivational enhancement therapy novel strategies patient oriented patient oriented research programs public health relevance randomized trial research study response self help skills treatment as usual treatment effect treatment program

项目摘要

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.

描述（由申请人提供）：在此 K24 申请中，我正在寻求资金来支持以患者为导向的研究 (POR) 中更深入的指导活动，并扩大我当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，用于成瘾性疾病的长期管理。这项工作的大部分内容涉及确定促进持续参与和更好结果的治疗组成部分和特征，包括尽可能减轻患者和家庭负担的适应性方案、将患者的选择纳入治疗方法的选择以及使用参与激励措施。我的长期职业目标涉及这些新护理模式的更广泛传播和实施。在指导方面，我的近期目标是投入更多时间给我目前在宾夕法尼亚大学和治疗研究所 (TRI) 指导的博士后研究员和新临床医生研究人员。这项工作将包括花更多的时间来规划和审查手稿和拨款申请，并提供设计和评估物质使用障碍适应性治疗干预措施的进一步培训。我还安排指导宾夕法尼亚大学其他几个部门和中心的更多学生和初级教师，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部门，即成瘾连续护理中心，通过雇用更多新的临床研究人员，并创建一个地方，让来自宾夕法尼亚大学其他部门和其他机构的对成瘾问题感兴趣的研究人员能够参与其中。成瘾和适应性治疗方法可以寻求指导、合作和支持。我目前受到 NIDA R01 的资助，这是 NIDA 资助的 P60 中的一个重大项目、NIAAA P01 中心和 NIAAA R01。所有这些项目都是随机临床试验。两个项目是序贯多重分配随机试验 (SMART)，它们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。另外两个项目分别针对照常治疗测试了两种扩展的持续护理模式。这些干预措施也是适应性的，随着患者的症状和状态随着时间的推移而变化，算法可以提高或降低患者的治疗强度。 K24 寻求资金来支持对治疗过程和变化机制的深入分析，这些变化与更好地遵守适应性协议和更好的药物使用结果相关。对于这项工作，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课程内容，分析患者自我报告数据，并对研究参与者进行访谈。公共卫生相关性：拟议的赠款为 James McKay 博士提供支持，以维持和扩大他对博士后研究员和新临床研究人员的指导，以进行以患者为导向的成瘾研究。这笔赠款还将支持新的研究，该研究建立在麦凯博士当前的研究计划的基础上，该研究计划致力于开发和评估持续护理的适应性方法。这项新工作旨在确定适应性治疗中的关键作用机制，以实现积极的结果和遵守方案。