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National Institute on Drug Abuse

Behavioral Therapies Development Program - Research Program Projects and Centers

Specialized Center Grants (P50)

Center for Treatment Research on Adolescent Drug Abuse

Liddle, Howard; University of Miami

Adolescent drug abuse (ADA) treatment research, from treatment development to mechanisms, evaluation, and dissemination, is the Center's overarching theme. Research studies and core activities exist to develop, investigate, and refine psychosocial interventions for adolescent drug abusers. The mission of the Center is to: (1) develop improved ADA family-based treatments, (2) test the efficacy and effectiveness of family-oriented as well as existing treatments, (3) develop a greater understanding of the treatment and patient/family characteristics that influence treatment outcome, (4) disseminate through training programs information on successful treatments, and (5) serve as a national resource to NIDA for matters related to ADA treatment.

Study 1 addresses the relative effectiveness and cost-benefit of widely utilized residential treatment compared to an intensive, family-based, outpatient modality. Study 2 seeks to uncover universal mechanisms in family therapists' behaviors and family processes that contribute to early outcomes. The Administrative Core, provides scientific leadership for the studies and cores, and aims to establish a national ADA treatment research resource by promoting dissemination of research findings, and establishment of resource archives. The Administrative Core will coordinate and facilitate the Center's research training efforts. The Methods Core seeks to provide support to the studies, and to address major methodological challenges in ADA treatment research. Finally, the Treatment Development, Clinical and Training Core aims to provide leadership in the development of family -based interventions for ADA populations for whom existing interventions are inadequate, to create a mechanism for providing the clinical infrastructure required for a major programmatic effort in ADA treatment research, and to provide mechanisms for direct clinical training in the modalities developed in association with the Center.

Center for Research on Treatment & Prevention of Intravenous Drug Abuse

O'Brien, Charles; University of Pennsylvania

The problem of intravenous drug abuse has been the focus of this research group since the early 1970's. This center with a flexible core unit includes an enhanced educational program, a mechanism for initiating new and innovative projects with minimal delay and a program for attracting new investigators to the field of substance abuse research.

Individual projects include an extension of the on-going studies of the use of psychotherapy in the treatment of intravenous opioid dependence. Another project involves the setting up of a research-oriented day hospital program for patients dependent on intravenous inhaled cocaine. A series of controlled studies on the treatment of cocaine dependence will be conducted using newly developed medications and psychological techniques. Two studies dealing with the safety and efficacy of the narcotic antagonist naltrexone in the treatment of intravenous opioid dependence will also be conducted. The first naltrexone study will address the question of possible opiate hypersensitivity induced in human subjects by naltrexone treatment by the mechanism of increased number or sensitivity of opiate receptors. The second naltrexone study deals with the practical benefits of naltrexone treatment in preventing relapse in federal probationers with a history of intravenous heroin dependence. Another new study extends the efforts of the research group into the problem of prescription drug dependence and in particular to the problem of benzodiazepine dependence.

The CENTER also includes a basic research component which interacts regularly with clinical researchers resulting in mutual influence. A series of studies will utilize animal models to investigate the role of stress in initiating intravenous drug dependence. Another series of studies will investigate the role of endogenous opioids in tolerance and dependence and, in particular, on the possible role of endogenous opioids in the problem of repetitive relapse to intravenous opiate use.

Psychotherapy Development for Cocaine and Opioid Abuse

Rounsaville, Bruce; Yale University

A psychotherapy research center was established at Yale University dedicated to the development, evaluation and refinement of psychotherapies for drug abuse. The Organizing theme is psychotherapy development and empirical testing based on the "technology model" of psychotherapy research (Waskow <1984). The center will catalyze the process of developing promising drug abuse treatments from the point where they are merely "good ideas" to one where they are capable of being disseminated to the clinical field as empirically validated treatments. This process requires research at sequential, progressively demanding phases (NIDA RFA #DA-94-02): Phase I consists of pilot testing, manual writing and training program development; Phase II consists of controlled efficacy trials and studies on effective components of treatments; Phase III consists of multisite studies to evaluate generalizability of efficacious treatments.

Research in the Center is organized around this sequential program with a Core facility and 6 individual research components. Core staff will provide scientific oversight, administration and technical assistance to individual Center projects and also provide consultation and technology transfer services to investigators and clinicians at other sites. Three Phase I projects will develop new approaches: Cognitive Therapy for Post Traumatic Stress Disorder in Drug Abusers, Expectancy-based Coping Skills training for Cocaine Abuse and A Relational Psychotherapy Parenting Group Therapy for Methadone-Maintained Mothers. Three Phase II projects will evaluate efficacy of more established approaches: CRA to improve Naltrexone Treatment, Relapse Prevention and Dynamic interactional group treatments for adolescent drug abusers, and a study of focused Coping Skills Components in cocaine abuse treatment.

The Treatment Research Center (TRC) has a Core facility and six individual research components. The Core functions include: 1) scientific planning and oversight provided by the Principal Investigator, Scientific Director and Executive Committee, with consultation from the Scientific Advisory Board; 2) central services to the component projects, including data analysis and management, administration, subject screening and recruitment, laboratory verification of self-reported substance use, and child care services for subjects; support for Pre-Phase I pilot studies to be undertaken by Center investigators and trainees; training in psychotherapy research methods for students, faculty and fellows; and technology transfer. The TRC is headed by Dr. Bruce J. Rounsaville, who is a Professor of Psychiatry. The Scientific Director is Dr. Kathleen Carroll.

Behavior Therapy Treatment Research Center

Stitzer, Maxine; Johns Hopkins University

This Behavior Therapy Treatment Research Center at the Behavioral Pharmacology Research Unit of the Johns Hopkins University/Key Medical Center emphasizes a consistent theme, which is development and evaluation of incentive therapies for the treatment of substance abuse. This emphasis builds on a long and productive history of the research group pioneering contingency management research with substance abusers. The research builds on significant recent developments in the field which have demonstrated the potency of incentive therapies for promoting drug abstinence of outpatient treatment samples. This research will extend current knowledge about the use of incentive therapies while obtaining important information on both mechanisms and practical application of these approaches.

The Center consists of five components. The Core provides essential central shared resources to all other components; these include psychiatric assessment, computer, statistical, subject recruiting, secretarial, and administrative support services. Component 1 will systematically explore parameters of methadone take -home incentives for intravenous polydrug abusers previously shown to be effective for improving treatment outcomes in methadone patients. Component 2 will conduct controlled evaluations of promising new voucher incentive therapies for intravenous polydrug abusers in which retail goods and services will be made available contingent on cessation of an ongoing drug abuse during methadone treatment. Component 3 will explore voucher incentive therapies for cigarette smokers designed to prevent relapse and improve smoking cessation outcomes by rewarding continuous post-cessation smoking abstinence. Finally, Component 4 will conduct controlled evaluations of voucher incentive therapies for pregnant drug abusing women enrolled in treatment at the Center for Addition and Pregnancy (CAP) that target program attendance and participation as well as reduced drug use in order to improve both maternal and fetal outcomes.

Overall, these components represent a coordinated effort that will provide systematic information about the mechanisms and effectiveness of incentive therapies for treatment of substance abuse. Valuable information will be obtained about the optimal conditions for applying these interventions as well as their utility across several specific populations of drug abusers.

The TRC and the Core will be headed by the Principal Investigator, Dr. Maxine L. Stitzer, who will provide overall scientific/administrative leadership, along with the Co-investigator, Dr. George E. Bigelow. The Core will provide shared resources (psychiatric assessment, computer, statistical, subject recruitment and administrative support) to the four projects. The Core will also pursue specific assessment research objectives.

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