ADATSA Five-Year Follow Up Study

Principal Investigator:
Bill Luchansky, PhD
Alcohol and Drug Abuse Institute

Date: Project completed
Sponsor: Washington State Division of Alcohol and Substance Abuse
Categories: Clinical and Health Services


Description: This project, funded by Washington State's Division of Alcohol and Substance Abuse, extends previous work on a sample of clients in the ADATSA program who received treatment in 1990-91. The previous work included an examination of the operation of the ADATSA program, and an evaluation of outcomes at 18 months following treatment. The purpose of the five-year follow-up is to examine the long-term outcomes of those clients, including employment outcomes and the utilization and costs of Medicaid services. A further goal is to examine outcomes of selected subgroups of clients, particularly those AFDC recipients and clients recently convicted of a felony.

ADATSA Integrated Outcome Database

Principal Investigator:
Dennis M. Donovan, PhD
Director, Alcohol and Drug Abuse Institute ; Professor, Psychiatry and Behavioral Sciences
Alcohol and Drug Abuse Institute
ddonovan@u.washington.edu

Date: Project completed
Sponsor: Washington State Division of Alcohol and Substance Abuse
Categories: Clinical and Health Services

Other Investigators: Luchansky, Bill PhD - Project Director


Description: This project, funded jointly by the Division of Alcohol and Substance Abuse (DASA), and a CSAT Technical Assistance grant to DASA, is designed to do two things: first, to build an outcomes database that aggregates data from DASA's TARGET data system with data on outcomes of treatment from other Washington State agencies. Those other data sources include wage data from the Employment Security Department, Medicaid data from Washington State's Medicaid Management Information System, and criminal justice data from the Washington State Patrol and the Department of Corrections. That data will eventually be a tool for a wide range of research projects. The second part of the project is a series of outcomes evaluations that will include not just a sample of the ADATSA population, but the population receiving services from January of 1994 through August of 1997.

ADATSA Treatment Outcome Evaluation (Project STOP)

Principal Investigator:
Dennis M. Donovan, PhD
Director, Alcohol and Drug Abuse Institute ; Professor, Psychiatry and Behavioral Sciences
Alcohol and Drug Abuse Institute
ddonovan@u.washington.edu

Date: Project completed
Sponsor: Center for Substance Abuse Treatment ; Washington State Division of Alcohol and Substance Abuse
Categories: Clinical and Health Services

Other Investigators: Michelle Hansten Ingalsbe, MSW - Project Manager


Description: This project is funded by a subcontract from the Center for Substance Abuse Treatment (CSAT) through the Division of Alcohol and Substance Abuse to develop and implement a follow-up evaluation of publicly-funded clients seeking treatment through the King County Division of Alcoholism and Substance Abuse Services (ADATSA) Assessment Center. A battery of assessment instruments will be administered to ADATSA clients, who are indigent; parts of the assessment process, which will include the Addiction Severity Index (ASI), will be conducted by DeltaMetrics in Philadelphia in collaboration with researchers from ADAI. Project Stop will provide DASA with information on post-discharge outcomes of ADATSA clients who began their treatment as either inpatients or outpatients.

Alcohol Abuse in Urban Indian Adolescents and Women

Principal Investigator:
Dennis M. Donovan, PhD
Director, Alcohol and Drug Abuse Institute ; Professor, Psychiatry and Behavioral Sciences
Alcohol and Drug Abuse Institute
ddonovan@u.washington.edu

Date: Project completed
Sponsor: National Institute on Alcohol Abuse and Alcoholism
Categories: Clinical and Health Services


Description: Caretakers of American Indian youth who meet criteria for a lifetime diagnosis of alcohol dependence are also more likely to experience additional psychiatric illness, most commonly major depression. These findings are particularly true for American Indian women. Clinicians who assess or treat those with alcohol dependence also need to assess and treat or refer patients for depressive or other psychiatric care. This prospective, longitudinal study seeks to identify risk and protective factors associated with alcohol and drug use and abuse and other mental health problems among American Indian youth and women. The project, initiated originally by R. Dale Walker, M.D., has been funded by NIAAA for over nine years.

Alcohol Intervention in a Level-1 Trauma Center

Principal Investigator:
Dennis M. Donovan, PhD
Professor, Psychiatry & Behavioral Sciences ; Director, Alcohol & Drug Abuse Institute

Date: Project completed
Sponsor: National Institute on Alcohol Abuse and Alcoholism
Categories: Clinical and Health Services


Description: The purpose of this NIAAA-funded study is to determine if incorporating a program of alcohol problem screening, intervention and referral in a trauma center reduces further alcohol related injuries and other morbidities. Alcohol-involved patients at a Level 1 Regional Trauma Center will be randomized into an intervention or control group. Brief motivational enhancement and/or referral to community-based alcohol treatment will be offered to the intervention group. The study will evaluate the effectiveness of the intervention at inducing treatment entry and completion, and in reducing subsequent admissions to hospitals problems. Statewide computerized databases will also be used to assess subsequent health care costs, mortality, motor vehicle crashes and DWI violations. If effective, the proposed intervention may provide an impetus for trauma centers to address alcohol problems as a routine component of care for the injured patient.

Alcohol Use and Decompression Sickness in Recreational Divers

Principal Investigator:
Barbara C. Leigh, PhD, MPH
Senior Research Scientist
Alcohol and Drug Abuse Institute
leigh@u.washington.edu

Date: Project completed
Sponsor: Alcohol Beverage Medical Research Foundation
Categories: Clinical and Health Services


Description: Although conventional wisdom in recreational scuba diving holds that alcohol consumption increases risk of decompression sickness (DCS), there are no epidemiological data supporting this contention. Because of the very low incidence of decompression sickness, a case-control method is a promising way to study risk factors for DCS. No case-control study of diving injuries in recreational scuba divers has ever been done, and implementing such a study has a number of potential difficulties, including the identification and recruitment of an appropriate control group. This pilot study, funded by the Alcohol Beverage Medical Research Foundation, will test the feasibility of applying procedures from case-control studies of alcohol-related injuries to the study of recreational diving injuries. We will recruit and interview 1) divers treated for DCS; and 2) other divers diving at the same locations. Interviews will include questions about the circumstances of the dive resulting in DCS (for cases) or for the most recent dive (for controls), including alcohol consumption before or after the dive. The pilot study will provide information on a) success of recruitment procedures for cases and controls; b) suitability of interview procedures for accident information and drinking information; and c) sample size requirements for future studies. This information will be used to develop future case-control studies of alcohol use as a risk factor for diving injuries.

Attrition while Awaiting Drug Treatment (Project START)

Principal Investigator:
Dennis M. Donovan, PhD
Director, Alcohol and Drug Abuse Institute ; Professor, Psychiatry and Behavioral Sciences
Alcohol and Drug Abuse Institute
ddonovan@u.washington.edu

Date: Project completed
Sponsor: National Institute on Drug Abuse
Categories: Clinical and Health Services

Other Investigators: Rosengren, David PhD - Project Director


Description: This NIDA-funded project will study clients who are seeking treatment for substance abuse. Particular focus will be on the problem of clients who are placed on a waiting list for state-supported treatment, but who drop out of the treatment process between their initial assessment and actual treatment entry. Help-seeking behavior, perceived barriers to treatment, and characteristics of those who drop out vs. those who actually enter treatment will be investigated. An "attrition prevention" intervention based on motivational interviewing and group-delivered case management will be designed and evaluated to determine its effectiveness in preventing waiting list drop out. In addition, subsequent use of substance abuse and other social services will be compared between clients who enter treatment vs. those who dropped out before entry. It is expected that the attrition prevention intervention will lead to a reduced rate of attrition from the waiting list, a greater likelihood of completing treatment that has been entered, and a reduced utilization of further services.

Brief Intervention in Primary Care for Problem Drug Use and Abuse

Principal Investigator:
Peter Roy-Byrne, MD
Professor
Psychiatry and Behavioral Sciences

Date: September 1, 2008 to June 30, 2013
Sponsor: National Institute on Drug Abuse (5 R01 DA026014-03)
Categories: Clinical and Health Services

Other Investigators: Dennis M. Donovan, PhD (ADAI Director, Professor Psychiatry & Behavioral Sciences) Co-Investigator


Description: This project is evaluating the effectiveness of an intervention that has recently been approved as a billable service in the medical care setting, despite the absence of data supporting its use in drug abuse and dependence. The results of the study will have implications for whether it is advisable to expand its application beyond hazardous alcohol abuse to include abuse of drugs.

A substantial body of research has established the effectiveness of brief interventions (BI) for hazardous alcohol use in patients seen in medical settings, prompting the implementation of dissemination projects of screening and brief intervention for "substance abuse" on a widespread scale. However, there are few studies examining the efficacy of BI for problem drug use and abuse in medical settings, and there is considerable variability in what actually constitutes a BI (i.e., what are the important or active therapeutic ingredients). The potential costs related to untreated drug abuse in medical settings are substantial. Although there is great human suffering and morbidity for the abuser, it is likely that potential healthcare cost savings and decreased adverse healthcare outcomes related to BI will be the major drivers of policy change to improve provision of BI treatment.

Accordingly, this application proposes to conduct a policy-relevant clinical trial with broad external validity (a hybrid "efficacy-effectiveness" study) informed by the literature on BI and alcohol use, to evaluate the efficacy of BI and referral to treatment when indicated, in patients with problem drug use and abuse seen in the primary care medical setting at a large safety-net hospital. The study has four aims: (1) to determine if BI is effective in reducing drug use and increasing completed referral to treatment (i.e., treatment initiation); (2) to test whether higher fidelity to a BI model that emphasizes motivational interviewing is more effective than lower fidelity; (3) to estimate the impact of BI on several public health outcomes; (4) to estimate the costs of the intervention, potential cost offsets, and incremental cost-effectiveness from the payer perspective based on health care service use and drug use frequency.

Related Web Sites:
NIH RePORTer Record

Brief Substance Abuse Treatment for Homeless Adolescents (STARRS)

Principal Investigator:
John S. Baer, PhD
Research Associate Professor
Psychology
jsbaer@u.washington.edu

Date: September 30, 2002 to June 30, 2008
Sponsor: National Institute on Drug Abuse (R01DA015751)
Categories: Clinical and Health Services

Other Investigators: Sharon Garrett (Project Director), Bryan Hartzler (Co-Investigator), Jennifer Mullane (Interviewer / Interventionist), Melissa Phares (Interviewer / Interventionist)


Description: Homeless youth constitute a group of adolescents at high risk for substance use disorders and associated psychosocial consequences, yet few interventions have been developed for this population. In response to PA-99-107, NIDA Behavioral Therapies Development Program, this application seeks support for a Stage I developmental project. The research program will develop and test a brief motivational enhancement and service-linking intervention tailored to the special needs of homeless youth. Social structures that have strong influence on adolescent behavior (such as families and schools) are not typically available for intervention. Most youth are not seeking substance abuse treatment. Youth also suffer from high rates of trauma, psychiatric co-morbidity, poverty, and victimization. The intervention will be guided by the Transtheoretical Model of behavior change (Prochaska and DiClemente, 1983). We propose to develop a brief, motivational and service linking intervention aimed at facilitating contemplation of change and use of available services. The intervention will be conducted over several individual meetings over a period of one month. Counselors will provide personalized feedback on substance use behavior and social network relations, use non-confrontational clinical interviewing techniques (Motivational Interviewing), and provide vouchers to encourage participation. The intervention is proposed to be conducted with youth who are not seeking treatment, and to be conducted and integrated with additional services within a local agency. The goals of the intervention will be to encourage homeless adolescents to question social influences about substance use, question assumptions about drug effects, consider treatment for drug problems, and make use of available social services. An initial period of funding will be used to develop a pilot intervention drawing from brief interventions tested with adults and adolescents, and to complete process analyses of service utilization among homeless adolescents. Subsequently, a randomized controlled trial will be conducted. A sample of 100 youth-stratified by age and gender, will be randomly assigned to Motivational Enhancement treatment (ME) or Treatment as Usual (TAU). TAU includes drop-in programs (hygiene, food, material assistance, and case management). Follow-up interviews at one- and three-months post-treatment, will assess substance use, stage of change, and service utilization.

Results: Baer JS, Beadnell B, Garrett SB, Hartzler B, Wells EA, Peterson PL. Adolescent change language within a brief motivational intervention and substance use outcomes. Psychol Addict Behav 2008;22(4):570-575. Full text PMC2605642

Center for Neuroregulation in Alcohol Dependence (CENIAD)

Principal Investigator:
Andrew J. Saxon, MD
Professor, Psychiatry and Behavioral Sciences

Date: September 30, 2009 to August 31, 2011
Sponsor: National Institute on Alcohol Abuse and Alcoholism (5P20AA017839-02)
Categories: Clinical and Health Services

Other Investigators: Dennis M. Donovan, PhD (Director, ADAI, and Professor, Psychiatry & Behavioral Sciences)


Description: [This grant is awarded to the Seattle Institute for Biomedical/Clinical Research]

The Developmental Center for Neuroregulation in Alcohol Dependence (CeNiAD) grew from the clinical observation that the CNS active generic alpha-one adrenoreceptor (AR) antagonist prazosin reduced or eliminated alcohol drinking in veterans with posttraumatic stress disorder (PTSD) and comorbid alcohol dependence. Recently we demonstrated in placebo-controlled studies that prazosin reduces alcohol consumption in two animal models of alcohol dependence and in a human study in persons with alcohol dependence but without PTSD. Our clinical observation, our compelling prazosin preclinical and clinical treatment data, emerging neuroscience data implicating the CM AR in mechanisms of addiction, and the presence at VA Puget Sound and the University of Washington of a critical mass of faculty investigating alcohol dependence have led to the proposed developmental center.

The CeNiAD has the following goals: (1) To create an interdisciplinary translational research team investigating alpha-one adrenergic receptor (AR) and other neuroregulatory mechanisms and interventions in alcohol use disorders (ADD); (2) To establish the collaborations, facilities, research capabilities, preliminary findings, career development opportunities, intellectual milieu and planning process to justify an application for a future new Specialized P50 Alcohol Research Center. An Administrative Core will support the scientific mission, develop and coordinate career development of basic and clinical AUD investigators, provide biostatistics and data management support, and provide the planning process for a future P50 Center. A distinguished External Advisory Board will help guide the CeNiAD in these activities. There will be two first wave exploratory projects and two first wave pilot projects. Exploratory Project 1 addresses effects of pharmacologic reduction of noradrenergic signaling in alcohol ingestion in alcohol preferring rats. Exploratory Project 2 is a placebo-controlled prazosin trial in persons with co-occurring alcohol dependence and PTSD. Pilot Project 1 addresses prazosin effects on cue-induced alcohol craving in humans. Pilot Project 2 addresses prazosin effects on alcohol craving and consumption in military returnees from Iraq and Afghanistan with PTSD. A process for solicitation and review of especially relevant additional exploratory and pilot projects has been established to support a second wave of such projects in the second 2.5 years of the CeNiAD.

Dr. Donovan will serve as a member of the CeNIAD Executive Committee and provide input on all aspects of CeNIAD research, training, and center development.

Related Web Sites:
NIH RePORTER Record

Clinical Trials Network: Pacific Northwest (Washington) Node

Principal Investigator:
Dennis M. Donovan, PhD
Director, Alcohol and Drug Abuse Institute ; Professor, Psychiatry and Behavioral Sciences
Alcohol and Drug Abuse Institute
ddonovan@u.washington.edu

Date: January 10, 2001 to August 31, 2007
Sponsor: National Institute on Drug Abuse (DA013714)
Categories: CTN (NIDA Clinical Trials Network) | Clinical and Health Services

Other Investigators: Elizabeth Wells, PhD; T. Ronald Jackson, MSW; Andrew J. Saxon, MD; Molly Carney, PhD; John Baer, PhD; Donald Calsyn, PhD; Brenda Stuvek; Mary Hatch-Maillette, PhD; Lisa Rey Thomas, PhD


Description: Drug dependence continues to be a persistent problem for which new treatments, both behavioral and pharmacological, are continually being developed. There is a great need to develop mechanisms by which such treatments, once shown to be efficacious, can be put into widespread clinical practice in community-based treatment programs where the largest number of drug abusers are seen. A number of barriers between researchers and clinicians, however, have made such a transition difficult, if at all possible. The recent Institute of Medicine report has challenged us to work on "bridging the gap," to address the barriers to facilitate a more functional working relationship between treatment providers and clinical researchers, who share a common goal of wanting to improve substance abuse treatment and its outcomes. NIDA has developed an action agenda to stimulate treatment providers and researchers to consider ways, from each of their perspectives, to narrow or bridge the "gap." NIDA's action agenda is the development of the National Clinical Trials Network (CTN), in which researchers at Regional Research and Training Centers work in partnership with Community-based Treatment Programs both to develop areas of mutual interest for future clinical research and to test promising therapies in community settings.

The present proposal seeks support to develop the Pacific Northwest (PN) Regional Research and Training Center of the NIDA-funded Clinical Trials Network. The interdisciplinary Regional Research and Training Center, to be housed within the University of Washington Alcohol and Drug Abuse Institute (ADAI), will have as its primary focus the development, implementation, and evaluation of behavioral and pharmacological therapies, alone and in combination, targeted at drug use as delivered in the real world settings of the affiliated community-based treatment programs. It will integrate behavioral and pharmacological research as a means of informing policy, therapy development, and the evaluation process, with a goal of contributing meaningfully to the improved effectiveness of new and promising therapies developed within the larger Clinical Trials Network. The investigators have a long history of working with community based programs in research and program evaluation, collaborating on multisite clinical trials, developing and evaluating both pharmacotherapy and behavioral therapy, and conducting services research, and translating and disseminating results into information useful for clinicians and policy makers. It is this experience that we offer to the larger Clinical Trials Network.

For more information about the Washington Node, including a list of the staff and active protocols, visit the CTN-WA web site.

Related Web Sites:
PNW Node website

Co-Occurring Disorders

Principal Investigator:
Gary B. Cox, PhD
Research Scientist
Alcohol and Drug Abuse Institute
gbcox@u.washington.edu
http://bit.ly/adaistaff_cox

Date: Project completed
Sponsor:
Categories: Clinical and Health Services


Description: What are the implications for medium-term outcomes of the co-occurrence or mental illness and alcohol or other substance abuse among consumers of public substance abuse and mental health services? In this case, outcomes will be measured by the utilization of medical services and public substance abuse and mental health services. Subjects will consist of all patients discharged from Western State Hospital in the calendar year 1996. They will be categorized based on discharge diagnoses into four groups: mental illness diagnoses only; substance abuse diagnoses only; substance abuse plus Axis I mental illness; and substance abuse plus other Axis II mental illness. These groups will be compared on utilization of public substance abuse services, and other medical service utilization over subsequent years. Data will be obtained from three DSHS sources: the Division of Alcohol and Substance Abuse, the Mental Health Division, and the Medical Assistance Administration. All data will be derived from administrative data sets, so there will be no contact with subjects, nor will any additional data be collected specifically for the purpose of this study. Various data analyses will be performed and the groups compared on treatment admission and re-admission patterns, and on patterns of utilization of services. The results will be used to inform planners and policy makers about whether clients with co-occurring disorders of these types require special treatment programs.

Combining Medications and Behavioral Interventions for Alcoholism

Principal Investigator:
Dennis M. Donovan, PhD
Director, Alcohol and Drug Abuse Institute ; Professor, Psychiatry and Behavioral Sciences
Alcohol and Drug Abuse Institute
ddonovan@u.washington.edu

Date: September 30, 1997 to August 31, 2005
Sponsor: National Institute on Alcohol Abuse and Alcoholism (U10AA011799)
Categories: Clinical and Health Services

Other Investigators: Michelle Hansten Ingalsbe, MSW - Research Consultant; Carolyn Cichanski - Research Coordinator; Jennifer Williams - Research Coordinator


Description: Recent research has suggested that a number of medications hold promise for improving outcomes in alcohol treatment. In particular, naltrexone and acamprosate act at different receptor sites and have each demonstrated an impact on alcohol consumption in animal and clinical trials. However, these drugs are typically given as an adjunct to behavioral interventions, despite little research to guide the specific nature of possible interactions between behavioral and pharmacological interventions. The present application proposes both a pilot study and a larger scale study for inclusion in the NIAAA cooperative agreement focusing on combined use of pharmacotherapies and behavioral interventions in the treatment of alcohol problems. A preliminary randomized trial is proposed that would evaluate the acceptability, safety, and clinical outcomes of naltrexone and acamprosate used in combination. The preliminary study will monitor side effects, adverse consequences, medication compliance, treatment retention, and changes in drinking, and craving during a 3-month trial period. The larger study is designed as a double-blind, placebo-controlled clinical efficacy trial of six-month intervention investigating the relative efficacy of two medications, naltrexone and acamprosate, used in combination with two behavioral interventions, one basic Motivation and Compliance Enhancement (MCE) and one where specific relapse preventive skills-training is added, MCE plus Integrated Relapse Prevention (MCE/IRP) across a twelve month post-intervention follow-up. Subjects will be randomly assigned to one of four conditions combining the medications 1) naltrexone/acamprosate, 2) naltrexone placebo, 3) placebo acamprosate, and 4) placebo/placebo. All subjects will also receive a behavioral intervention to enhance motivation for chance (based on Motivational Enhancement Therapy) and medication compliance. Participants will be randomized to either eight sessions of Motivation and Compliance Enhancement or fifteen sessions of Integrated Relapse Prevention. Aims for the large study include: a) comparing, main and interactive effects of naltrexone, acamprosate, and behavioral interventions on outcome, b) evaluating medication compliance, treatment retention, and therapist effects medication clinical outcomes, and c) identifying patient attributes associated with differential response to the intervention combinations, thus suggesting, possible client-treatment matches.

Related Web Sites:
Local COMBINE Study site: http://adai.uw.edu/combine_uw.htm
National COMBINE site: http://www.cscc.unc.edu/combine/

Computer Modeling of Alcohol Services Research Data

Principal Investigator:
Gary B. Cox, PhD
Research Scientist
Alcohol and Drug Abuse Institute

Date: Project completed
Sponsor: National Institute on Alcohol Abuse and Alcoholism
Categories: Clinical and Health Services


Description: This NIAAA-funded study will apply computer modeling research methods to study the public alcohol treatment system in Seattle/King County. The goals of the project are to learn more about the patterns of service utilization by clients of public alcohol treatment, and to investigate how best to communicate that information to the agencies responsible for managing the public treatment system so that they may make more informed administrative decisions. The investigators will develop a computerized model of the treatment system which can then be applied to hypothetical management decisions, such as varying patterns of resource allocation, or the introduction of different or new interventions into the treatment system, or when services are organized in a new way. The project will identify the types of service utilization data which are most important for describing the treatment system, and which data will be most useful to the decision makers who manage the system, in turn improving the effectiveness and efficiency of the public alcohol treatment system.

Daily Self-Reports of Injection Drug Use and Risk

Principal Investigator:
Barbara C. Leigh, PhD, MPH
Senior Research Scientist
Alcohol and Drug Abuse Institute
leigh@u.washington.edu
http://bit.ly/adaistaff_leigh

Date: April 1, 2006 to March 31, 2008
Sponsor: National Institute on Drug Abuse (R21 DA021092)
Categories: Clinical and Health Services

Other Investigators: Devon Brewer, PhD


Description: Injection drug users (IDUs) are at high risk for blood-borne infections, including HIV, hepatitis B (HBV), and hepatitis C (HCV), due to the sharing of drug injection equipment and other blood exposures. Measurement issues in this domain are crucial but are difficult to address adequately given the limitations of retrospective self-reports. Daily measurements of behavior, although still imperfect, may be more accurate than retrospective accounts.

The purpose of this R21 project is to conduct a pilot study in which injection drug users report daily on their drug use and injection risk behavior, using an innovative technique of computerized telephone interviewing (Interactive Voice Response, or IVR). The aims of the project include assessing the feasibility of collecting daily reports from this difficult population, comparing daily reports with retrospective measures of drug use and risk, assessing the completeness of retrospective reports of drug injection partners, describing patterns of injection drug use and risk over time within individuals, and describing episode- and day-level contemporaneous correlates and prospective predictors of individuals’ injection drug use and risk. By comparing daily reports to retrospective measures, we can examine some of the ways in which retrospective reports may or may not capture injection drug use and risk behaviors. If we demonstrate that the use of daily IVR is feasible with this population, future studies can make use of IVR as a cost-effective means of measuring injection drug use and risk in IDUs.

Related Web Sites:
NIH RePORTER Record

Developing Research Capacity and Culturally Appropriate Research Methods: Community-Based Participatory Research Manual for Collaborative Research in Drug Abuse for American Indians and Alaska Natives

Principal Investigator:
Dennis M. Donovan, PhD
Alcohol and Drug Abuse Institute

Date: 2008? to August 31, 2010
Sponsor: National Institute on Drug Abuse ; National Center on Minority Health and Health Disparities
Categories: American Indians / Alaska Natives | Clinical and Health Services | CTN (NIDA Clinical Trials Network)

Other Investigators: Cynthia Pearson, PhD (Project Director)


Description: This study is in collaboration with the NIH National Center for Minority Health and Health Disparities and will be conducted in the Pacific Northwest Node of the NIDA CTN. The specific aim of this project is to develop a user-friendly manual or "field guide" on the use of community-based participatory research (CBPR) and Tribal participatory research (TPR) methods for academic researchers and Tribal communities to use when developing and implementing culturally relevant, truly collaborative research in the areas of substance abuse, HIV/AIDS, mental health, and other areas of health disparities in American Indian/Alaska Native (AIAN) populations.

The manual will be developed by collecting and incorporating information from several sources: (1) review of available literature; (2) focus groups or interviews with participants from Tribal communities; (3) focus groups or interviews with academic representatives; and (4) asking both community and academic partners to provide information about their experiences with research in AIAN communities (via email list).

Related Web Sites:
Protocol record in CTN Library

Development and Characteristics of the Managed Care Mental Health Care System in North Sound Regional Support Network

Principal Investigator:
Linda Brown, RN, PhD
Research Scientist
Alcohol and Drug Abuse Institute

Date: Project completed
Sponsor: Washington Institute for Mental Illness Research and Training
Categories: Clinical and Health Services


Description: This study is designed to identify and map the developmental process and organization of the managed mental health care model in North Sound Regional Support Network (NSRSN). Made up of a five-county region (Island, San Juan, Skagit, Snohomish and Whatcom counties), the NSRSN has approximately 900,000 residents. The region encompasses a range of geographical areas and kinds of communities including metropolitan, semi-urban, rural, and very remote island areas that are accessible only by ferry. In anticipation of expanded managed care, mental health providers in the region initiated a network to more effectively meet the challenges of developing and implementing a coordinated managed care system. This system, Associated Providers Network (APN), marks the first time that a multi-county group of non-profit provider agencies had organized into a single entity within Washington state. This study, funded by the Washington Institute for Mental Illness Research and Training, will identify and map the development and implementation of the organization structure, service delivery processes, quality management, and data systems of the APN, as well as develop blueprints that can be used in other mental health regions of the state. An additional purpose of the study is to provide information for a second stage study focused more specifically on issues of access, treatment packages, and client outcomes.

Disseminating Organizational SBI Services (DO-SBIS) at Trauma Centers.

Principal Investigator:
Douglas Zatzick, MD
Professor
Psychiatry and Behavioral Sciences

Date: August 1, 2007 to July 31, 2012
Sponsor: National Institute on Alcohol Abuse and Alcoholism (5 R01 AA016102-04)
Categories: Clinical and Health Services

Other Investigators: Dennis M. Donovan, PhD (ADAI Director, Professor Psychiatry & Behavioral Sciences) Co-Investigator


Description: Each year in the United States approximately 2.5 million individuals are so severely injured that they require inpatient hospital admission. The integration of screening and brief interventions (SBI) into acute injury care has the potential to markedly increase the number of patients who receive needed services and has been a longstanding public health objective. In January of 2005 the American College of Surgeons, the primary agency responsible for developing trauma center requirements, passed a landmark resolution mandating that level I trauma centers must screen injured patients for an alcohol use disorder, and provide an intervention to those who screen positive. Preliminary studies suggest that there is a substantial risk that the SBI mandate will be implemented with marked variability and that low quality SBI procedures could become the default standard of trauma center care.

The goal of the Disseminating Organizational Screening and Brief Interventions Services (DO-SBIS) investigation is to capitalize on the unique opportunity afforded by the American College of Surgeons' mandate by taking early steps to insure high quality, evidence-based SBI services are implemented and outcomes are assessed. In the first phase of the investigation, SBI services will be assessed for all 190 level I trauma centers in the United States. In the second phase of the investigation, 20 level I trauma centers will be selected for randomization to intervention or control conditions. Providers at each intervention trauma center will receive workshop training and ongoing telephone coaching in the delivery of evidence-based motivational interviewing (Ml) intervention; Ml training will be embedded within evidence-based organizational development activities that aim to facilitate the integration of SBI services into routine trauma center care. Control trauma centers will implement SBI care as usual.

The investigation hypothesizes that intervention trauma centers, when compared to control trauma centers, will demonstrate higher quality SBI, as evidenced by greater provider proficiency in SBI delivery, significant reductions in 6- and 12-month post-injury alcohol use in patients receiving SBI, and enhanced organizational acceptance of SBI services. Without DO-SBIS baseline data on SBI services and follow-up RCT data on patient, provider, and organizational outcomes, a critical opportunity to provide empiric support of a historic policy decision to require alcohol services at level I trauma centers could be lost. The DO-SBIS interdisciplinary research group includes trauma surgery opinion leaders who are dedicated to implementing future policy mandates that derive from the DO-SBIS research program. Future mandates will aim to strengthen and refine trauma center delivery of evidence-based SBI services.

The dissemination of high quality SBI services at level I trauma centers has the potential to influence alcohol policy in other health care settings nationwide.

Related Web Sites:
NIH RePORTer Record

Domestic Violence among Pregnant Substance Abusers

Principal Investigator:
Jeanette Norris, PhD
Senior Scientist
Alcohol and Drug Abuse Institute
norris@u.washington.edu

Date: Project completed
Sponsor: Washington State Division of Alcohol and Substance Abuse
Categories: Clinical and Health Services


Description: In this study for DASA, the researchers will furnish pilot data documenting the extent of domestic violence as an issue in the treatment of pregnant and postpartum substance abusers. Women in residential and outpatient treatment programs will be interviewed about domestic violence to provide descriptive information about the relationships between domestic violence and other variables related to treatment. The ultimate goal of the study is to aid in the development of more effective treatment strategies for pregnant and postpartum substance abusing women.

Drinking Trajectories after Behavior Intervention: Assessing Mechanisms of Change

Principal Investigator:
Katie Witkiewitz, PhD
Research Scientist
Alcohol and Drug Abuse Institute
kate19@u.washington.edu
http://bit.ly/adaistaff_witkiewitz

Date: September 15, 2007 to September 29, 2010
Sponsor: National Institute on Alcohol Abuse and Alcoholism (R21 AA017137)
Categories: Clinical and Health Services

Other Investigators: Bryan Hartzler, PhD (ADAI Research Scientist)


Description: The proposed research will use existing data from the COMBINE study to evaluate the mechanisms of behavior change following a combined behavioral intervention (CBI) for alcohol dependence. COMBINE was a multisite clinical trial conducted to evaluate the efficacy of two medications for alcohol dependence (naltrexone and acamprosate) when used in conjunction with one of two behavioral interventions (CBI and medical management). This project will focus specifically on individuals who were randomly assigned to the CBI conditions (n=776). Assessments of psychological, drinking, and behavioral outcomes were conducted at 8, 16, 26, 52, and 68 weeks. Using a multi-method analysis framework, the relationship between background variables, risk and protective factors, and treatment process measures, will be examined with respect to drinking outcomes (including quantity, frequency, and drinking-related consequences). In addition, this study will incorporate a dynamical systems approach to examining the impact of two specific CBI modules, Mood Management and Coping with Craving and Urges, which are intended to change mood and craving, respectively. It is well-documented that a lack of effective coping responses increases relapse risk; and craving, mood, and perceived stress have been identified as important mediators in the return to heavy drinking following treatment. However, the relationship between these variables in the relapse process has not been clearly established. Focusing on the process of relapse, this project will examine trajectories of drinking behavior and related consequences during treatment and in the first year following treatment for alcohol dependence. The first goal of the project is to model the discontinuous and complex drinking behavior patterns following treatment. The second goal is to quantify the relationship between processes of change during treatment, specific treatment modules intended to impact change mechanisms, and post-treatment drinking patterns.

Results: Witkiewitz KA, Donovan DM, Hartzler B. Drink refusal training as part of a combined behavioral intervention: Effectiveness and mechanisms of change. J Consult Clin Psychol 2012;80(3):440-449. Full text PMC3349797

Witkiewitz KA, Villarroel NA, Hartzler B, Donovan DM. Drinking outcomes following drink refusal skills training: Differential effects for African-American and Non-Hispanic White clients. Psychol Addict Behav 2011;25(1):162-7. PubMed abstract

Hartzler B, Witkiewitz KA, Villarroel NA, Donovan DM. Self-efficacy change as a mediator of associations between therapeutic bond and one-year outcomes in treatments for alcohol dependence. Psychol Addict Behav 2011;25(2):269-278. Full text PMC3236109>/a>

Related Web Sites:
NIH RePORTER record

Evaluation of the Adolescent Treatment Enhancement Project

Principal Investigator:
Megan J. Rutherford, PhD
Research Scientist
Alcohol and Drug Abuse Institute
mruthfrd@u.washington.edu
http://bit.ly/adaistaff_rutherford

Date: Project completed
Sponsor: King County Mental Health, Chemical Abuse and Dependency Services Division
Categories: Clinical and Health Services


Description: Funded by King County Mental Health, Chemical Abuse & Dependency Services Division, on Evaluation of the Adolescent Treatment Enhancement Project, this project will implement enhanced treatment capacity for 200 adolescents who are involved in the juvenile justice system, or who are at high risk for involvement, and who are members of one of five special populations: Hispanic/Latino, Asian, African-American, Native American, or sexual minority. The purpose of the project is to increase the number of youth from these special population groups who are offered effective treatment as an alternative to juvenile justice sanctions. The project will document the contribution of increased attention and resources to outreach and engagement-focused case management to increased treatment referrals, enrollment, engagement and retention for the special populations served. It will demonstrate that such young people can be offered treatment in lieu of juvenile justice sanctions with positive outcomes. It will further demonstrate the benefit of explicitly providing multicultural alliance and leadership opportunities for these young people and the degree to which these measures can improve treatment retention and recovery.

Evaluation of the Pierce County Alliance PROMETA Protocol

Principal Investigator:
Dennis M. Donovan, PhD

Date: October 12, 2007 to June 30, 2009
Sponsor: Washington State Division of Alcohol and Substance Abuse
Categories: Clinical and Health Services


Description: There has been increasing concern about the impact of methamphetamine abuse on individuals and families. To date there have been no effective pharmacological or behavioral treatments for methamphetamine abuse. Recently a new protocol, PROMETA, has been marketed as a potential treatment for this disorder, combining the use of previously approved medications, nutritional supplements, and counseling. There have been a number of testimonials of its effectiveness from individuals who have been treated with it. However, there have been few more rigorous outcome evaluations. The washington State Legislature provided funding to conduct a pilot of the PROMETA protocol by the Pierce County Alliance, a large substance abuse treatment program in the Tacoma -Pierce County area, in conjunction with the Family Dependency Drug Court. The goal of the trial is to treat methamphetamine abusers who have dependent children at risk and with the possibility of their being removed from the home. As part of the Legislature's funding there was the requirement that the Division of Alcohol and Substance Abuse (DASA) conduct an evaluation of the pilot of the PROMETA protocol with respect to both substance use and child welfare outcomes. The Alcohol and Drug Abuse Institute has been contracted by DASA to conduct this outcome evaluation.

Evaluation Plan for Adolescent Detox

Principal Investigator:
Peggy L. Peterson, PhD, MPH
Research Scientist
Alcohol and Drug Abuse Institute

Date: Project completed
Sponsor: Washington State Division of Alcohol and Substance Abuse
Categories: Clinical and Health Services


Description: This DASA-funded study is a formative evaluation of detox and crisis stabilization services for adolescents in the state of Washington. Eight agencies in the state provide detox/crisis stabilization services which provide a safe, temporary protective environment for at-risk/runaway youth who are experiencing harmful effects and/or withdrawal from alcohol and other drugs. These programs also assist in the referral, access, admission and completion of chemical dependency assessment and treatment for adolescents. Investigators will interview program staff of detox/crisis stabilization services and review client record information to learn 1) to what extent are the programs meeting their goals; 2) program implementation barriers and problems experienced by the service provider agencies; and 3) ways to improve the programs.

Increasing Post-Discharge Follow-up Among Hospitalized Smokers

Principal Investigator:
Kimber P. Richter, PhD, MPH
Associate Professor, Preventive Medicine & Public Health
University of Kansas Medical Center

Date: September 20, 2010 to May 31, 2014
Sponsor: National Heart, Lung and Blood Institute (1 U01 HL105232-01)
Categories: Tobacco Cessation | Clinical and Health Services

Other Investigators: Beatriz H. Carlini, PhD, MPH (ADAI Research Scientist, Co-Investigator)


Description: The primary aim of this project is to test the effects of warm transfer versus fax referral on quitline enrollments, post-discharge counseling adherence and smoking cessation. The secondary aim of this project is to determine mediators of the treatment effects on enrollment, post-discharge counseling and cessation.

Related Web Sites:
NIH RePORTER record

Informing Dissemination of Behavior Therapies to Enhance HIV Care Among Substance Abusers

Principal Investigator:
Bryan Hartzler, PhD
Research Scientist
Alcohol and Drug Abuse Institute
hartzb@u.washington.edu

Date: April, 2015 to March, 2017
Sponsor: National Institute on Drug Abuse (NIDA R03DA039719)
Categories: Clinical and Health Services | Sexual Behavior and HIV Risk

Other Investigators: Blair Beadnell, Heidi Crane, Julia C. Dombrowski, Dennis M. Donovan


Description: Substance abuse and HIV infection are a domestic health syndemic that compromises universal test-and-treat approaches for preventing HIV transmission and precipitates calls for quality improvement across the HIV Care Continuum. Dissemination of an empirically-supported behavior therapy to prompt HIV testing in addiction care settings is a large-scale effort, but with benefits attenuated by substance abusers’ poor clinic attendance and antiretroviral (ARV) therapy adherence. Thus, expanded transport of available empirically-supported behavior therapies to HIV care settings is needed to pre-empt such care disengagement. To identify a candidate therapy compatible for HIV care, one must consider with whom and with what intent the HIV workforce is to intervene. Extant prevalence rates for substance use disorders (SUDs) among HIV care enrollees are drawn from single-site trials, and vary by selected patient demography and history. Corresponding sample sizes often preclude analysis at a substance-specific level, even as some substances carry distinct considerations for transmission and course of HIV. Likewise, single-site trials evaluating impacts of substance abuse on patient adherence and response to HIV care offer limited generalizability. Fortunately, a coordinated multisite HIV care repository, governed by Center for AIDS Research Network of Integrated Clinical Systems (CNICS), incorporates data from sites across the U.S. and offers opportunity to determine the scope and impact of substance-specific SUDs in a large, diverse population of patients linked to HIV care. Proposed analyses will focus on care engagement, defined as a two-year period following HIV diagnosis and linkage to care. An available CNICS sample of ~10,000 patients will enable computation of broadly representative prevalence rates for substance-specific SUDs and comparisons of such SUD subgroups to non-SUD patients on key outcomes like cumulative viral burden, clinic attendance, ARV adherence, health risks, and quality-of-life. Relative to non-SUD counterparts, SUD subgroups are expected to exhibit greater viral burden, poorer clinic attendance and ARV adherence, more health risks, and lesser quality-of-life. In response to NIDA PA-12-282 (AIDS-Science Track Award for Research Transition), a New Investigator to HIV Research proposes to complement these CNICS-based analyses by gathering of dissemination-focused data during site visits to regional HIV care clinics. Data will be collected from site directors and direct-care staff via mixed-method procedures, with intent to identify from among NIDA-endorsed candidate behavior therapies an approach perceived as contextually-compatible. This low-cost, high-yield approach will advance knowledge of the SUD-HIV syndemic, and inform a future R01 testing implementation of an empirically-supported behavior therapy to engage substance abusers in HIV care.

Integrating Behavioral Interventions in Substance Abuse Treatment

Principal Investigator:
Bryan Hartzler, PhD
Research Scientist
Alcohol and Drug Abuse Institute
hartzb@u.washington.edu

Date: April, 2010 to March, 2015
Sponsor: National Institute on Drug Abuse (NIDA K23 DA025678A2)
Categories: Clinical and Health Services


Description: This project seeks to foster more effective provision of therapeutic services to substance-using treatment-seekers in our communities. This mentored early career development award will fund professional development activities and a sequence of three pilot research studies conducted over a 5-year period. The award’s overarching aim is development of a model of integrated clinical use of motivational interviewing and contingency management in opiate agonist treatment (OAT) settings. Professional development activities include advanced biostatistics coursework, supervised literature reviews with content experts, multi-regional site visits to community OAT clinics, attendance and provision of intervention training workshops for treatment providers, and facilitation of panel discussions among award contributors concerning model development.

Pilot research studies will: 1) examine policies, practices, and preferences of clinical directors and staff of national community OAT settings, 2) design and test a fidelity-monitoring instrument for contingency management implementation in OAT, and 3) evaluate impacts of a two-day contingency management training workshop on practitioner skillfulness and aggregate clinical outcomes at a large community OAT setting. This collective work informs an eventual RO1 grant application that will propose to test the utility of integrated vs. segregated training in MI and CM for OAT practitioners.

Award contributors are Dennis Donovan, Ph.D. (co-mentor), Don Calsyn, Ph.D. (co-mentor), John Roll, Ph.D. (CM content expert), Steve Lash, Ph.D. (CM content expert), David Rosengren, Ph.D. (MI content expert), Blair Beadnell, Ph.D. (biostatistician), and Ron Jackson, M.S.W. (OAT field expert).

Results: Hartzler B, Jackson R, Jones BE, Beadnell B, Calsyn DA. Disseminating contingency management: Impacts of staff training and implementation at an opiate treatment program. J Subst Abuse Treat 2014;46:429–438. doi: 10.1016/j.jsat.2013.12.007.

Hartzler B, Rabun C. Training addiction professionals in empirically supported treatments: perspectives from the treatment community. Subst Abuse 2014;35(1):30-6. doi: 10.1080/08897077.2013.789816.

Hartzler B, Rabun C. Community treatment adoption of contingency management: A conceptual profile of U.S. clinics based on innovativeness of executive staff. Int J Drug Policy 2013;24(4):333-41. doi: j.drugpo.2012.07.009

Hartzler B, Rabun C. Community opioid treatment perspectives on contingency management: Perceived feasibility, effectiveness, and transportability of social and financial incentives. J Subst Abuse Treat 2013;45(2):242-8. doi: 10.1016/j.jsat.2013.01.014

Hartzler B, Donovan DM, Tillotson C, Mongoue-Tchokote S, Doyle SR, McCarty D. A multilevel approach to predicting community addiction treatment attitudes about contingency management. J Subst Abuse Treat 2012;42(2):213–221. Full text PMC3268877

Hartzler B, Lash SJ, Roll JM. Contingency management in substance abuse treatment: A structured review of the evidence for its transportability. Drug Alcohol Depend 2012;122(1-2):1-10. Full text PMC3307900

Related Web Sites:
NIH RePORTER Record

Kitsap Outcome Evaluation

Principal Investigator:
Megan J. Rutherford, PhD
Alcohol and Drug Abuse Institute
mruthfrd@u.washington.edu
http://bit.ly/adaistaff_rutherford

Date: Project completed
Sponsor:
Categories: Clinical and Health Services


Description: This project will expand the previous outcome evaluation study for the Kitsap County Adult and Juvenile Court, to include a process evaluation for juvenile drug court and an outcome evaluation for adult drug court. The outcome evaluation will assess clients' reduction in recidivism, reduction in substance use, improvement in other areas of life functioning, and the relationships of these outcomes to the structure of the treatment and court program.

Long-term Opioid Management of Chronic Pain: Trends and Risks

Principal Investigator:
Michael Von Korff, ScD
Senior Scientific Investigator
Center for Health Studies, Group Health Cooperative
vonkorff.m@ghc.org

Date: September 28, 2006 to April 30, 2010
Sponsor: National Institute on Drug Abuse
Categories: Clinical and Health Services | Epidemiology and Drug Abuse Trends

Other Investigators: Caleb Banta-Green, PhD, MSW, MPH (ADAI Research Scientist)


Description: Health services research and epidemiologic methods will be used to understand who receives long-term opioid therapy and to assess associated risks including onset of opioid abuse and mortality. This research will be conducted in two large, non-profit health plans serving over 1% of the U.S. population. Research goals - Our goals are to advance knowledge concerning determinants and risks of long-term opioid therapy among chronic pain patients. Aim 1-Examine trends: We will describe trends in use of long-term opioid therapy in the participating health plans from 1995-2006 and determine how patient characteristics indicating clinical complexity and prior substance abuse are related to trends in long-term opioid use. Aim 2-Assess risks of opioid abuse: We will assess risk factors for opioid abuse among persons receiving long-term opioid therapy. Aim 3-Assess mortality and other adverse event risks: We will assess whether mortality and other adverse event risks are increased by long-term opioid therapy. We will extend these analyses by studying the effects of long-term opioid therapy on other adverse events including: all-cause and opioid-related hospitalization; opioid overdose; and onset of recognized mood disorder.

This project is based at the Center for Health Studies, Group Health Cooperative. ADAI has a subcontract for the work of Dr. Banta-Green; his primary role will be in the development, implementation and analysis of the interview study used to address Aim 2, risk factors for opioid abuse.

Related Web Sites:
NIH RePORTER record

Matching Patients to Alcoholism Treatments: Seattle CRU

Principal Investigator:
Dennis M. Donovan, PhD
Director, Alcohol and Drug Abuse Institute ; Professor, Psychiatry and Behavioral Sciences
Alcohol and Drug Abuse Institute
ddonovan@u.washington.edu

Date: Project completed
Sponsor: National Institute on Alcohol Abuse and Alcoholism
Categories: Clinical and Health Services


Description: This study, a component of the multi-site Project MATCH funded by NIAAA, aims to test the "matching hypothesis" that alcohol treatment effectiveness can be increased by assigning clients with certain characteristics to particular treatments. Currently in year eight, the project (1) tests primary and secondary a priori matching hypothesis over the course of 15 months of follow-up, (2) conducts psychometric and other analyses of patient, treatment process, and outcome variables to test these matching hypotheses, (3) examines alternative analytic strategies and variables for testing matching, and (4) determines the extent to which matching effects persist over a three year period following treatment completion.

Methadone Maintenance in Primary Care

Principal Investigator:
Joseph O. Merrill, MD
Alcohol and Drug Abuse Institute

Date: Project completed
Sponsor:
Categories: Clinical and Health Services


Description: Methadone maintenance treatment of heroin addiction has been found to be effective in reducing drug use, enhancing social productivity, and preventing the spread of infectious diseases, yet strict regulatory policies, budget constraints and social stigmatization have limited access to methadone. The emergence of AIDS among injection drug users, and an accelerating HIV epidemic among injection drug users in nearby Vancouver, B.C. has added urgency to the search for policies and programs that improve access and lower the cost of methadone treatment in Washington State. One identified policy response is the implementation of "medical maintenance" - providing methadone through community physicians outside traditional drug treatment programs. The purpose of this research is to use the planned development and implementation of a pilot medical maintenance program in King County, Washington as an opportunity to study the policy barriers, physician training challenges, and patient safety and acceptability concerns that must be resolved for such programs to be widely replicated.

Methadone maintenance treatment is a highly regulated and controversial activity, and any effort to improve access to methadone services must respond to the numerous federal, state and local regulatory interests, as well as medical and community concerns. Phase I of this project will study a broadly inclusive policy development process as it defines the structure and protocols for a pilot medical maintenance program. Research using key informant interviews and a consensus meeting process will assist others as they approach the regulatory, administrative and political obstacles to, and opportunities for, medical maintenance.

The regulatory history of methadone has led to a centralized treatment system, difficult to expand and isolated from mainstream medical care. Physicians who plan to care for methadone maintenance patients must overcome the lack of education and experience associated with this isolation. Phase II of this project will develop and conduct a physician training program and an ongoing clinical support system, and evaluate its effects on physician knowledge and attitudes.

Phase III of this project will implement the medical maintenance model defined in Phase I as a small feasibility pilot program. Patients will transfer their methadone maintenance treatment to a primary care medical setting, keeping close ties to the traditional methadone treatment program. Data documenting patient addiction severity, service utilization, and patient safety handling methadone will be collected, as will patient, provider, and program staff satisfaction information. This will assure the safety and feasibility of a medical maintenance model, and provide pilot data and estimates of key parameters necessary to the design of a randomized trial of medical maintenance.

Integrating methadone maintenance and primary medical care is a concrete step toward both improved access to methadone treatment and coordination of treatment services for drug users. It will also increase physicians' knowledge and experience concerning methadone treatment and substance abuse issues more broadly. Finally, it begins to address the isolation and stigma that have prevented methadone treatment from reaching its full potential.

Mindful Awareness in Body-Oriented Therapy for Women's Substance Abuse Treatment: A Feasibility Study

Principal Investigator:
Cynthia Price, PhD
Research Assistant Professor
Biobehavioral Nursing and Health Systems

Date: May 1, 2008 to April 30, 2011
Sponsor: National Institute on Drug Abuse (5 R21 DA024771-02)
Categories: Clinical and Health Services

Other Investigators: Dennis M. Donovan, PhD (ADAI Director, Professor Psychiatry & Behavioral Sciences)


Description: The broad, long-term objective of the current research is to improve substance abuse treatment for women through an innovative mind-body approach, 'Mindful Awareness in Body-Oriented Therapy' (MABT). The MABT approach is designed to enhance embodiment and to facilitate mindfulness through the combination of massage, body awareness exercises and the acquisition of mindfulness skills. The treatment goals of MABT include reduction of avoidant coping responses, increase of emotional-regulation, and decrease of trauma symptoms through access to and acceptance (vs. avoidance) of sensory and emotional experience. These are thought to be important for relapse prevention given the positive association between stress, negative affect and relapse; and risk of relapse associated with PTSD symptoms.

The specific aims of the research are to: 1) to examine feasibility of recruitment to and retention in MABT as an adjunct to substance abuse treatment, 2) describe intervention acceptability, and 3) compare the effect of body-oriented therapy vs. treatment-as-usual on reported days abstinent for substance use in order to estimate effect size. The trial will involve a two-group repeated measures design in which participants are assigned to either the Treatment-as- Usual comparison group or the MABT experimental group, also receiving usual care. Both conditions will be compared at baseline, post-intervention, and at six and nine month follow-up.

This study involves examination of the MABT intervention as a complement to treatment-as-usual within a comprehensive substance abuse treatment program for women. The research will contribute to a program of research in body-oriented therapy.

Related Web Sites:
NIH RePORTer Record

Mindfulness-based Relapse Prevention: Efficacy and Mechanisms

Principal Investigator:
G. Alan Marlatt, PhD
Professor
Psychology
kate19@u.washington.edu

Date: August 1, 2009 to July 31, 2011
Sponsor: National Institute on Drug Abuse (5R01DA025764-02)
Categories: Clinical and Health Services | Prevention Research

Other Investigators: Katie Witkiewitz, PhD (ADAI Research Scientist)


Description: [ADAI has a subcontract to support the participation of Katie Witkiewitz on this project].

The broad, long-term objective of the proposed randomized clinical trial is to evaluate the efficacy, moderators and mechanisms of change of two cognitive-behavioral aftercare treatments for alcohol and other drug (AOD) use disorders in preventing AOD relapse compared to standard aftercare (SA) offered in the community. The two cognitive-behavioral aftercare treatments are relapse prevention (RP; Daley & Marlatt, 2006) and Mindfulness-Based Relapse Prevention (MBRP), which integrates mindfulness meditation and RP aftercare components.

The proposed research plan will address three specific aims. The first aim is to examine the efficacy of MBRP and RP compared to SA in preventing AOD relapse following intensive inpatient (IP) and outpatient (IOP) AOD treatment. Participants will be recruited from IP and IOP treatment and randomized to 8 weeks of MBRP, RP or SA. Treatment efficacy, as defined by reductions in AOD use and related consequences, will be evaluated at posttreatment and 3-, 6-, 9- and 12- month follow-up assessments. It is hypothesized that both MBRP and RP will result in significantly less AOD use and related consequences compared to SA. The second specific aim is to evaluate potential mediators of MBRP and RP treatment efficacy. It is proposed that the MBRP and RP interventions will be differentially effective in reducing AOD use and consequences based on the unique objectives of each treatment approach. It is therefore hypothesized that MBRP efficacy will be mediated by metacognitive processes, locus of control, mindfulness, thought suppression, ability to cope with craving and negative affect, experiential avoidance, emotion regulation and intensity of meditation practice. It is further hypothesized that RP efficacy will be mediated by negative affect, positive expectancies, self-efficacy and coping abilities. The final aim is to test potential moderators of treatment efficacy. It is hypothesized that participants with higher baseline levels of avoidant coping, experiential avoidance and lower levels of emotion regulation will benefit more from MBRP vs. RP treatments; whereas participants with lower self-efficacy and higher positive expectancies at baseline will benefit more from RP vs. MBRP treatments.

In fulfilling these specific aims, the proposed research will address the NIDA mission for Stage II treatment research by examining the efficacy, moderators and differential mechanisms of change of various AOD aftercare treatments. Further, the proposed research is designed to gain a better understanding of why these treatments work and for whom.

Related Web Sites:
NIH RePORTER record

Modeling Individual Heterogeneity in the Alcohol Relapse Process

Principal Investigator:
Katie Witkiewitz, PhD
Research Scientist
Alcohol and Drug Abuse Institute
kate19@u.washington.edu
http://bit.ly/adaistaff_witkiewitz

Date: August 15, 2006 to July 31, 2008
Sponsor: National Institute on Alcohol Abuse and Alcoholism (R03AA016322)
Categories: Clinical and Health Services

Other Investigators: Bryan Hartzler, PhD (ADAI Research Scientist)


Description: By analyzing data from Project MATCH, this study aims to delineate patterns in post-treatment drinking during the first year following alcohol treatment.

Approximately 17.6 million Americans meet criteria for alcohol abuse or dependence, and 12.5 percent of individuals who meet criteria for alcohol abuse or dependence (2.2 million Americans) will receive treatment for an alcohol problem. Of those who receive treatment, the majority of individuals will have at least one drink in the first 12 months following treatment. This study aims to delineate patterns in post-treatment drinking during the first year following alcohol treatment. Data from Project MATCH, a multi-site investigation of alcohol treatment sponsored by the NIAAA, will be used to test the hypothesis that there is significant variability in the drinking behavior between individuals and within individuals across time. Secondary data analyses of the Project MATCH data will be conducted for three distinct purposes. The first goal of the proposed study will be to replicate previous research using latent growth mixture modeling to investigate common patterns and individual differences in trajectories of drinking after the initial post-treatment drink. The second goal is to describe the differences in drinking trajectories using a biopsychosocial model of relapse risk factors. The third goal is to quantify the complexity of the relapse process by extending the latent growth mixture models to analyze the behavior of individuals who transition in-and-out of abstinence. The goal of these analyses is to understand why and when individuals experience major shifts in drinking over time. The major aim of the proposed research is to provide an empirically-driven model of relapse that incorporates the individual variability and abrupt, discontinuous nature of the relapse process, as illustrated in theoretical and qualitative reports. The ultimate goal of this inquiry is to provide clinicians and their clients with a heightened awareness of risk factors that may predispose an individual to heavy drinking and those factors that increases the probability of transitioning from light-to-heavy drinking following treatment.

Results: Witkiewitz KA, Hartzler B, Donovan DM. Matching motivation enhancement treatment to client motivation: Re-examining the Project MATCH motivation matching hypothesis. Addiction 2010 105(8):1403-1413; comment on pp. 1414-15. PMC3157315

Motivational Enhancement to Reduce Risk of Street Youth

Principal Investigator:
Peggy L. Peterson, PhD, MPH
Research Scientist
Alcohol and Drug Abuse Institute

Date: Project completed
Sponsor:
Categories: Clinical and Health Services


Description: Street youth constitute a group of adolescents at high risk for alcohol problems. Although the high level of substance use risk among street youth has been documented, and alcohol use is known to increase risks for trauma and continued street life, few interventions have been developed for this population. The proposed four year study will develop and test a brief motivational enhancement intervention tailored to street youth. The goals of the intervention are to increase motivation to change alcohol and drug risk behavior, increase alcohol and drug-related help-seeking behavior, and to reduce alcohol and drug risk. The intervention is guided by the Transtheoretical Model of behavior change (Prochaska and DiClemente, 1983). In short, we propose a brief, motivational intervention aimed at facilitating contemplation of change. The intervention uses personalized feedback on risk behavior and non-confrontational clinical interviewing techniques to encourage young adolescents without stable living environments to consider treatment for alcohol problems, question social influences, and make use of available social services. A sample of 240 youth -- stratified by age, gender, and ethnicity -- will be randomly assigned to one of two groups: Motivational Enhancement treatment (ME) or assessment only (AO). Follow-up interviews will be conducted at one-month (immediate post-test) and three-months post-treatment and will assess stage of change for heavy alcohol and drug use, attitudes and social norms, social network characteristics, quantity and frequency of alcohol and drug use, alcohol and drug use consequences, help seeking, and treatment services utilization. We hypothesize that compared to youth in the AO condition, youth in the ME condition will: a) show greater change in motivation to reduce alcohol and drug risk as evidenced by movement in stage of change; b) show greater change in attitudes and social norms favorable to reducing alcohol and drug risk; c) show greater reduction in use quantity and patterns of risky use of alcohol and other drugs; and d) engage in more help-seeking behavior for alcohol and other drug use.

National Drug Abuse Treatment Clinical Trials Network (CTN) Pacific Northwest Node

Principal Investigator:
Dennis M. Donovan, PhD
Director, Alcohol and Drug Abuse Institute
Professor, Psychiatry and Behavioral Sciences

Mary Hatch-Maillette, PhD
Co-Principal Investigator, Pacific NW Node
Senior Research Scientist, Alcohol and Drug Abuse Institute

ddonovan@u.washington.edu
http://bit.ly/adaistaff_donovan

Date: January 10, 2001 to May 31, 2020
Sponsor: National Institute on Drug Abuse (U10DA013714)
Categories: Clinical and Health Services | CTN (NIDA Clinical Trials Network)

Other Investigators: Co-Principal Investigator: Mary Hatch-Maillette, PhD; Elizabeth Wells, PhD; T. Ronald Jackson, MSW; Andrew J. Saxon, MD; John Baer, PhD; Donald A. Calsyn, PhD (deceased); Sharon Garrett, MPH, MA; Brenda Stuvek; Mary Hatch-Maillette, PhD; Lisa Rey Thomas, PhD


Description: Drug dependence continues to be a persistent problem for which new treatments, both behavioral and pharmacological, are continually being developed. There is a great need to develop mechanisms by which such treatments, once shown to be efficacious, can be put into widespread clinical practice in community-based treatment programs where the largest number of drug abusers are seen. A number of barriers between researchers and clinicians, however, have made such a transition difficult, if at all possible. The recent Institute of Medicine report has challenged us to work on "bridging the gap," to address the barriers to facilitate a more functional working relationship between treatment providers and clinical researchers, who share a common goal of wanting to improve substance abuse treatment and its outcomes. NIDA has developed an action agenda to stimulate treatment providers and researchers to consider ways, from each of their perspectives, to narrow or bridge the "gap." NIDA's action agenda is the development of the National Clinical Trials Network (CTN), in which researchers at Regional Research and Training Centers work in partnership with Community-based Treatment Programs both to develop areas of mutual interest for future clinical research and to test promising therapies in community settings.

In January 2001, the University of Washington Alcohol and Drug Abuse Institute received a five-year grant from NIDA to join the CTN as the Pacific Northwest Node, one of seventeen state and regional nodes throughout the country. ADAI and UW researchers from many departments comprise the node's Regional Research and Training Center which has as its primary focus the development, implementation, and evaluation of behavioral and pharmacological therapies for drug abuse, targeted at treatment as delivered in community settings. As part of the larger Clinical Trials Network, the Pacific Northwest Node conducts behavioral and pharmacological research studies as a means of informing policy, therapy development, and the evaluation process, with a goal of contributing meaningfully to improved effectiveness of new and promising therapies. Investigators at the UW have a long history of working with community programs in research and program evaluation, collaborating on multi-site clinical trials, developing and evaluating both pharmacotherapy and behavioral therapy, conducting services research, and translating and disseminating results into information useful for clinicians and policy makers.

Expansion: In 2007, the PN Node was awarded an additional three years of funding, and expanded to include a treatment center in Sitka, Alaska, the SouthEast Alaska Regional Health Consortium, as well as the Addiction Treatment Center at the VA Puget Sound and American Lake hospitals in Washington. A subsequent renewal (continuing our funding through August 2014), we expanded our collaborative network through a partnership with Dr. John Roll, Associated Dean for Research and Professor in the School of Nursing at Washington State University, Spokane. Drs. Donovan and Roll now serve as Multiple PIs for the Pacific Northwest Node. This expansion leverages the resources of ADAI and the existing PNW Node Regional Research and Training Center at UW with those of the Program of Excellence in Rural Mental Health and Substance Abuse Treatment (RMHSAT) and the Program of Excellence in the Addiction, both of which are directed by Dr. Roll at WSU. This partnership also provides the opportunity to expand the scope of the Node to include increased attention to the issues of substance abuse in rural settings.

Community-Based Treatment Programs: We currently have 15 collaborating community-based treatment and health care programs affiliated with the PNW Node http://adai.washington.edu/ctn/chart.htm.

The Alcohol and Drug Abuse Institute also serves as the National CTN Dissemination Library for the Clinical Trials Network (http://ctndisseminationlibrary.org/). It is a digital repository of resources created by and about NIDA's National Drug Abuse Treatment Clinical Trials Network (CTN). It provides CTN members and the public with a single point of access to research findings and other materials that are approved for dissemination throughout the CTN and to the larger community of providers, researchers and policy-makers. The CTN Library is described more fully later in this report in the section entitled Dissemination of Research Findings.

The Pacific NW Node has participated in 20 CTN protocols or ancillary studies since joining the CTN in 2001, collaborating with community treatment programs in Washington and other CTN Nodes. For more information about the Washington Node, including a list of the staff and active protocols, visit the CTN PN Node website.

Related Web Sites:
NIH RePORTER record
PNW Node website
CTN Dissemination Library

Native Pathways to Sobriety: Pacific Northwest Oral Life Histories

Principal Investigator:
Lisa Rey Thomas, PhD
Research Scientist
Alcohol and Drug Abuse Institute
lrthomas@u.washington.edu
http://bit.ly/adaistaff_thomas

Date: September 30, 2009 to August 31, 2013
Sponsor: National Institute on Drug Abuse (1R01DA029002-01)
Categories: American Indians / Alaska Natives | Clinical and Health Services

Other Investigators: Lisette Austin


Description: Like other NARCH components, this project will be conducted according to the principles of Community-Based Participatory Research (CBPR), with the consensus and collaboration of tribal communities and tribal partners. The NARCH Initiative supports partnerships throught the nation, between Tribes and Tribally-based organizations and institutions to develop opportunities for conducting research, research training, and faculty development to meet the needs of tribal communities.

Related Web Sites:
NIH RePORTER record

Outcome Analyses of Persons in Chemical Dependency Treatment

Principal Investigator:
Brent L. Baxter, PhD
Research Scientist
Alcohol and Drug Abuse Institute
http://bit.ly/adaistaff_baxter

Date: Project completed
Sponsor: Washington State Division of Alcohol and Substance Abuse
Categories: Clinical and Health Services


Description: This set of studies was conducted for Washington State's Division of Alcohol and Substance Abuse (DASA) to assess the effectiveness of chemical dependency treatment in Washington State. Through analyses using individual-level data from DASA's "TARGET" management information system, the studies examined changes in clients' lifestyles occurring between treatment admission and discharge. Outcome variables included substance use, employment status, criminal justice involvement, health-services utilization, residential status and public assistance. These studies included the following:

Inpatient/Outpatient Treatment: Analyses of inpatient/outpatient treatment outcomes were based on a sample of 3066 clients discharged from publicly-supported inpatient or outpatient chemical dependency treatment (excluding opiate-substitution treatment) in Washington State between July 1, 1995 and November 30, 1995. Findings presented included those for selected subgroups of clients, including adult, youth, ADATSA recipients, pregnant/parenting women, and clients completing treatment.

Opiate-Substitution Treatment: Analyses of opiate-substitution treatment outcomes were based on a sample of 1698 clients admitted to opiate-substitution treatment in Washington State between July 1, 1993 and June 30, 1996 and discharged from treatment by mid-October 1996. Findings were presented for both publicly-funded and private-pay clients, and for each of the ten opiate-substitution treatment providers.

Pattern of Alcohol Use and Alcohol-Related Diagnoses among Drug Abusing/Dependent Participants

Principal Investigator:
Dennis M. Donovan, PhD
Director, Alcohol and Drug Abuse Institute ; Professor, Psychiatry and Behavioral Sciences
Alcohol and Drug Abuse Institute ; Psychiatry and Behavioral Sciences
ddonovan@u.washington.edu


Sponsor: National Institute on Drug Abuse
Categories: Clinical and Health Services | CTN (NIDA Clinical Trials Network)

Other Investigators: Bryan Hartzler, Ph.D.


Description: Alcohol use, abuse, and dependence are common among individuals who are dependent on other drugs such as cocaine, other stimulants such as methamphetamine, and opiates. This secondary analysis of data from ten CTN protocols (CTN-0001, 0002, 0004, 0006, 0007, 0009, 0013, 0017, 0018, 0019) examines the pattern of alcohol use, alcohol-related diagnoses, and severity of other problems among a large sample of drug abusing/dependent participants enrolled in community-based drug treatment programs across the country.

Related Web Sites:
CTN Library page for this Protocol

Pioneer Center North Evaluation

Principal Investigator:
Gary B. Cox, PhD
Research Scientist
Alcohol and Drug Abuse Institute

Date: Project completed
Sponsor:
Categories: Clinical and Health Services


Description: This study, funded by the Mental Health Division of Washington State's Department of Social and Health Services, studies outcomes from the Dual Diagnosis Program and the Chemical Dependency Involuntary Treatment Program at Pioneer Center North. The goals of this research are: (1) to assess the use of community and institutional services for individuals in these two treatment programs both before and after treatment, (2) to assess the impact of maintaining community linkages during treatment on subsequent use of community services, (3) to assess the rates of contact with law enforcement for individuals in these programs both before and after treatment at the facilities, (4) to assess the cost of maintaining individuals in the community both before and after treatment for those who have completed treatment, ( 5) to identify the data elements in the TARGET and MHD's Management Information System that could be used to produce indices of the desired outcome measure over time, and (6) to identify elements that are necessary for these measures of outcomes, but missing from existing data sets.

Preventing Addiction Related Suicide

Principal Investigator:
Richard Ries, MD
Professor
Psychiatry and Behavioral Sciences

Date: May 15, 2009 to April 30, 2011
Sponsor: National Institute on Drug Abuse (5 R21 DA026494-02)
Categories: Prevention Research | Clinical and Health Services

Other Investigators: Dennis M. Donovan, PhD (ADAI Director, Professor Psychiatry & Behavioral Sciences) Co-Investigator


Description: This proposal aims to improve drug and alcohol addiction treatment by developing and testing a behavioral suicide education and prevention module for integration into standard intensive outpatient addiction treatment. Addiction is a potent risk factor for suicide and suicidal behavior. Although studies show that suicide or suicide attempts are 10 to 50 times more frequent among people with addiction disorders-and even higher among people requiring addiction treatment-no suicide prevention efforts have been developed and tested specifically for addiction treatment settings.

The key aims of this R21 exploratory research proposal are: 1) to develop the Preventing Addiction Related Suicide (PARS) module, a suicide risk reduction training and intervention program that can be incorporated into standard group-based, intensive outpatient program (IOP) addiction treatment; 2) to obtain pilot data on its acceptance and feasibility, as rated by IOP patients and counselors; and 3) to assess changes in knowledge, attitudes, and adaptive behaviors about suicide prevention following exposure to the PARS, as rated by addiction treatment participants and counselors at two NIDA CTN (Clinical Trials Network) addiction treatment agencies.

Related Web Sites:
NIH RePORTer Record

Project COMBINE RTI

Principal Investigator:
Dennis M. Donovan, PhD

Date: August 1, 2004 to January 31, 2008
Sponsor: Research Triangle Institute
Categories: Clinical and Health Services


Re-Engagement in Evidence-Based Quitline Treatment for Low Income Smokers

Principal Investigator:
Beatriz H. Carlini, PhD, MPH
Research Scientist
Alcohol and Drug Abuse Institute
bia@u.washington.edu
http://bit.ly/adaistaff_carlini

Date: September 1, 2009 to August 31, 2011
Sponsor: National Cancer Institute (5R21CA141568-02)
Categories: Tobacco Cessation | Clinical and Health Services


Description: Tobacco dependence is a chronic relapsing condition that usually requires repeat quit attempts from tobacco users and long-term behavioral and pharmacotherapy support to achieve long term abstinence. Unfortunately, most cessation programs are not designed to treat tobacco use as a chronic condition and offer only one-time treatments with a finite period of intervention. Low income smokers face even more challenges in benefiting from this "one-shot" approach, as their relapse rates are typically higher than average, due in part to obstacles related to maintaining behavioral change while working and socializing in environments that are more conducive to tobacco use. Quitlines typically serve a large proportion of low-income smokers and are often the only source of tobacco cessation support available to this population. An intervention that targets low income smokers to re-engage in quitline treatment could have great public health impact by exposing this hard to quit group to additional opportunities to receive customized, evidence-based telephone- based tobacco cessation treatment. Interactive voice response (IVR) systems are capable of proactively contacting individuals and can be programmed to provide targeted motivational and informational messages.

The primary aims of this research are to 1) Develop an IVR system that delivers tailored audio messages to increase smokers' re-engagement in treatment offered by two state quit lines and 2) Evaluate the feasibility and efficacy of an IVR system as a tool to reengage smokers into quitline treatment measured by number of IVR calls answered, number of smokers who re-engage in treatment and satisfaction with IVR calls. A secondary aim of this research is to obtain preliminary evidence of the efficacy of proactively re-engaging low income smokers into treatment on abstinence as compared to usual care. In the development phase of this proposal, smokers who have used quitline support in a previous quit attempt will be recruited and interviewed by telephone to support the development of tailored messages to encourage re-engagement in treatment among low income smokers. In the second phase, a randomized control trial will be conducted, with a sample of 3,000 smokers who used services from two state quitlines. Participants in the trial will be randomized to either receive usual care (no intervention to increase re-engagement) or the IVR intervention to increase re- engagement in treatment. Re-engagement in quitline treatment and quit rates will be measured at six month follow up.

ADAI has a subcontract from Free and Clear, Inc for its role in this project.

Related Web Sites:
NIH RePORTER Record
Free & Clear, Inc.

Reducing HIV/STD Risk Behaviors: A Research Study for Men in Drug Abuse Treatment

Principal Investigator:
Donald A. Calsyn, PhD
Chief, Outpatient Programs, Addiction Treatment Center, VA Puget Sound ; Affiliated Faculty Research, Alcohol and Drug Abuse Institute, UW
Alcohol and Drug Abuse Institute
dcalsyn@u.washington.edu
http://bit.ly/adaistaff_calsyn


Sponsor: National Institute on Drug Abuse
Categories: Clinical and Health Services | CTN (NIDA Clinical Trials Network)


Description: Drug treatment, itself, can have a powerful positive effect on HIV drug use risk behavior, especially needle use behaviors. Research suggests that men and women are less likely to engage in risky sex behavior with an intense HIV risk reduction intensity, peer group discussion, and the use of separate sex sessions. This study evaluates a five-session HIV/AIDS group therapy designed specifically for heterosexual men. This therapy is compared to standard HIV/AIDS education, which generally consists of a single session of HIV education. The researchers hypothesize that men in the gender-specific therapy group will report less risky sexual behavior than men in standard therapy. They are also expected to have a more positive attitude about condoms, be more likely to have condoms, be more likely to have taken condoms from clinic supplies, report less drug use in combination with sex, and hold a more egalitarian attitude toward women.

The Washington Node is the Lead Node on this protocol. Also participating are the California/Arizona, Delaware Valley, Long Island, New England, North Carolina, Ohio Valley, Pacific Region, South Carolina, and Southwest nodes.

Related Web Sites:
Washington Node home page: http://depts.washington.edu/adai/ctn-wa

The Role of Alcohol Consumption in Classifications of Alcohol Use Disorders: A Clinical Study

Principal Investigator:
Dennis M. Donovan, PhD
Alcohol and Drug Abuse Institute

Date: 2008 to August 31, 2010
Sponsor: National Institute on Drug Abuse ; National Institute on Alcohol Abuse and Alcoholism
Categories: Clinical and Health Services | CTN (NIDA Clinical Trials Network)


Description: This CTN- and NIAAA-funded ancillary study is related to CTN-0031, "Stimulant Abusers Group to Engage in 12-Step (STAGE-12)."

This study will investigate the utility of adding a frequency measure of alcohol consumption to the DSM-V diagnostic criteria for alcohol use disorders, by analyzing the statistical performance of the alcohol consumption measure in conjunction with the other DSM-IV alcohol abuse and dependence criteria arrayed along a continuum of severity in clinical samples. The alcohol consumption measure will be the frequency of drinking 5+ drinks (men) or 4+ drinks (women) on an occasion. To accomplish this goal, the study will collect baseline data in clinical samples on the 5+/4+ alcohol consumption measure and DSM-IV alcohol abuse and dependence criteria.

These data will be used in two stages of analysis. First, it will conduct IRT analyses to determine whether the diagnostic criteria in conjunction with the 5+/4+ consumption measure form patterns similar to those found in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Second, it will determine whether the alcohol severity indicator derived from the first stage of analysis predicts repeated measures of alcohol consumption collected at the follow-up points in the study.

Related Web Sites:
Protocol record in CTN Library

Screening Motivational Assessment and Referral to Treatment in Emergency Departments (SMART-ED): Evaluation of Screening, Brief Intervention, Referral to Treatment (SBIRT) and Booster Session for Drug Use Patients Presenting for Treatment in the Emergency Department

Principal Investigator:
Michael Bogenschutz, MD
Center on Alcoholism, Substance Abuse, and Addictions (CASAA), University of New Mexico


Sponsor: National Institute on Drug Abuse (NIDA-CTN-0047)
Categories: Clinical and Health Services

Other Investigators: Dennis M. Donovan, PhD (ADAI Director, Professor Psychiatry & Behavioral Sciences) Co-Principal Investigator


Description: This study is a protocol for NIDA's National Drug Abuse Treatment Clinical Trials Network (CTN). It builds on the knowledge base in developing and implementing screening and brief interventions for harmful and hazardous alcohol use delivered in emergency departments and trauma centers, by transferring and evaluating these procedures when applied to drug use.

The study will contrast substance use and substance-related outcomes among patients endorsing problematic substance use during an emergency department (ED) visit who are randomly assigned to one of three treatment conditions: 1) minimal screening only (MSO); 2) screening, assessment, and referral to treatment (if indicated) (SAR); and 3) screening, assessment, and referral plus a brief intervention (BI) with two telephone follow-up booster sessions (BI-B). The primary outcome is days of use of the patient-defined primary problem drug at 3 months following enrollment. Secondary outcomes include change from baseline in days of use of the primary substance, the number days abstinent from all drugs, days of heavy drinking, total quantity of drug use, objective change in drug use based on analysis of hair samples, self-reported consequences of drug and alcohol use, percent entering treatment among those classified as having probable dependence, and ED and other health care utilization.

Related Web Sites:
CTN Dissemination Library Protocol page

SSI Battelle

Principal Investigator:
Gary B. Cox, PhD
Alcohol and Drug Abuse Institute
gbcox@u.washington.edu

Date: Project completed
Sponsor: Washington State Division of Alcohol and Substance Abuse
Categories: Clinical and Health Services


Description: Funded by DASA, this project has two primary aims: 1) to estimate the impact of the Contract with America Advancement Act, which terminated the Social Security Administration's Disability Insurance (DI) and Supplemental Insurance (SSI) benefits for persons diagnosed with substance abuse problems; and 2) to estimate based on findings from Aim 1, the economic impact of the benefits termination on federal, state, and local government resources for the people denied these benefits as a whole and in subgroups. ADAI will be responsible for building and documenting the analytic data base that will be used in determining outcomes for former recipients of these benefits.

SSI Project Evaluation

Principal Investigator:
Gary B. Cox, PhD
Research Scientist
Alcohol and Drug Abuse Institute

Date: Project completed
Sponsor: Washington State Division of Alcohol and Substance Abuse
Categories: Clinical and Health Services


Description: This project is funded by a contract from DASA to evaluate a program which monitors persons who receive Supplemental Security Income benefits (SSI) from the federal Social Security Administration for disability due to alcohol or drug abuse problems. The monitoring agency assesses recipients of SSI who have alcohol or other drug abuse problems, then refers them to appropriate chemical dependency treatment, vocational rehabilitation, and/or mental health programs. SSI benefits are paid to designated "payees" on behalf of the client, to either "professional payees," (SSA-approved payees, project payees, or treatment centers), or "non-professional payees," who may be friends, relatives or have some other relationship with the client. Four questions are addressed in the evaluation: How effective are the outreach efforts in reaching qualified clients? Do monitored clients have better outcomes than those who are not monitored? Do more intense levels of monitoring result in better client outcomes? and Do clients with professional payees have better short-term outcomes (including treatment compliance) than clients with non-professional payees?

Starting Treatment with Agonist Replacement Therapies

Principal Investigator:
Dennis M. Donovan, PhD
Director
Alcohol and Drug Abuse Institute

Date: September 1, 2005 to August 31, 2007
Sponsor: University of California, Los Angeles
Categories: Clinical and Health Services | CTN (NIDA Clinical Trials Network)

Other Investigators: Andrew J. Saxon, MD


Description: START is a randomized, open-label, multi-center phase IV study designed to compare the changes in liver enzymes related to treatment with Buprenorphine/Naloxone (BUP/NX) to the changes in liver enzymes related to treatment with methadone in an outpatient setting. Secondary objectives will be to attempt to identify risk factors at baseline and during treatment that could contribute to interactions with BUP/NX or methadone causing liver dysfunction, and to assess abstinence from illicit drugs or alcohol during the active study period.

This CTN "platform" study was requested by the FDA and uses the collaboration of two NIDA divisions -- the Center for Clinical Trials Network (CCTN) and the Division of Pharmacotherapies & Medical Consequences of Drug Abuse.

Related Web Sites:
Protocxol page in the CTN Library

Stimulant Abuser Groups to Engage in 12-Step (STAGE-12): Evaluation of a Combined Individual-Group Intervention to Reduce Stimulant and Other Drug Use by Increasing 12-Step Involvement

Principal Investigator:
Dennis M. Donovan, PhD
Professor, Psychiatry & Behavioral Sciences ; Director, Alcohol and Drug Abuse Institute
Alcohol and Drug Abuse Institute
ddonovan@u.washington.edu
http://bit.ly/adaistaff_donovan

Date: 2008 to August 31, 2010
Sponsor: National Institute on Drug Abuse
Categories: Clinical and Health Services | CTN (NIDA Clinical Trials Network)

Other Investigators: Sharon Garrett 9Project Director), Betsy Wells, Lindsay Jenkins, Michelle Peavy


Description: This NIDA CTN protocol will evaluate the degree to which a combined group and individual intervention that also uses recovery mentors, "Stimulant Abuser Groups to Engage in 12-Step" (STAGE-12), improves substance-related outcomes compared to treatment as usual (TAU) without STAGE-12 among stimulant (methamphetamine and/or cocaine) abusers. The primary objective of the protocol is to evaluate reduction in percent of days of stimulant use. Secondary objectives include evaluating reduction in percent days of use of other substances, the degree to which STAGE-12 increases involvement in 12-step activities and attendance at 12-step meetings, and the extent to which such 12-step involvement and meeting attendance influences substance use outcomes.

Related Web Sites:
Protocol record in CTN Library

Substance Use and Suicide in Street Youth

Principal Investigator:
Joshua A. Ginzler, PhD
Research Scientist
Alcohol and Drug Abuse Institute
shua@u.washington.edu

Date: August 1, 2003 to July 31, 2008
Sponsor: National Institute on Drug Abuse (K01DA014685)
Categories: Clinical and Health Services


Description: This proposal is in response to PA 00-019. My goal is to pursue a research career in an academic setting with a substantive focus on the etiology of adolescent psychopathology. In particular, I am interested in understanding the factors that promote substance use disorders (SUD), and the comorbid relationship that SUD has with other psychopathology. Although my past training has provided me with a foundation in conducting longitudinal studies of adolescent SUD, none of my prior training has been broadly focused on developmental psychopathology. The central aims of the proposed Research Career Award (RCA) will be to (1) provide advanced training in research methods and quantitative techniques necessary for me to continue developing as an independent investigator and (2) to conduct an investigation that will advance our understanding of the SUD and suicidality, particularly in an extremely high-risk population of homeless adolescents. The performance site will be the University of Washington at Seattle, and my training mentors will be Drs. Thompson, Baer, and Cauce locally, and Dr. Hops from the Oregon Research Institute in Eugene, OR. I would like to develop a unique understanding of comorbidity issues within the street youth and eventually expand my research into comorbidity issues with adolescents in general.

Specific Aims of the study are: 1) Examine a specific set of variables that potentially lead to substance abuse or suicidality in homeless adolescents. This will be accomplished by empirically testing and validating a "risk amplification" model based upon a set of risk factors that are prevalent with homeless adolescents. 2) Second, we will examine whether drug involvement in homeless adolescents can be described in the same manner as it has for a high school sample of adolescents. Specifically, we will empirically test whether a multidimensional model of drug involvement developed to explicate the substance abuse of domiciled youth can be extrapolated to an extremely high-risk sample of street youth. I will also (1) continue my collaborative work with Drs. Thompson, Baer, Cauce, Hops on studies from their labs/research teams, (2) take courses in quantitative techniques, methodology, developmental psychopathology, and ethics, and (3) develop an R01 based upon the findings from this study.

Technology-Enhanced Quitline Services to Prevent Smoking Relapse

Principal Investigator:
Anna M. McDaniel, PhD, RN, FAAN
Indiana Unviersity-Perdue University at Indianapolis
http://nursing.iupui.edu/directory/amcdanie

Date: March 1, 2009 to January 31, 2011
Sponsor: National Cancer Institute (5R01CA138936-02)
Categories: Tobacco Cessation | Clinical and Health Services | Prevention Research

Other Investigators: Beatriz H. Carlini, PhD, MPH (ADAI Research Scientist, Co-Investigator); Katie Witkiewitz, PhD (ADAI Research Scientist, Co-Investigator)


Description: The purpose of this study is to test the efficacy of IVR technology for enhancing a widely used tobacco treatment service delivery model (Free & Clear's Quit for Life(R) program) to prevent smoking relapse and achieve abstinence. Our technology will enhance quitline services through (1) screening individuals during the post quit date period for increased risk of relapse and (2) providing evidence-based telephone counseling at the point of need tailored to the individual's extant risk factors. Using IVR monitoring, individuals will be screened for specific indicators of increased risk for relapse including smoking lapse, physical withdrawal symptoms, depressive symptoms, perceived stress, decreased self-efficacy for quitting, and decreased motivation to quit. In addition to these well-established predictors of relapse, there is compelling evidence to suggest that the risk of relapse is most intense during the first two weeks post-quit.

Thus we propose to compare two models for timing and frequency of IVR screening. In the Technology Enhanced Quitline (TEQ) arm, 10 proactive IVR calls will be placed at decreasing frequency for 8 weeks post-quit (twice a week for the first two weeks, then weekly). In the High Intensity Technology-Enhanced Quitline (HI-TEQ) arm, 20 proactive IVR calls will be placed over the 8 weeks post-quit (daily for the first 2 weeks, then weekly). The proposed study is a randomized controlled trial to compare smoking abstinence and cost-effectiveness at 6 and 12 months among participants in the Quit for Life quitline program. Three treatment groups will be compared, namely (1) standard Quit for Life care, (2) IVR monitoring of risk for smoking relapse in combination with telephone-based tobacco cessation treatment service (TEQ), and (3) high frequency monitoring of risk for smoking relapse in combination with telephone- based tobacco cessation treatment service (HI-TEQ). Subjects will be recruited from three large clients (two employers and one health plan client) of the Free & Clear Quit for Life telephone-based tobacco cessation treatment program.

If successful, this intervention could be incorporated into existing quitline protocols and delivered to millions of individuals who are trying to quit smoking, meeting a significant public health need for the dissemination of effective smoking cessation interventions. Public Health Relevance: Relapse after smoking cessation is an important health concern and is the most significant problem faced by individuals who are attempting to maintain abstinence from smoking.

Related Web Sites:
NIH RePORTER Record

Treatment of At-Risk Drinkers in Primary Care

Principal Investigator:
Dennis M. Donovan, PhD
Professor, Psychiatry & Behavioral Sciences ; Director, Alcohol & Drug Abuse Institute

Date: Project completed
Sponsor: National Institute on Alcohol Abuse and Alcoholism
Categories: Clinical and Health Services


Description: This NIAAA-funded project will conduct a randomized trial in a population of at-risk drinkers to evaluate the impact of interventions consisting of physician-delivered self- help materials, written personalized feedback, and supportive telephone counseling. Drinkers' readiness to change, their motivations across stages of changes, and self-help interventions which are hypothesized to mediate change will be studied, as will changes in the knowledge, practices and confidence of physicians regarding treating at-risk drinkers. The long term goal is to develop a protocol for identifying and treating at-risk drinkers in a primary health care system.

Treatment Outcomes of DASA Clients

Principal Investigator:
Dennis M. Donovan, PhD
Director, Alcohol and Drug Abuse Institute ; Professor, Psychiatry and Behavioral Sciences
Alcohol and Drug Abuse Institute
ddonovan@u.washington.edu

Date: Project completed
Sponsor: Washington State Division of Alcohol and Substance Abuse
Categories: Clinical and Health Services

Other Investigators: Carney, Molly PhD - Project Director


Description: This study, funded by the Washington State Division of Alcohol and Substance Abuse (DASA) will develop an on-going treatment follow-up system of publicly-funded substance abuse clients. The system to be developed by the project will provide DASA with information on post-discharge outcomes of clients. Outcomes to be measured by the study include: employment and earnings, physical health (especially use of emergency rooms), mental/psychological condition (especially inpatient psychiatric hospitalizations ), arrests, substance use, and school performance.


Powered by DB/Text WebPublisher, from Inmagic WebPublisher PRO