A Mentored Patient-Oriented Research Career Development Award (K23) is requested from NIAAA to facilitate the candidate's professional development as a productive, independent clinical scientist. Specifically, the candidate will use the five-year award to receive training relevant to examining processes associated with successful changes in drinking among those diagnosed with alcohol use disorders (AUDs), with a particular focus on applying a novel theoretical model for studying craving. Through the application of the Ambivalence Model of Craving, which views craving as a complex experience requiring consideration of contextual and other factors, including both desires to use (approach) and desires to not use (avoidance), the candidate will re-examine the craving-drinking relationship among those diagnosed with AUDs prior to, during, and after receiving a brief alcohol intervention. Greater understanding of craving processes during the course of recovery has the potential to inform current treatment strategies, and to highlight an important process associated with pretreatment changes in drinking, treatment initiation, and positive treatment outcomes. A long term career goal of the candidate is to investigate the processes by which individuals successfully change problematic drinking behaviors, and applying this knowledge to the development, refinement and implementation of treatment programs. The proposed five-year training plan and research study are a fundamental step in the candidate's professional development, and will focus on extensive training and mentoring in: 1) clinical trial methodology, 2) daily process methodology, 3) advanced statistical techniques for modeling complex daily data (i.e., multilevel modeling), and 4) the use of automated and web-based technologies in alcohol-related research. Further, the award will provide ongoing guidance for the professional development of the candidate as a clinical scientist, including further training in the responsible conduct of research. As part of this career development award, the candidate proposes a study combining both clinical trial and daily process methodology to examine the dynamic longitudinal relationships between daily approach and avoidance inclinations (i.e., craving) and drinking behaviors in those diagnosed with AUDs prior to, during, and after receiving a brief alcohol intervention. It is hypothesized that daily avoidance inclinations will significantly moderate the effect of daily approach inclinations on drinking behaviors, and that significant increases in avoidance inclinations will be observed prior to treatment entry, followed by significant decreases in approach inclinations during treatment. The research environment at the Research Institute on Addictions, combined with the carefully selected expert mentoring team, will provide the candidate with excellent support and guidance during the award period. The training and research experiences outlined in the proposed career development award will provide the necessary skills for the candidate to pursue a program of independent research addressing the complexities in the craving-drinking relationship among those diagnosed with AUDs.
Craving is hypothesized to play an important role in the development, maintenance, and reinstatement of alcohol use disorders (AUDs), yet the literature has failed to yield strong associations. The purpose of this study is to evaluate a nove theoretical model (i.e., Ambivalence Model of Craving) that emphasizes the importance of both the desire or urge to consume alcohol (i.e., approach inclinations) and the desire or urge to avoid consuming alcohol (i.e., avoidance inclinations). This model captures the ambivalence experienced by many alcoholics and may improve the ability to predict future drinking behaviors and treatment outcomes among those diagnosed with AUDs. The long-term goal of this study is to identify important processes (i.e., changes in craving) associated with changes in drinking behaviors, and how such information can be applied to enhance standard AUD treatment protocols.
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