This K23 career development program will prepare the Candidate, Raj K. Kalapatapu, M.D., as an independent investigator studying cognitive rehabilitation for individuals with substance use disorders. Specifically, using the Stage Model of Behavioral Therapies, this K23. As cognitive impairment moderates clinical outcomes in cocaine abusers, effectively treating cognitive impairment as part of a comprehensive treatment plan for cocaine abusers can potentially improve important clinical outcomes, such as abstinence, quality of life, and treatment completion. Because existing models of cognitive rehabilitation have yielded small effect sizes in improving cognition in cocaine abusers, newer models of cognitive rehabilitation are needed to enhance existing models to improve cognition more effectively in cocaine abusers. This K23 will allow Dr. Raj to learn cognitive rehabilitation principles from the OT field and adapt such principles to substance abusers. OT improves the function of various cognitively impaired patients (e.g., stroke, traumatic brain injury, schizophrenia) by using cognitive-adaptation to enhance cognition in daily quality of life/function and OT can address the cognitive and problem solving deficits that lead to a breakdown in daily life skills. A model of OT-based cognitive rehabilitation in cocaine abusers may strongly improve cognition, ultimately improving important clinical outcomes. A mentoring team led by Frances R. Levin, M.D., including experts from addiction psychiatry, occupational therapy, neuropsychology and biostatistics, will guide Dr. Raj in a 5-year multidisciplinary research and training in: 1) design, methodology, and logistics of substance abuse/psychiatric research in clinical trials, 2) cognitive rehabilitation interventions, 3) behavioral therapy development, 4) biostatistics, and 5) responsible conduct of research. The area of study is consistent with Objective #1 in the Treatment goal of NIDA's Strategic Plan, in that a behavioral intervention (OT-based cognitive rehabilitation) is being developed for drug abuse treatment. Based on The Stage Model of Behavioral Therapies, the Stage 1a feasibility study and the Stage 1b pilot study will be a 12-week, randomized, parallel-group outpatient study of treatment-seeking cocaine abusers (age 18- 65) who are mild-to-moderately cognitively impaired and dissatisfied with their quality of life Participants will be randomized to a "Cog-Rehab" arm (drug counseling plus OT-based cognitive rehabilitation), or to a "Control" arm (drug counseling + psychoeducation/games). Primary outcomes will be improvements in cognition, cocaine abstinence, and daily quality of life/function. Feasibility is demonstrated in our pilot data, where we have enrolled 4 participants

Public Health Relevance

Cocaine use disorders remain a significant public health problem in the U.S., and cognitive impairment moderates clinical outcomes in cocaine abusers. Integrating OT-based cognitive rehabilitation in a comprehensive treatment plan for cocaine abusers would have a direct and significant positive impact on the public health burden of this population.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
1K23DA034883-01
Application #
8424636
Study Section
Risk, Prevention and Intervention for Addictions Study Section (RPIA)
Program Officer
Aklin, Will
Project Start
2013-04-01
Project End
2018-03-31
Budget Start
2013-04-01
Budget End
2014-03-31
Support Year
1
Fiscal Year
2013
Total Cost
$178,278
Indirect Cost
$11,428
Name
University of California San Francisco
Department
Psychiatry
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
Askalsky, Paula; Kalapatapu, Raj K; Foltin, Richard W et al. (2015) Butyrylcholinesterase levels and subjective effects of smoked cocaine in healthy cocaine users. Am J Drug Alcohol Abuse 41:161-5
Kalapatapu, Raj K; Neylan, Thomas C; Regan, Mathilda C et al. (2014) Association of alcohol use biomarkers and cognitive performance in veterans with problematic alcohol use and posttraumatic stress disorder: data from the mind your heart study. J Addict Dis 33:67-76
Striebel, Joan M; Kalapatapu, Raj K (2014) The anti-suicidal potential of buprenorphine: a case report. Int J Psychiatry Med 47:169-74
Kalapatapu, Raj K; Ho, Joyce; Cai, Xuan et al. (2014) Cognitive-behavioral therapy in depressed primary care patients with co-occurring problematic alcohol use: effect of telephone-administered vs. face-to-face treatment-a secondary analysis. J Psychoactive Drugs 46:85-92
Kalapatapu, Raj K; Delucchi, Kevin L; Lasher, Brooke A et al. (2013) Alcohol use biomarkers predicting cognitive performance: a secondary analysis in veterans with alcohol dependence and posttraumatic stress disorder. Mil Med 178:974-80
Kalapatapu, Raj K; Lewis, Daniel F; Vinogradov, Sophia et al. (2013) Relationship of age to impulsivity and decision making: a baseline secondary analysis of a behavioral treatment study in stimulant use disorders. J Addict Dis 32:206-16
Kalapatapu, Raj K; Delucchi, Kevin L (2013) APOE e4 genotype and cigarette smoking in adults with normal cognition and mild cognitive impairment: a retrospective baseline analysis of a national dataset. Am J Drug Alcohol Abuse 39:219-26