A Research Scientist Development award is requested to allow the candidate to pursue research on the development and evaluation of psychotherapeutic treatments for substance abuse on a full-time basis. As described in the Scientific Autobiography, through adherence to a technology model of psychotherapy research, and with emphasis on development and expansion of these rigorous methods to other investigators, the candidate's long-term goal is to improve the effectiveness of substance abuse treatment. As described in the Research Plan, during the term of support from the proposed Research Scientist Development Award, the candidate will serve as Principal Investigator on two projects designed to advance knowledge on the effectiveness of psychosocial treatments for substance use disorders: The first project, Matching and Maintenance Treatments for Cocaine Dependence, will be a randomized clinical trial with 200 ambulatory cocaine abusers which will prospectively test the hypothesis that more severely dependent cocaine abusers will have better outcome when treated with cognitive-behavioral coping skills therapy (Relapse Prevention) over a less structured, supportive approach (Interpersonal Psychotherapy). In addition, this project will evaluate the value of maintenance therapy as a strategy to improve the durability of the effects of brief psychotherapeutic approaches for cocaine abuse. Subjects who complete the initial twelve-week course of treatment and whose cocaine use has improved over pretreatment levels will be randomly assigned to either (1) maintenance treatment, consisting of continuing their study treatment (Relapse Prevention or IPT) on a less frequent basis for six months, or (2) monthly assessment only for six months. The second project, CRA and Naltrexone for Opioid Dependence, will use a dismantling strategy to evaluate whether outcomes for naltrexone treatment can be enhanced through combining it with behavioral incentives and reciprocal relationship counseling. 180 recently detoxified opioid addicts will be randomly assigned to either (1) contingency management plus significant other involvement in addition to standard naltrexone treatment, (2) contingency management in addition to standard naltrexone treatment, or (3) standard naltrexone treatment alone, consisting of thrice weekly clinic visits for naltrexone, thrice weekly supervised urine toxicology screens, and weekly group counseling.
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