An Independent Scientist Award (K02) is requested to allow the candidate to continue to focus on and to expand his research programs on the impact of aftercare for substance abusers and the assessment of factors in relapse. The award would also make it possible for the candidate to pursue additional training in longitudinal data analytic techniques, cost-effective research, and assessment instrument development. These training experiences will be accomplished through a combination of formal course work and directed readings with acknowledged experts in these areas. The candidate's long-term career goal is to integrate findings from studies of various approaches to continuing care, or """"""""aftercare,"""""""" and studies of factors in relapse to generate more effective and cost-effective approaches to relapse prevention in substance abusers. As described in the research plan, during the term of support from this proposed Independent Scientist Award the candidate will serve as Principal Investigator on two RO1 grants that evaluate the effectiveness and cost-effectiveness of aftercare of cocaine and alcohol dependent individuals who have completed a primary treatment program. As these projects are similar, only the cocaine study is described in detail. In this project, entitled """"""""Aftercare for Cocaine Patients: Effectiveness and Costs,"""""""" cocaine dependent patients who complete intensive outpatient rehabilitation (IOP) will be randomly assigned to one of the following interventions: (1) Minimal aftercare (MIN), a combination of referral to self-help groups and brief telephone case-management; (2) Standard disease model aftercare counseling (STND), provided through two group therapy sessions per week; and (3) Individual aftercare (IND), provided through one individual cognitive-behavioral, relapse prevention session and one group therapy session per week. The effectiveness analysis will include the testing of main effect and patient by treatment """"""""matching"""""""" hypotheses generated by prior work by the candidate and other investigators. The cost-effectiveness analysis, which will be done in collaboration with Dr. Donald Shepard of Brandeis University, will focus on the identification of the types of patients who are treated most cost effectively in each aftercare condition. Based on prior research, it is anticipated that the IND condition will be particularly effective, relative to the other conditions, for poor prognosis patients, such as those who did not achieve remission from cocaine dependence during IOP and those with greater psychiatric severity. Outcome measures in this study will include measures of cocaine and alcohol use and frequency of behaviors that place patients at high risk for contracting or spreading AIDS. The funding provided by the KO2 award also will allow the candidate to further the development and refinement of the Cocaine Relapse Interview, an assessment instrument that was initially developed with a First Award.
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