A renewal of Research Scientist Development Award (K02), with advancement to the Senior Scientist (K05) level, is requested to allow the candidate to continue to pursue research on behavioral 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 broader dissemination of these methods and treatments, 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 a project to evaluate manual-guided Twelve Step Facilitation and disulfiram as treatment for cocaine-dependence individuals on methadone maintenance: In this 2x2 factorial study, 180 cocaine-dependent methadone-maintained opioid addicts will be assigned to one of four treatments: (1) Twelve-Step Facilitation (TSF) in addition to standard counseling plus disulfiram, (2) Twelve-Step Facilitation (TSF) plus placebo, (3) Standard counseling plus disulfiram, or (4) Standard methadone counseling plus placebo. Study treatments will be manual-guided and will last 12 weeks. The primary outcome will be reduction in cocaine use, as assessed by self-report and confirmed by thrice-weekly urinalyses. Secondary outcomes will include reductions in illicit opioid and alcohol use, as well as improvements in psychosocial functioning. Treatments will be delivered by experienced clinicians, who will receive training and ongoing supervision to prevent drift during the course of the study. Supervised urines will be collected thrice weekly. All counseling sessions will be videotaped for ongoing therapist supervision and process assessment. Follow-ups at 1, 3, 6, 9 and 12 months after cessation of study treatments will assess the durability and/or delayed emergence of treatment effects.
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