This application is designed to provide the candidate, Dr. Sarah Book, with skills and expertise in the treatment of alcoholism and co-occurring psychiatric disorders (psychiatric comorbidity), in general, and co-occurring alcoholism and social phobia, in particular. Psychiatric comorbidity is an area of recent interest to NIAAA, and one where well trained psychiatric researchers are needed. Perhaps more than 60% of individuals with alcoholism suffer from psychiatric comorbidity. This population is more likely to seek alcoholism treatment, their alcohol problems are more severe, and their outcomes tend to be more complicated and less favorable than for those without psychiatric comorbidity. In the past decade, there has been interest in using psychiatric comorbidity to sub-group alcoholics for treatment matching. The anxiety area has received considerably less attention than depression comorbidity, and more research is needed. Dr. Book's goal is to be a clinical-scientist with unique expertise in the treatment of alcoholism and anxiety disorder comorbidity. She desires K23 training to permit the development of a research program to enable her to conduct research, treat patients, and educate future medical professionals about the challenges faced in treating alcoholic individuals with comorbidity. The proposed research integrates her skills developed in clinical treatment of anxiety disorders with more recently acquired ones in treatment of alcohol dependence as inpatient attending in the Center for Drug and Alcohol Programs. The training plan identifies areas to be developed, including mastery of the literature, delivery of cognitive behavioral therapy for alcohol treatment, and exploration of gender differences in alcohol use disorders and psychiatric comorbidity. She will refine skills in critical reasoning, and develop skills in quantitative methods and grant writing. This award will allow Dr. Book protected time from her extensive clinical, education, and administrative responsibilities as an inpatient attending to further develop her research skills. Her ultimate goal is to become an independent clinical researcher, while still treating patients and providing didactic substance abuse education to future generations of medical professionals.
