This K23 mentored patient-oriented research application will support the career development of the candidate in the areas of integrated behavioral and pharmacological therapies development for drug dependence treatment and long- term maintenance of recovery. Dr. Eugene Somoza of the University of Cincinnati will serve as the primary mentor. Dr. Natasha Slesnick of the Ohio State University and Dr. Robert Booth of the University of Colorado will serve as secondary mentors for behavioral therapies development and HIV risk behavior reduction respectively. In addition a team of accomplished investigators will serve as consultants to provide both training and supervision in specialized areas of the career development and research plans. The goal of the career development plan is to provide the candidate with the training and practical experience necessary to succeed as an independent investigator. The plan includes a range of mentor supervised activities including: 1) management of clinical trials, 2) publications and proposal writing, 3) attendance of graduate course work and professional seminars and, 4) the conduct of original research. The planned research will adapt a therapy of known efficacy to target a new outcome of significant importance to public health. The Community Reinforcement and Family Training (CRAFT) procedures will be adapted, from reinforcing treatment entry, to reinforcing treatment retention and HIV risk behavior reduction in persons with opioid dependence who receive a buprenorphine taper detoxification. The research plan includes three phases: 1) development of a manual guided therapy, 2) development of therapist training and fidelity measures and, 3) a randomized pilot with 52 patients receiving either the new CRAFT treatment or treatment as usual. Assessments will occur at baseline, end of treatment, 3 months and, 6 months. The primary outcome is retention in drug abuse treatment, specifically time to the opiate dependent person's first drop from services of 30 consecutive days. Secondary outcomes include: HIV risk behavior reduction, utilization of available treatment and, drug abuse. Opiate dependent individuals present a significant health risk to themselves and the public. With the recent approval of buprenorphine for drug abuse treatment, detoxification programs have become more effective at managing opioid withdrawal and transitioning patients to ongoing treatment. Following transfer to ongoing treatment retention rates decline and persons who return to opiate use are at high risk for direct negative consequences such as accidental drug over-dose and associated health risks such as HIV. Further improvements in treatment retention, maintenance of recovery and, HIV risk reduction are needed. This research and career development plan will lead to significant knowledge for improving treatment retention and reducing HIV risk behavior and, will prepare the candidate for a productive career as an independent patient-oriented clinical research scientist.
