This application is a response to the RFA for Treatment Research Centers that can support the clinical costs of research on the treatment of substance abuse. Our former Treatment Research Unit (TRU) was funded as the only non-VA clinical program in substance abuse associated with the University of Pennsylvania on 10/1/89 and it will expire on 8/31/94. This TRU was particularly productive over the past four years, accounting for 60 research reports, 46 reviews and 2 books. Further, studies completed within this Division have been repeatedly utilized in Congressional testimony and in formulating national healthcare policy. Prominent examples include a controlled study of the effects of three levels of psychosocial intervention in combination with methadone treatment, a longitudinal study of HIV conversion rates in opiate addicts in and out of treatment, a study of the efficacy of impatient and outpatient rehabilitation for cocaine dependence and a controlled study of naltrexone treatment on reincarceration among Federal probationers. Figure 1 describes the organization of the overall Division of Addiction Studies at this University/VA complex. The proposed Center has been efficiently integrated into the existing structure of the Division and the administrative costs for the proposed Center have been kept low by utilizing existing resources from within the Division. For example, costs of the Scientific Advisory Board, a centralized Data Management Unit, Graduate and Post-Doctoral training costs, instrument development and testing costs and other administrative costs are not requested in this application. They will be contributed by our existing grants. Similarly, the proposed projects have been designed to expand upon both the clinical resources and the treatment research done in our former TRU. For example, the current proposal involves new treatment research projects consisting of behavioral and medication studies that will be conducted within the Core Treatment Unit set up by the expiring TRU funding in space provided by the University at no direct cost to any research budget. This Core Clinical Unit is a full service outpatient treatment program with short term inpatient and residential beds as needed. The staff of the proposed Core Treatment Unit are all trained, experienced and centrally supervised in conducting clinical research protocols, thus offering the most efficient means of providing the necessary conditions for the delivery and study of novel treatments for substance abusers. The clinical program has been specifically designed and staffed to conduct clinical research and this application summarizes its productivity over the past four years. The present application is for six studies and five years of funding. All standard clinical costs are included in the Core Treatment Unit and they are for the proposed new projects only. Project 1 builds on our pilot work in setting up and comparing the effectiveness of enhanced versus standard psychosocial treatments for cocaine abusing new mothers. This project will also generate treatment manuals that will be made widely available. Project 2 consists of a series of studies to develop medications for the treatment of cocaine dependence. Project 3 explores methods to improve retention for outpatient substance abuse treatment. Project 4 examines the predictive validity of responses to cocaine related cues in cocaine dependent patients during treatment. This approach may provide an efficient screening test for new medications and preliminary results suggest that it can be used to identify poor prognosis patients who require more intensive treatment. Project 5, a clinical outcome study in nicotine dependent patients, represents a new population for our group, but it is a familiar concept. We have a long history of studies of the interaction of behavioral therapy and medications in the treatment of drug dependence. We hope to improve the effectiveness of nicotine patch treatment using techniques that can be readily taught to other practitioners. Project 6 will utilize the women in treatment in Project 1 as well as women who fail to become engaged in treatment to address fundamental questions about the long term prognosis of cocaine dependent women and the factors that may influence it.
