This is Competing Renewal of a currently funded Center Grant, """"""""Treatments for Complex Patients in New Settings."""""""" The San Francisco Treatment Research Center (TRC) now has an integrating focus on nicotine. The center has been productive during the past 4 years with 286 scientific articles either published, under review, or in press. The center structure maintains the potential to expand to other drugs of abuse, and to foster the development of investigators across the addictions. There are two Cores--a Scientific and Administrative core and a Quantitative core, and five components. Two of the projects are clinical trials. In Project 1, a series of hypotheses about the efficacy and effectiveness of usual care, tailored counseling, and Internet counseling for HIV positive smokers are tested. Project 2 tests a series of efficacy and effectiveness hypotheses in a study comparing an intensive smoking treatment for alcohol dependent smokers with unusual treatment. Project 3 is a study of organizational change conducted in the clinics participating in Projects 1 and 2 and in two control clinics. Project 4 is a statistical methods study that relies on past TRC data and data generated by Projects 1 and 2 to better develop Latent Class Growth Modeling (LCGM) in treatment research in the addictions. Project 5 is developmental. It supports the TRC aims of the development of treatment investigators, treatment developmental studies, and continues the involvement across drugs of abuse that has characterized our Center. It has two sections: (1) a pilot study grant program that continues and extends the existing TRC pilot study program for trainees; and (2) a developmental support program that will select, mentor and further develop treatment development studies. Two such studies have been selected for completion during the first half of the funding period. The first is an innovative study of smoking cessation treatment in substance abuse treatment in a large Health Maintenance Organization (HMO). The second is an intervention to treat depressed stimulant abuse patients recruited from medical care settings. One potential study, focusing on treatment linkages for substance using and abusing patients in an HMO mental health setting has been proposed, and others will be developed.
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