This K02 application seeks support for a psychiatrist researcher to conduct a program of research that translates behavioral principles into clinical interventions for patients with substance abuse disorders and concomitant psychiatric or medical diagnoses. The candidate has a background in clinical opioid pharmacology, and has recently shifted his research focus to behavioral therapy interventions addressing two clinical problems: (1) improving management of funds by dually diagnosed patients so that disability checks are not used to purchase drugs and (2) improving adherence to medication prescribed for concomitant disorders such as HIV. The candidate has applied innovative behavioral approaches to these problems, and he now seeks to expand this work to make it more broadly applicable to clinical practice. He will further develop his skills in (a) treatment dissemination strategies, (b) determination of cost-effectiveness and cost benefit, (c) the application of delayed discounting theory to patient budgeting and treatment adherence (d) understanding the procedures followed by the Social Security Administration and Veterans Benefits Administration in determining payee need and practice among disabled persons with substance abuse disorders and (e) more advanced statistical analyses. During the period of support, his research will include studies of three types: (a) clinical trials of behavioral interventions targeted to money management and medication adherence (b) a diagnostic study evaluating the reliability and validity of alternative diagnostic criteria for """"""""need for money management"""""""" and aimed at development of a structured diagnostic interview to diagnose the need for money management and (c) a secondary analysis of the effects of payee assignment on substance abuse and cost outcomes in a large data set that describes payee-ship assignment and practice in """"""""real world"""""""" settings. The planned research studies are intertwined with career development activities: (a) the clinical trials will include the collection of time preference data - funds saved and spent, decisions to trade immediate prizes for larger delayed prizes, and paper-and-pencil measures of preferences for immediate vs. delayed rewards and losses (e.g. delayed discounting functions); (b) the diagnostic study will be carried out with input from the Social Security Administration officials involved in payee assignment;(c) statistical and cost training will be part of the clinical trials and secondary dataset analysis.
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