? This is a proposal for a Mentored Patient-Oriented Research Career Development Award (K23). A team of highly accomplished and diverse mentors, all full professors at Johns Hopkins, has committed to support the proposed work to facilitate my transition to an independent patient-oriented drug abuse treatment researcher. Their records of productive research and experience in mentoring junior faculty are extensive and their respective areas of expertise are complementary and central to the content of this proposal (involving drug abuse treatment, cost/cost-benefit analysis, and adherence to treatment services). Dr. Eric Strain is a psychiatrist highly recognized for his research involving clinical pharmacology and drug abuse treatment-evaluation. Dr. Robert Brooner is a widely respected clinician and researcher with particular interest in novel treatment models utilizing behavioral enhancements. Dr. David Salkever is a highly recognized leader on the cost/cost-benefits of medical care. This proposal consist of three highly related components of my career development plan which will be enabled by this award: 1) enhance my knowledge and expertise in medical economics, cost/cost-benefit methodologies, general clinical trials methodology and analyses; 2) design, conduct, analyses and publication of the results of four studies involving cost and cost benefit of varying treatment models and interventions and on improving adherence to drug abuse treatment plans; and 3) use of this experience and data to inform the development and submission of future R01 or similar grant mechanisms to extend my work in these areas. The joint focus on the cost/cost-benefits of treatment and adherence to treatment services springs from their interdependence. For example, poor adherence effectively increases the cost of services actually delivered to patients in a treatment program, while good adherence can reduce those costs. My proposed research will therefore evaluate the cost and cost-benefit of drug abuse treatment services and both interventions and service models designed to improve patient adherence. It is hypothesized that significant interactions exist between drug abuse treatment interventions, patient adherence and treatment outcome and cost. This work will require completion of a series of academic courses on medical economics, cost-effectiveness and cost-benefit analyses and the completion of four studies. The first two studies evaluate cost and cost-benefit of a novel Motivated Stepped Care (MSC) treatment system for patients receiving either methadone or LAAM. The third study compares treatment costs and cost-benefit for combinations of MSC and voucher-based incentive to reduce drug use. The fourth study examines the effectiveness of a """"""""significant other"""""""" intervention in improving rates of follow-up care after discharge from an inpatient unit. The results of this work will be used to inform the development of a new R01 type application to extend my work to a series of controlled evaluations of services and service models to improve patient adherence and maximize the cost effectiveness of treatment services. This accomplishment will document my transition to the status of an independent patient-oriented researcher and recognized expert in the field of drug abuse treatment. ? ? ? ?
