This application is for a Midcareer Investigator Award in Patient-Oriented Research (K24) so that over the next five years I can focus predominantly on clinical research, writing and mentoring beginning investigators. My research has been aimed at improving the accessibility, availability and efficacy of substance abuse treatment through clinical trials and clinical epidemiologic studies. The general themes of my research and approaches utilized are evident in my two major research programs, investigating pharmacologic and behavioral components of opioid agonist maintenance treatment and investigating treatments for cocaine dependent pregnant women and women with young children. Coordination and integration of substance abuse and medical services has been one important strategy explored in this research, as exemplified by current projects and clinical research planned for the proposed award period. These studies include evaluation of buprenorphine maintenance in a primary care clinic, medical maintenance for stabilized methadone maintained patients, and behavioral treatments for cocaine-dependent women identified in prenatal and pediatric clinics. The latter study is one of the major projects planned for the initial years of the proposed award and is described more fully in this application. The study is a 2X2 clinical trial comparing two manual-guided treatments, Community Reinforcement Approach (CRA) and Drug Counseling (DC) based on a 12-step model, and comparing Contingency Management (CM) using a voucher procedure to reward abstinence and a yoked, non-contingent Voucher Control (VC). For nearly a decade, I have been PI on between 2 and 4 externally funded studies at any time. I anticipate maintaining at least this level of support in the future, especially if I receive a K24 award and am thus able to be relieved of most of my now substantial clinical and administrative responsibilities. My clinical research and mentoring activities are facilitated by the extensive clinical research, teaching and clinical programs in drug abuse at Yale which also provide outstanding opportunities for recruitment of beginning investigators needing mentoring and a fertile environment for training them. I have had considerable experience training and mentoring beginning investigators and I am currently mentoring four recently appointed faculty members and one post-doctoral trainee. A K24 award would thus provide a critical opportunity for me to enhance my own clinical research career and devote more time to mentoring beginning investigators, as proposed in this application.
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