In this K24 application, I am seeking funding to support more intensive mentoring activities in patient oriented research (POR) and to expand the aims of my current funded research projects. The focus of my work is on the development, evaluation, and implementation of adaptive, patient-oriented models of care for the long-term management of addictive disorders. Much of this work is concerned with identifying the treatment components and features that promote sustained participation and better outcomes, including adaptive protocols that reduce patient and family burden when possible, incorporation of patient choice in the selection of treatment approaches, and use of incentives for participation. My long-term career objectives concern the wider dissemination and implementation of these new models of care. With regard to mentoring, my immediate goal is to devote more time to the postdoctoral fellows and new clinician investigators whom I am currently mentoring at Penn and the Treatment Research Institute (TRI). This work will include more time spent in planning and reviewing manuscripts and grant applications, and providing further training in the design and evaluation of adaptive treatment interventions for substance use disorders. I have also made arrangements to mentor additional students and junior faculty in several other divisions and centers at the University of Pennsylvania, including the School of Public Health, Clinical Epidemiology, the Center for Mental Health Policy and Services Research, and the Transdisciplinary Tobacco Use Research Center. My longer term goal is to grow my unit at Penn, the Center on the Continuum of Care in the Addictions, by hiring more new clinician investigators and creating a place where investigators from other units at Penn and at other institutions who have an interest in the addictions and in adaptive approaches to treatment can seek mentoring, collaboration, and support. I am currently funded by a NIDA R01, a major project in a NIDA-funded P60, a NIAAA P01 Center, and a NIAAA R01. All of these projects are randomized clinical trials. Two projects are sequential multiple assignment randomized trials (SMART), which use multiple randomizations to develop optimal adaptive algorithms for the treatment of cocaine and alcohol dependence. The other two projects each test two extended continuing care models against treatment as usual. These interventions are also adaptive, with algorithms to step patients up and down in treatment intensity as their symptoms and status change over time. The K24 seeks funds to support an in-depth analysis of processes and mechanisms of change in the treatment sessions that are associated with better adherence to the adaptive protocols and better substance use outcomes. For this work, we will perform mediation analyses on combined data sets, apply various coding systems to the content of the treatment sessions in these studies, analyze patient self-report data, and conduct interviews with study participants.
The proposed grant provides support to Dr. James McKay to sustain and expand his mentoring of postdoctoral fellows and new clinical investigators conducting patient oriented research in the addictions. The grant will also support new research, which builds on Dr. McKay's current research program on the development and evaluation of adaptive approaches to continuing care. This new work seeks to identify key mechanisms of action in adaptive treatments that account for positive outcomes and adherence to the protocols.
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