CAUSAL MODEL OF ADDICTION TREATMENT
Jon Morgenstern, Associate Professor
Rutgers The St Univ Of Nj New Brunswick Asb Iii New Brunswick, Nj 08901
Grant 1R01AA010955-01 from National Institute On Alcohol Abuse And Alcoholism IRG: ALCP
Abstract: Many claim that substance abuse evaluation research has failed to adequately conceptualize clinically relevant aspects of the treatment process or adequately measure treatment effects and thus failed to find that treatment has much effect. The goal of this study is to examine the relationships among patient characteristics, life context factors, treatment processes and outcomes in the treatment of drug problems using an improved evaluation design. Theory-based measures of treatment processes will be used to assess treatment effects in the context of ar expanded evaluation paradigm. The specific focus of this study is on evaluating the 12-Step chemical dependency treatment model, since processes mobilized by this approach are claimed to be curative, but have received little study. Subjects (N =400) in residential and outpatient chemical dependency treatment programs will be assessed at baseline and followed at 6 weeks, and at 6, 12 and 24 months. Illness severity, life context, treatment process and outcomes will be assessed. Structural equation modeling will be used to assess study hypotheses. The study will provide a rigorous test of the treatment theory that underlies 12-Step treatment approaches by assessing whether processes hypothesized as curative by this approach such as accepting powerlessness actually mediate outcomes. In addition, the study will examine whether processes mobilized by this approach may be more effective for some types of patients, but less effective for others. Several alternative hypotheses concerning predictors of outcome will also be considered. In addition, the study will assess whether the curative effects of 12-Step treatment are specific and unique or are able to be subsumed under a broader set of change factors. Study results should provide a clearer understanding of how change occurs in substance abuse treatment and enhance ability to match patients to treatment.
Project start date: 1996-05-01
Project end date: 1996-08-31
1R01AA010955-01 (1996): $31995
Sponsored Links Excellgen http://Excellgen.com
Grants awarded to Jon Morgenstern
COMPONENT ANALYSIS OF MOTIVATIONAL INTERVIEWING
Jon Morgenstern, Vp/director Of Health & Treatment Resear
New York State Psychiatric Institute, Room 1914 - Unit #33, New York, Ny 10032
Grant 5R21AA017135-02 from National Institute On Alcohol Abuse And Alcoholism
Abstract: This R21 application proposes to rigorously examine the mechanisms of behavior change (MOBC in Motivational Interviewing (MI). We will conduct a small pilot study to disaggregate MI into its component parts and test full MI compared to MI without its directive strategies. This test will compare whether the directive elements of MI are critical or whether MI effects may be attributable solely to its Rogerian, non-directive components. Rogerian elements are commonly referred to as MI spirit. We label our treatment conditions Full MI (FMI) and Spirit-Only MI (SOMI). In addition, we will test whether hypothesized main effects of FMI are mediated via increases in commitment to using state-of-the-art assessment methods. We will also examine whether non-specific therapy factors alone significantly reduce drinking when compared to a condition that controls for non-therapy factors. We will test this by comparing outcomes of SOMI to a wait-list control (WTL) that incorporates assessment and encourages self-monitoring and self-change. We will also test whether SOMI´s main effects are mediated by increases in mood and greater belief in the ability to change. In addition, we will examine patterns of temporal relationship between mediators and drinking using daily process data in an attempt to address temporal ordering issues. Finally, we will employ, extend, and evaluate a number of new methodologies that hold promise for improving future MOBC research. Our work on MOBC for MI will take place in the context of studying brief treatment for individuals with primary AUD who seek to reduce but not stop drinking. We will recruit 90 individuals with AUD; collect daily process data during a pre-treatment week; and then assess and randomly assign them to 3 conditions FMI, SOMI, and WTL. Participants will be followed for 9 weeks using daily Interactive Voice Recording (IVR) and in-laboratory assessments at weeks 0, 1, 4 and 8. Those in treatment conditions will receive 4 sessions of treatment at weeks 1, 2, 4, and 8. WTL will receive treatment after completing the 8 week assessment period. Participants in FMI and SOMI will be followed for an additional 4 weeks post-treatment (week 12). We note that, consistent with the purposes of the R21, the aims of this study are exploratory and designed to generate preliminary results. Motivational Interviewing (MI) is an effective intervention with tremendous implications for a variety of populations suffering from conditions and disorders related to public health, including smoking, gambling, exercise adherence, nutrition, illicit drug use, and alcohol abuse. This R21 grant is a pilot study to investigate the mechanisms of change of MI. If its aims are achieved, it will strengthen the efficacy of MI, which can be utilized and implemented in a variety of healthsettings
Keywords: Abstinence; Address; Adherence; Adherence (attribute); After Care; After-Treatment; Aftercare; Alcohol abuse; Alcohol dependence; Arts; Belief; Client; Code; Coding System; Condition; Daily; Development; Disease; Disease regression; Disorder; Drug usage; Drugs; Drugs, Illicit; Early treatment; Elements; Empathy; Equilibrium; Ethanol dependence; Exercise; Exercise, Physical; Frequencies (time pattern); Frequency; Future; Gambling; Gamblings; Goals; Grant; Illicit Drugs; Individual; Intervention; Intervention Strategies; Label; Laboratories; Language; Measurement; Measures; Mediating; Mediator; Mediator of Activation; Mediator of activation protein; Medication; Method LOINC Axis 6; Methodology; Methods; Monitor; Moods; Numbers; Nutrition; Nutritional Science; Outcome; PBO; Participant; Patient Self-Report; Pattern; Persons; Pharmaceutic Preparations; Pharmaceutical Preparations; Pilot Projects; Placebo Effect; Placebos; Population; Preparedness; Process; Process Measure; Public Health; Purpose; Randomized; Readiness; Recruitment Activity; Regression; Relative; Relative (related person); Research; Science of nutrition; Self Efficacy; Self-Report; Sham Treatment; Smoking; Testing; Time; Treatment Period; Voice; Waiting Lists; Week; Work; alcohol addiction; alcohol dependency; alcohol problem; alcohol use disorder; alcohol-dependent; balance; balance function; behavior change; computerized data processing; coping; data processing; design; designing; disease/disorder; drinking; drug use; drug/agent; ethanol abuse; ethanol addiction; ethanol dependency; ethanol use disorder; ethanol-dependent; expectancy effect; expectation effect; hazardous alcohol use; improved; interventional strategy; motivational enhancement therapy; motivational interview; nocebo; nutrition; pilot study; placebo response; positive mood; problem drinking; public health medicine (field); randomisation; randomization; randomly assigned; recruit; sham therapy; signal processing; size; theories; treatment days; treatment duration
Project start date: 2007-09-01
Project end date: 2010-08-31
Budget start date: 1-SEP-2008
Budget end date: 31-AUG-2010
PFA/PA: RFA-AA-07-005
5R21AA017135-02 (2008): $0
1R21AA017135-01 (2007): $212894
RESTRUCTURING SERVICES FOR DRUG ABUSING TANF WOMEN
Jon Morgenstern, Associate Professor
National Center On Addiction/sub Abuse Substance Abuse New York, Ny 100176706
Grant 5R01DA012256-06 from National Institute On Drug Abuse IRG: NIDA
Abstract: The primary goal of this study is to rigorously evaluate the effectiveness and costs of two contrasting approaches to organizing and structuring substance abuse treatment for women entering welfare-to-work programs. One approach will deliver standard care. The alternative approach will deliver care based on an innovative, public health model. Evidence-based interventions will serve as the core components of the innovative approach. The context of this study is a naturally occurring experiment. The State of New Jersey is conducting a welfare demonstration project in two counties. Women in welfare-to-work programs with substance abuse problems will be randomly assigned to two intervention conditions, standard care or innovative care. This study will evaluate the two-year outcomes of the demonstration project. In addition, the study will compare outcomes and costs of the substance abusing women in the demonstration with those of a comparison group of non-symptomatic women in welfare-to work programs. The study sample will consist of 600 women diagnosed with DSM-IV substance abuse only, and 600 women diagnosed with DSM-IV substance dependence who are participants in the demonstration. In addition, 200 non-symptomatic women in welfare-to work programs will be studied. All study participants will be recruited at two welfare offices, assessed at baseline, and followed in-person at 3, 6, 12, 18, and 24 months. The study will examine treatment utilization patterns, and substance abuse, employment and other psychosocial outcomes. In addition, a full cost study including cost-effectiveness and cost-benefit analyses will be conducted.
Keywords: drug abuse therapy, female, health service demonstration project, human therapy evaluation, social service, employment /unemployment, health care service utilization, longitudinal human study, psychometrics, substance abuse related behavior, behavioral /social science research tag, clinical research, computer data analysis, health services research tag, human subject
Project start date: 1999-06-20
Project end date: 2006-06-30
5R01DA012256-06 (2003): $618680
5R01DA012256-04 (2001): $774876
5R01DA012256-02 (2000): $879752
1R01DA012256-01 (1999): $696887
COGNITIVE BEHAVIORAL RISK REDUCTION TREATMENT
Jon Morgenstern, Associate Professor
Psychiatrymount Sinai School Of Medicine Of Nyu
of New York University
new York, Ny 100296574
Grant 5R01AA011745-04 from National Institute On Alcohol Abuse And Alcoholism IRG: ZAA1
Abstract: The primary aim of this proposal is to develop and test the efficacy of a cognitive behavioral treatment (CBT) for the co-occurrence of alcohol use disorders (AUD) and sexual-risk taking behaviors among men-who-have-sex-with men (MSM). This proposal will build on empirical research demonstrating the effectiveness of current CBT for AUD and HIV prevention, and recommended strategies to improve CBT by providing more individualized and broad focused interventions. Cognitive Behavioral Risk Reduction Treatment (CBRRT) will address motivational factors, teach skills to cope with proximal risk antecedents, and teach skills to cope with underlying problems that serve to maintain AUD and sexual-risk taking behaviors. Three types of underlying problems will be addressed sensation seeking, gay identity issues, and psychological distress. A secondary aim of this proposal is to examine moderators and mediators of CBRRT. Specifically, the proposal will test whether MSM with higher levels of underlying problems or higher levels of baseline risky behaviors will differentially benefit from CBRRT. In addition, the proposal will test whether changes in CBT mediators (e.g., self-efficacy) or underlying problems mediate the effects of CBRRT on outcomes. In order to accomplish these aims, a randomized clinical trial will be conducted. Two hundred and forty seronegative MSM seeking treatment for AUD and sexual risk-taking behaviors will be recruited into the study and assessed. Subjects will be randomly assigned to two intervention conditions CBRRT or a control treatment consisting of alcohol skills treatment. Each treatment will consist of 12 weekly individual psychotherapy sessions. Observation and ratings of treatment sessions (via videotape) and weekly supervision will be used to monitor and document treatment delivery. Subjects will be assessed at baseline, end of treatment, and at three, six and 12 months following treatment. Biological and collateral verification of self-reported alcohol and drug use will be conducted. The primary outcomes measured will be the number of unprotected anal intercourse acts with a partner of positive or unknown HIV status and the number of drinks per possible drinking day
Keywords: alcoholism /alcohol abuse, alcoholism /alcohol abuse therapy, cognitive behavior therapy, homosexual, human therapy evaluation HIV infection, clinical trial, comorbidity, coping, high risk life style, identity, personality, psychological stressor, self concept behavioral /social science research tag, clinical research, human subject, male
Project start date: 1998-09-28
Project end date: 2003-06-30
5R01AA011745-04 (2001): $418623
5R01AA011745-03 (2000): $502101
5R01AA011745-02 (1999): $476032
1R01AA011745-01A1 (1998): $464284
Sponsored Links Excellgen http://Excellgen.com
Club Drug Use And Risky Behaviors Among Men
Jon Morgenstern, Associate Professor
New York State Psychiatric Institute New York, Ny 10032
Grant 5R01DA015971-06 from National Institute On Drug Abuse IRG: ZDA1
Abstract: Since the late 1990s, there has been an explosion in the use of club drugs among men who have sex with men (MSM) and young adults, which includes cocaine, MDMA (ecstasy), methamphetamine, ketamine, and GHB, among others (NIDA, 2001). These drugs pose an immediate and severe threat to the health and well-being of gay and bisexual men, particularly in urban areas. The health risks associated with these drugs stem from two sources the physical and psychological risks that are associated with the use of club drugs, and the risk of HIV infection or transmission through unsafe sexual behavior while under the influence. Research shows that MSM are reporting more sexual risk behavior than in previous years and there is significant concern that HIV infection rates may once again be on the rise after more than a decade of remaining relatively stable. Currently there are no evidence-based interventions available that address club drug abuse and HIV sexual risk behaviors. We propose a theory-based brief intervention, based on the principles of Motivational Interviewing (MI) designed to reduce unsafe sexual practices and club drug use among HIV seropositive and seronegative men who have sex with men (MSM) who use club drugs. The objectives of the project are to (1) recruit and enroll an ethnically diverse sample of 240 MSM; (2) test the efficacy of a brief MI intervention compared to a video-based educational control intervention; (3) test whether baseline quantity/frequency of club drug use and unprotected sex, psychiatric severity, motivation, and self-efficacy are significant predictors of change over time, and (4) test the cognitive mediators that are hypothesized to be fundamental to MI. Participants will be randomized into either an MI condition or an attention control condition that will consist of viewing videotapes. Participants will complete an intake assessment, and follow-up assessments at 3, 6, 9, and 12-months in order to assess short-term and longer-term effects. Biological markers will include urine testing for club drug and other drug use and HIV antibody testing will be utilized to confirm self-report data. Participants will be recruited through active and passive recruitment strategies from a variety of community-based venues in New York City.
Keywords: behavior therapy, drug abuse, high risk behavior /lifestyle, homosexual, motivation, AIDS education /prevention, HIV infection, bisexual, drug abuse therapy, human therapy evaluation, longitudinal human study, safe sex /sex abstinence, substance abuse epidemiology, substance abuse related behavior, AIDS /HIV test, behavioral /social science research tag, clinical research, human subject, patient oriented research, urinalysis
Project start date: 2002-09-27
Project end date: 2008-06-30
5R01DA015971-06 (2006): $666322
3R01DA015971-05S1 (2005): $136108
5R01DA015971-05 (2005): $601530
5R01DA015971-03 (2004): $856852
5R01DA015971-02 (2003): $778853
1R01DA015971-01 (2002): $605595
A CAUSAL MODEL OF TREATMENT OUTCOME
Jon Morgenstern, Associate Professor
Rutgers The St Univ Of Nj New Brunswick Asb Iii New Brunswick, Nj 08901
Grant 3P50AA008747-04S10005 from National Institute On Alcohol Abuse And Alcoholism
Abstract: Public Health Relevance This Public H3P50AA008747-05S10004
Keywords: 1996
NALTREXONE AND CBT FOR PROBLEM DRINKING
Jon Morgenstern, Vp/director Of Health & Treatment Resear
New York State Psychiatric Institute, Room 1914 - Unit #33, New York, Ny 10032
Grant 5R01AA015553-05 from National Institute On Alcohol Abuse And Alcoholism
Abstract: Problem drinking MSM are at risk for relapse because their social milieux are often associated with alcohol, and are at elevated risk for HIV because of high base rates of HIV and because drinking is associated with HIV-risk behavior. Although substantial research exists on HIV risk reduction in MSM alone or in combination with alcohol abuse treatment, few studies have examined the impact of alcohol-only treatment on HIV risk. Problem drinkers are most receptive to interventions focused on moderation of drinking rather than abstinence; however moderation-oriented cognitive-behavior therapy (CBT) is limited in that success depends on the successful implementation of new coping strategies for urges to drink and development of self-efficacy for coping. Naltrexone (NTX) is also a well established treatment for problem drinkers with moderated drinking goals, but its effects diminish after treatment is discontinued. The limitations of these treatments suggest that their combination might enhance the efficacy of both. We propose combining moderation-oriented CBT with NTX in the treatment of problem drinking,HIV- positive and -negative MSM, to evaluate their efficacy alone and in combination. We also propose to utilize new data collection technology, Interactive Voice Response, to collect data on daily relations among drinking, sexual behavior and psychological variables thought to mediate treatment response. Our objectives are to 1) enroll a sample of 240 problem drinking MSM using active and passive recruitment strategies; 2) evaluate the efficacy of 12 weeks of randomly assigned treatment, with 50 mg of NTX or placebo, combined with modified, behavioral self-control therapy or brief supportive therapy; 3) evaluate conditional relationships between heavy drinking and likelihood of HIV risk behavior; 4) evaluate daily associations among mood, craving, self-efficacy, motivation, and drinking. Assessments will include baseline, 3, 6, & 9 month follow-up. This application is of tremendous relevance to alcoholism treatment and HIV prevention. First, we will evaluate established treatments for problem drinking in an under-studied but unique population, namely MSM. Second, we will examine the impact of alcohol-focused treatment on HIV risk behavior in a very high- risk population. Third, we will use new data collection technology to examine complex relationships among drinking, HIV risk, and psychological factors to better inform future interventions
Keywords: No Project Terms available
Project start date: 2006-04-01
Project end date: 2011-03-31
Budget start date: 1-APR-2010
Budget end date: 31-MAR-2011
PFA/PA: PA-02-039
5R01AA015553-05 (2010): $518661
5R01AA015553-02 (2007): $652213
Sponsored Links Excellgen http://Excellgen.com
1R01AA015553-01A1 (2006): $585697
3R01AA015553-01A1S1 (2006): $62106
DISEASE MANAGEMENT FOR CHRONIC DRUG ABUSE
Jon Morgenstern, Vp/director Of Health & Treatment Resear
National Center On Addiction/sub Abuse, 633 3rd Ave, New York, Ny 10017-6706
Grant 5R01DA023891-04 from National Institute On Drug Abuse
Abstract: Individuals with long-standing, treatment refractory alcohol and other drug (AOD) disorders remain a vexing challenge for State governments. As with other chronic diseases, a small proportion of clients absorb a disproportionate share of treatment dollars. Often these clients cycle through crisis episodes with bouts of high-cost care followed by poorly coordinated aftercare. As the primary payers, state and county agencies not only are concerned with inefficient spending for AOD treatment (TX) but also must contend with supporting multiple crisis services for these individuals. Recently states have been turning to disease management programs (DMP) to control Medicaid costs of caring for chronic illnesses. Despite their promise, there is only modest scientific evidence of the effectiveness of DMPs for healthcare, and for AOD disorders. New York State (NYS) just initiated a 3-year, $25 million demonstration pilot that provides grants to 23 counties to provide case management services to high-cost utilizers of AODTX. This time sensitive R01 application in response to PAR-05-150 seeks to capitalize on this demonstration to mount and rigorously test an innovative disease management intervention for chronic addiction (DM-CA). The application is time-sensitive because the intervention and evaluation must be funded by summer of 2007 to take advantage of the demonstration. The NYS Office of Alcoholism and Substance Abuse Services (OASAS) and two counties will partner with our research group to develop and rigorously test DM-CA. The DM-CA will be a system level intervention with a framework drawn from recent innovations in health care encapsulated in the Chronic Care Model. DM-CA will be designed to improve monitoring and coordination of care in order to avert crisis events (e.g., ED visits) and help engage clients in stabilizing outpatient services, thereby reducing health care costs. Over two years, OASAS will identify 1,700 high cost AOD disordered clients (i.e., using >=$10k of AODTX in the prior year) and then randomly assign them within county to DM- CA or a control condition of usual care (UC), consisting of no case management or DMP services. Client characteristics and outcomes will be collected from extensive administrative records. Primary Aims will examine 1) reductions in crises events, 2) increases in number of outpatient AODTX, 3) increases in likelihood of HIV/HCV testing & counseling, 4) Medicaid cost reductions associated with the intervention
Keywords: AIDS test; AIDS/HIV test; Accident and Emergency department; After Care; After-Treatment; Aftercare; Alcoholism; CDC; Care, Health; Caring; Case Management; Centers for Disease Control; Centers for Disease Control (U.S.); Centers for Disease Control and Prevention; Centers for Disease Control and Prevention (U.S.); Characteristics; Chronic; Chronic Disease; Chronic Illness; Client; Counseling; County; Criminal Justice; Data; Disease; Disease Management; Disorder; Disorder Management; Drug Metabolic Detoxication; Drug abuse; Drugs; Effectiveness; Emergency Department; Emergency room; Encapsulated; Enrollment; Evaluation; Event; Expenditure; Funding; Grant; Guidelines; HIV test; HOSP; Health Care Costs; Health Costs; Healthcare; Healthcare Costs; Hospitalization; Human immunodeficiency virus test; Individual; Inpatients; Intervention; Intervention Strategies; Investigators; Length of Stay; Medicaid; Medical; Medication; Metabolic Detoxication, Drug; Metabolic Detoxification, Drug; Metabolic Drug Detoxications; Metabolism of Toxic Agents; Methods; Monitor; New York; Number of Days in Hospital; Out-patients; Outcome; Outpatients; Performance; Pharmaceutic Preparations; Pharmaceutical Preparations; Physical Health Services / Rehabilitation; Programs (PT); Programs [Publication Type]; Provincial Government; Randomized; Records; Refractory; Rehabilitation; Rehabilitation therapy; Rehabilitation, Medical; Relative; Relative (related person); Research; Research Personnel; Researchers; Services; State Government; Substance abuse problem; System; System, LOINC Axis 4; Testing; Time; United States Centers for Disease Control; United States Centers for Disease Control and Prevention; Visit; abuse of drugs; abuse of substances; abuses drugs; addiction; alcohol and other drug; chronic care model; chronic disease/disorder; chronic disorder; cost; design; designing; detoxification; disease/disorder; drug/agent; enroll; high risk; hospital days; hospital length of stay; hospital stay; improved; innovate; innovation; innovative; interventional strategy; primary outcome; programs; randomisation; randomization; randomly assigned; rehabilitative; response; substance abuse; treatment as usual
Project start date: 2007-07-01
Project end date: 2012-06-30
Budget start date: 1-JUL-2010
Budget end date: 30-JUN-2011
PFA/PA: PAR-05-150
5R01DA023891-04 (2010): $642140
3R01DA023891-04S1 (2010): $149999
5R01DA023891-03 (2009): $644446
1R01DA023891-01 (2007): $642677
RESTRUCTURING SERVICES FOR DRUG ABUSING TANF WOMEN
Jon Morgenstern
National Center On Addiction/sub Abuse, 633 3rd Ave, New York, Ny 10017-6706
Grant 5R01DA012256-10 from National Institute On Drug Abuse
Abstract: Federal legislation in the mid 1990s related to social welfare programs, including welfare reform, was arguably the most important policy development in recent times to impact substance abuse treatment services for low-income Americans. Over the last 8 years, our work has focused on two broad issues one policy and one scientific as well as the intersection between them. From a policy perspective, we developed a strong and ongoing partnership with the New Jersey Department of Human Services (NJDHS) and a myriad of providers to implement a statewide screening and assessment program for AOD clients located in welfare settings and conduct a two-county welfare demonstration project. From a scientific perspective, we have examined whether science-based interventions can be adapted for delivery in routine care settings and lead to improved outcomes as compared to usual care. Results of our randomized clinical trial indicated that intensive case management (ICM) delivered within a welfare setting increased access, engagement, and retention in substance abuse treatment as well as improved outcomes for drug abusing TANF mothers when compared to usual care (UC). This competitive continuation R01 proposes to take two next important steps in this line of research to provide policy-makers and scientists with crucial information needed for dissemination 1) conducting an economic evaluation of ICM including a cost of illness study and cost benefit study; and 2) increasing adoption of evidence-based practice by examining the effectiveness of ICM as delivered in a real-world setting. Methods to accomplish these aims include analysis of cost data collected as part of the earlier trial, collection of additional administrative data on clients from the original trial, recruiting and following for 9 months a new sample of TANF women with substance use disorders, and collecting administrative data on the newly recruited sample. Results from this study should guide dissemination of this promising intervention
Keywords: Address; Adoption; Affect; American; Analysis, Cost; Benchmarking; Best Practice Analysis; Budgets; Caring; Case Management; Child Welfare; Client; Clinical; Collection; Cost Analyses; Cost Analysis; Cost Benefit Analyses; Cost Savings; Cost of Illness; Cost-Benefit Analysis; Cost/Benefit Analyses; Cost/Benefit Analysis; Costs and Benefits; County; Criminal Justice; Data; Dependence, Substance; Diagnosis; Disease Costs; Drug Costs; Drug Use Disorder; Drug abuser; Drugs; Economics; Economics, Cost/Benefit; Effectiveness; Effectiveness of Interventions; Employment; Evidence based practice; Federal Government; Foundations; Funding; Future; Goals; Government; Grant; Guidelines; Health Care Research; Health Services Evaluation; Health Services Research; Healthcare Research; Housing; Human; Human, General; Individual; Intervention; Intervention Strategies; Investigators; Jobs; Label; Lead; Legislation; Low income; Man (Taxonomy); Man, Modern; Measures; Medicaid; Medical; Medical Care Research; Medication; Methods; Misuses drugs; Modeling; Mothers; NIDA; Names; National Government; National Institute of Drug Abuse; New Jersey; Occupations; Outcome; PROV; Participant; Pb element; Performance; Pharmaceutic Preparations; Pharmaceutical Preparations; Policies; Policy Developments; Policy Maker; Population; Problem drug user; Professional Postions; Programs (PT); Programs [Publication Type]; Provider; Public Sector; RFP; Randomized Clinical Trials; Recovery; Recruitment Activity; Regulation; Relative; Relative (related person); Request for Proposals; Research; Research Personnel; Researchers; Role; Sampling; Saving, Cost; Science; Scientist; Screening procedure; Services; Sickness Cost; Social Welfare; Statutes and Laws; Substance Addiction; Substance Use Disorder; Substance abuse problem; Testing; Time; Training; Woman; Work; abuse of substances; adolescent welfare; base; cost; cost benefit economics; cost benefit effectiveness; cost effectiveness; disability; drug/agent; economic evaluation; effect of intervention; evidence base; experiment; experimental research; experimental study; heavy metal Pb; heavy metal lead; improved; interventional strategy; programs; recruit; research study; routine care; screening; screenings; services research; social; social role; substance abuse; substance abuse treatment; treatment as usual; welfare
Project start date: 1999-06-20
Project end date: 2012-08-31
Budget start date: 1-SEP-2010
Budget end date: 31-AUG-2011
5R01DA012256-10 (2010): $376286
5R01DA012256-09 (2009): $492008
2R01DA012256-07A2 (2007): $501975
APPLYING TREATMENT RESEARCH TECHNOLOGIES
Jon Morgenstern, Associate Professor
Psychiatrymount Sinai School Of Medicine Of Nyu
of New York University
new York, Ny 100296574
Grant 5R01AA010268-04 from National Institute On Alcohol Abuse And Alcoholism IRG: SRCA
Abstract: Despite dramatic progress in treatment research, most alcoholics are treated "with tools and techniques developed over 50 years ago" (Gordis, 1991 pg.-173). The task of increasing knowledge transfer has been given high priority by NIAAA, but efforts have met with mixed success, at least as regards directly influencing real-world treatment practices. Controlled clinical trials have demonstrated the effectiveness of several treatments for alcohol problems. However, the overwhelming majority of alcohol treatment delivered in this country continues to use intervention strategies with limited evidence of effectiveness. Technology transfer is an important strategy for bridging the gap between research and practice and for translating treatments with established effectiveness for use in the field. No study has evaluated the feasibility and effectiveness of applying methods for training therapists in clinical trials (manuals and therapist training procedures) in order to broaden the repertoire of alcoholism counselors or increase their effectiveness. Few studies have examined whether implementing research based alcohol treatments in real world settings can improve outcome. This proposed study attempts to address these questions. "Front-line" counselors from two alcohol treatment programs will be randomly assigned to receive Cognitive Behavioral Coping Skills Treatment (CBCST) training or an attention placebo control training. Cognitively trained counselors will then be assigned to deliver CBCST under conditions of high or low treatment standardization. Patients will be randomly assigned to one of three conditions Manualized CBCST (high standardization), Real World CBCST (low standardization), or Traditional Treatment. The content of treatment delivered will be monitored using videotaping of sessions. Patients will be assessed at intake, at the end of treatment and six and 12 months following treatment. Differences on outcome and process variables will be assessed for the two groups of patients receiving CBCST versus those receiving traditional treatment
Keywords: alcoholism /alcohol abuse therapy, cognitive behavior therapy, health care personnel, health care personnel performance, human therapy evaluation, training alcoholic beverage consumption, coping, health care personnel education, health care service evaluation, mental health service, outcomes research behavioral /social science research tag, human subject, videotape /videodisc
Project start date: 1995-09-30
Project end date: 2000-08-31
5R01AA010268-04 (1998): $492286
Sponsored Links Excellgen http://Excellgen.com
5R01AA010268-03 (1997): $486550
TREATING ADDICTION AS A CHRONIC ILLNESS
Jon Morgenstern, Vp/director Of Health & Treatment Resear
National Center On Addiction/sub Abuse, 633 3rd Ave, New York, Ny 10017-6706
Grant 1RC1DA028446-01 from National Institute On Drug Abuse
Abstract: Challenge Area 5. Comparative Effectiveness Research Challenge Topic Behavioral and Medication Interventions To Treat Drug Abuse Disorders in Non-Specialty Care Settings (05-DA-101) Substance Use Disorders (SUD) are among the most prevalent and costly health conditions in the U.S. Experts agree that the current quality of care for SUD is mediocre and that profound changes must occur in systems of care in order to translate groundbreaking science into meaningful improvement for the millions of Americans suffering with SUD. Progress on solving systemic problems in SUD care has been impeded by a lack of good science regarding system change in healthcare, the complex multi-level (e.g., regulatory, clinical delivery, financing) obstacles to SUD system change, and limitations in comparative effectiveness research to provide informative knowledge to guide policy. This proposal will capitalize on a unique set of policy events occurring in New York State (NYS) led by Governor Paterson that seeks to transform the entire SUD care system, with a special focus on criminal offenders with SUD. We believe the momentum created by these events can be harnessed to jumpstart a science-based, systems-level transform of the SUD care system and in the process create a national model for state-level interventions. Specifically, we plan to work with Ed Wagner and colleagues to extend their state-level CCM interventions to SUD using NYS as a laboratory. We have strong support from the Governor´s Office and the relevant state agency Commissioners to partner in this venture. The proposal has two specific aims 1) to develop a state-level model to treat addiction as a chronic illness across multiple agencies (e.g., substance abuse and criminal justice) and system components (e.g., financing, regulation, service delivery) and 2) to conduct all developmental work necessary to design a rigorous comparative effectiveness research (CER) trial to test a chronic care model for SUD offenders. During the grant period, we will convene a multi-specialty group comprised of scientists and government leaders. As described in the application, this group will oversee activities and complete a clearly defined set of products related to study aims within a two year time period. Substance Use Disorders (SUD) are among the most prevalent and costly health conditions in the U.S. Experts agree that the quality of care for SUD is mediocre. This proposal will capitalize on a unique set of policy events occurring in New York State to jump start a science-based, systems-level transform of the SUD care system and in the process create a national model for state-level interventions to improve the quality of care and reduce costs associated with SUD
Keywords: Accountability; Active Follow-up; Address; American; Area; Asthma; Behavioral; Biology; Bronchial Asthma; Care, Health; Caring; Chronic; Chronic Disease; Chronic Illness; Clinical; Complex; Consensus; Criminal Justice; Development; Diabetes Mellitus; Disease; Disorder; Drug abuse; Drugs; Event; Freedom; Funding; Goals; Government; Grant; Health; Health system; Healthcare; Intervention; Intervention Strategies; Justice, Criminal; Knowledge; Laboratories; Liberty; Local Government; Medical Specialities; Medication; Medicine; Modeling; Nanoscale Science; Nanotechnology; Nature; Neurosciences; New York; PROV; Pharmaceutic Preparations; Pharmaceutical Preparations; Policies; Population; Pressure; Pressure- physical agent; Process; Provider; Public Sector; QOC; Quality of Care; Recommendation; Regulation; Reporting; Science; Science of Medicine; Scientist; Services; Solutions; Specialties, Medical; Specialty; Substance Use Disorder; Substance abuse problem; System; System, LOINC Axis 4; Testing; Time; Translating; Translatings; Treatment Cost; Work; abuse of drugs; abuse of substances; abuses drugs; addiction; base; behavioral health; care systems; chronic care model; chronic disease/disorder; chronic disorder; comparative effectiveness; cost; cost effective; criminal offender; design; designing; diabetes; disease/disorder; drug/agent; effective intervention; effectiveness research; experiment; experimental research; experimental study; follow-up; implementation science; improved; innovate; innovation; innovative; interventional strategy; language translation; medical specialties; nano scale Science; nano tech; nano technology; nanotech; offender; pressure; research study; substance abuse; systems of care; tool
Relevance: Substance Use Disorders (SUD) are among the most prevalent and costly health conditions in the U.S. Experts agree that the quality of care for SUD is mediocre. This proposal will capitalize on a unique set of policy events occurring in New York State to jump start a science-based, systems-level transform of the SUD care system and in the process create a national model for state-level interventions to improve the quality of care and reduce costs associated with SUD
Project start date: 2010-01-15
Project end date: 2010-12-31
Budget start date: 15-JAN-2010
Budget end date: 31-DEC-2010
PFA/PA: RFA-OD-09-003
1RC1DA028446-01 (2010): $499999
Interventions For Welfare Clients With AOD Disorders
Jon Morgenstern, Associate Professor
National Center On Addiction/sub Abuse Substance Abuse New York, Ny 100176706
Grant 5R01AA013873-05 from National Institute On Alcohol Abuse And Alcoholism IRG: ZAA1
Abstract: Beginning in 1996, legislation has been enacted to move those with alcohol and other drug use (AOD) problems off public assistance and into self-sufficiency by requiring work and limiting the time period of welfare receipt. The impact of change in welfare on substance abusers receiving public assistance and the publicly funded treatment system could be profound. Unfortunately, the inherent difficulty of examining this area has limited the number of high quality research studies looking at the treatment of alcohol problems in the context of welfare reform. This application capitalizes on a unique opportunity to test the effectiveness of three intervention approaches for welfare recipients who have been identified in a welfare setting as requiring substance abuse treatment. Participant will be randomly assigned to three conditions 1) triage and referral to a treatment program (usual care); 2) referral to a treatment program and case management services designed to link them with auxiliary services (case management); and 3) case management services and referral to a substance abuse program that provides integrated medical, mental health, family, employment, and child care services (case management with integrated services). Participants (N=450) will be assessed in-person at baseline and months 1, 3, 6, and 12. In addition, administrative data on labor and welfare outcome will be available for outcomes up to three years following recruitment. Biological and collateral verification will be used to verify self-report of substance use. HLM will be used to test the impact of the interventions on substance use, employment, and other psychosocial outcomes. The grant money we are requesting will fund the evaluation of these conditions as well as the substance abuse program in the integrated services condition. Funding for the usual care group and all case management has already been provided for by Human Resources Administration (HRA).
Keywords: alcoholism /alcohol abuse, health care referral /consultation, health care service, health care service evaluation, patient care management, public assistance, social service, social service evaluation, substance abuse related disorder, employment /unemployment, interdisciplinary collaboration, longitudinal human study, low socioeconomic status, medically underserved population, outcomes research, therapy compliance, urban area, adult human (21+), behavioral /social science research tag, clinical research, human subject, interview, patient oriented research
Project start date: 2002-09-12
Project end date: 2008-08-31
5R01AA013873-05 (2006): $411804
5R01AA013873-04 (2005): $535991
5R01AA013873-03 (2004): $928687
5R01AA013873-02 (2003): $1314436
1R01AA013873-01 (2002): $1018232
APPLYING TREATMENT RESEARCH TECHNOLOGIES
Jon Morgenstern, Associate Professor
Mount Sinai School Of Medicine Of Nyu Of New York University New York, Ny 100296574
Grant 5R01AA010268-05 from National Institute On Alcohol Abuse And Alcoholism IRG: SRCA
Abstract: APPLICANT S Despite dramatic progress in treatment research, most alcoholics are treated "with tools and techniques developed over 50 years ago" (Gordis, 1991 pg.-173). The task of increasing knowledge transfer has been given high priority by NIAAA, but efforts have met with mixed success, at least as regards directly influencing real-world treatment practices. Controlled clinical trials have demonstrated the effectiveness of several treatments for alcohol problems. However, the overwhelming majority of alcohol treatment delivered in this country continues to use intervention strategies with limited evidence of effectiveness. Technology transfer is an important strategy for bridging the gap between research and practice and for translating treatments with established effectiveness for use in the field. No study has evaluated the feasibility and effectiveness of applying methods for training therapists in clinical trials (manuals and therapist training procedures) in order to broaden the repertoire of alcoholism counselors or increase their effectiveness. Few studies have examined whether implementing research based alcohol treatments in real world settings can improve outcome. This proposed study attempts to address these questions. "Front-line" counselors from two alcohol treatment programs will be randomly assigned to receive Cognitive Behavioral Coping Skills Treatment (CBCST) training or an attention placebo control training. Cognitively trained counselors will then be assigned to deliver CBCST under conditions of high or low treatment standardization. Patients will be randomly assigned to one of three conditions Manualized CBCST (high standardization), Real World CBCST (low standardization), or Traditional Treatment. The content of treatment delivered will be monitored using videotaping of sessions. Patients will be assessed at intake, at the end of treatment and six and 12 months following treatment. Differences on outcome and process variables will be assessed for the two groups of patients receiving CBCST versus those receiving traditional treatment.
Keywords: alcoholism /alcohol abuse therapy, cognitive behavior therapy, health care personnel, health care personnel performance, human therapy evaluation, training, alcoholic beverage consumption, coping, health care personnel education, health care service evaluation, mental health service, outcomes research, behavioral /social science research tag, human subject, videotape /videodisc
Project start date: 1995-09-30
Project end date: 2001-08-31
5R01AA010268-05 (1999): $345346
Applying Treatment Research Technologies In New Settings
Jon Morgenstern, Associate Professor
Psychiatrymount Sinai School Of Medicine Of Nyu
of New York University
new York, Ny 100296574
Grant 2R01AA010268-06 from National Institute On Alcohol Abuse And Alcoholism IRG: AA
Project start date: 1995-09-30
Project end date: 2003-06-30
2R01AA010268-06 (2001): $336151
APPLYING TREATMENT RESEARCH TECHNOLOGIES
Jon Morgenstern, Associate Professor
Psychiatrymount Sinai School Of Medicine Of Nyu
of New York University
new York, Ny 100296574
Grant 3R01AA010268-03S1 from National Institute On Alcohol Abuse And Alcoholism IRG: SRCA
Project start date: 1995-09-30
Project end date: 2000-08-31
3R01AA010268-03S1 (1998): $48126
Sponsored Links Excellgen http://Excellgen.com
7R01AA010268-02 (1996): $479541
CAUSAL MODEL OF ADDICTION TREATMENT
Jon Morgenstern, Associate Professor
Mount Sinai School Of Medicine Of Nyu Of New York University New York, Ny 100296574
Grant 7R01AA010955-02 from National Institute On Alcohol Abuse And Alcoholism IRG: ALCP
Project start date: 1996-05-01
Project end date: 1998-04-30
7R01AA010955-02 (1996): $64000