2011 — 2012 |
Worley, Matthew J. |
F31Activity Code Description: To provide predoctoral individuals with supervised research training in specified health and health-related areas leading toward the research degree (e.g., Ph.D.). |
Mediators of Outpatient Treatment For Comorbid Substance Use Disorder and Major D @ University of California San Diego
Among individuals with a substance use disorder (SUD), major depressive disorder (MDD) is the most common comorbid Axis I disorder, and is associated with a multitude of negative outcomes, including higher treatment costs, greater risk of suicide attempts, worse overall quality of life, and poorer treatment response. Integrated interventions for concurrent treatment of both disorders have been suggested as the optimal mode of treatment delivery. However, few randomized trials have tested integrated treatment against evidence-based comparison treatments, and integrated interventions are not yet empirically-supported. Treatment researchers have begun focusing on the mediating processes involved in behavioral treatments for SUDs, with hopes of increasing the effectiveness, efficiency, and portability of interventions. By comparison, the existing literature on mediating processes in comorbid populations is strikingly lacking. Discovery of mediating processes should provide insight into the common and unique mechanisms of integrated and non-integrated treatment approaches, informing the development of more powerful interventions. The proposed research will examine mediators of substance use and depression outcomes during a randomized, controlled trial of outpatient group therapies for veterans with comorbid SUD-MDD. Veterans were randomized to either Integrated Cognitive- Behavioral Therapy (ICBT) or Twelve-Step Facilitation (TSF). Key mediators from previous studies of SUDs (self-efficacy, 12-step affiliation, social support for abstinence, coping skills) and MDD (dysfunctional attitudes, negative mood regulation) were assessed quarterly during 6 months of treatment and 12-months of follow-up. Under the first primary aim, latent trajectories of 12-step affiliation, dysfunctional attitudes, and negative mood regulation during treatment will be estimated with latent growth curve models, with the prediction that the TSF group will have increases in 12-step affiliation over time, and change in each mediator will be associated with change in depression. Under the second aim, trajectories of self-efficacy, 12-step affiliation, social support for abstinence, and coping skills during follow-up will be estimated, with the hypothesis that TSF will have reductions in 12-step affiliation, ICBT will maintain levels of self-efficacy, and both groups will have reductions in social support for abstinence and coping skills over time. Changes in each mediator are expected to be associated with substance use trajectories. The third aim will examine the effects of baseline neurocognitive impairment on mediators and their association with outcome. It is predicted that greater neurocognitive impairment will have a deleterious effect on latent trajectories of self-efficacy, dysfunctional attitudes, and negative mood regulation. In addition, the strength of association between these mediators and outcomes will be weaker for patients with greater neurocognitive impairment.
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2016 — 2020 |
Worley, Matthew J. |
K23Activity Code Description: To provide support for the career development of investigators who have made a commitment of focus their research endeavors on patient-oriented research. This mechanism provides support for a 3 year minimum up to 5 year period of supervised study and research for clinically trained professionals who have the potential to develop into productive, clinical investigators. |
Behavioral Economic Mechanisms of Prescription Opioid Addiction in Chronic Pain @ University of California San Diego
? DESCRIPTION (provided by applicant): This application seeks to investigate potential behavioral economic markers of prescription opioid addiction in patients with chronic, non-cancer pain. Drawing from previous studies of behavioral economic mechanisms of drug use, Aim 1 will validate a novel laboratory procedure to examine pain-related prescription opioid demand in chronic pain patients who misuse prescribed opioid medications (n =30). A novel opioid purchase task will assess prescription opioid demand under conditions of experimentally-induced pain, and will be validated against an established laboratory task of opioid reinforcement. Aim 2 will utilize a randomized, within-subjects design to compare behavioral economic markers in two groups of patients with chronic pain: 1) those with current prescription opioid addiction (n = 40), and 2) a control group of patients with low opioid misuse risk and no history of opioid or other drug addiction (n = 40). Patients with prescription opioid addiction are expected to exhibit greater delay discounting and prescription opioid demand compared to controls. This research will validate novel experimental methodology and provide initial data on behavioral economic mechanisms of prescription opioid addiction in chronic pain patients. The candidate is a clinical psychologist with an early track record of research productivity in mechanisms of substance use and behavioral interventions in adults with co-occurring disorders. This K23 will provide him with necessary methodological and substantive training to support his long-term research goal of identifying neurobehavioral mechanisms of risk for prescription opioid addiction in patients with chronic pain. The candidate's short-term objectives are to acquire methodological skills in behavioral economics, develop mastery in opioid pharmacology, increase his expertise in the neurobiology of addiction, and gain knowledge in the neurocognitive mechanisms of chronic pain and experimental pain methodology. The candidate will be mentored by senior investigators with expertise in each of these domains. He is supported by the institutional resources of the Center for Behavioral and Addiction Medicine at UCLA, an environment well-suited for the purpose of research in chronic pain and addictions via the integration of addiction medicine into primary care settings. The proposed research and training will equip the candidate with unique expertise in the overlapping and mechanistic neurobehavioral processes implicated in chronic pain, addictive behavior, and reward processing, with the long-term goal of establishing an independent laboratory conducting NIH-funded research in this area.
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