Barbara S. McCrady - US grants

The goals of this study are: (1) study ways to improve the maintenance of change initated through outpatient couples treatment for alcoholism; (2) increase the generalizability of the therapy procedures from previous couples treatment research by applying the treatments to a more heterogenous clinical population; (3) begin to identify the active elements in outpatient couples treatment for alcohol abuse and alcoholism; (4) study the relationships between beliefs about drinking and relapses; (5) identify environmental and cognitive variables that predict successful or unsuccessful patient-treatment interactions; (6) study changes in spouse functioning as a result of treatment, and identify environmental and cognitive variables that predict successful or unsuccessful spouse-treatment interactions. Subjects will be 105 male alcoholics and their spouses who meet DSM-III criteria for alcohol abuse and alcohol dependence. Subjects who are psychotic, show evidence of chronic organic brain syndrome, or are physically dependent on other drugs will be excluded. Couples will be randomly assigned to one of 3 experimental conditions: AA/Alanon involvement, Marlatt Relapse Prevention, or a no-maintenance control. All couples will receive standardized treatments for their experimental group. Subjects will be assessed at baseline, at in-person interviews after treatment, at 6, 12, and 18 months after treatment, and through monthly phone calls. Outcome will be measured by assessing: drinking and drug use and problem consequences, psychological functioning, family functioning, physical health, legal and occupational status. Treatment variables and cognitive variables related to relapses, and coping skills will be assessed.

Rutgers University is proposing an Alcohol Research Center devoted to research on the treatment of alcoholism. The application is a collaborative effort among the Rutgers Center of Alcohol Studies, the Rutgers Alcohol Behavior Research Lab, Carrier Foundation and the Stonington Institute. The theme of the center is the linking of treatment studies to recent findings in the psychological and biological sciences. The first grant period will test models of recent findings in the areas of psychosocial treatment, subtyping and the psychophysiology of alcoholism. The Center includes the following components: 1. Cue Exposure Treatment of Alcoholism. This study tests the comparative effectiveness of cue exposure and control treatment among alcoholics of different levels of alcohol dependence. The study also investigates rival theories of the therapeutic mechanisms underlying cue exposure treatment. 2. A Serotonin Re-uptake Inhibitor and Cue Exposure in Reducing Craving. This study tests the relative effectiveness of two different approaches to reducing craving among alcoholics - a serotonin reuptake inhibitor or cue exposure treatment. 3. Medical Patients: Matching consultation to Stage of Change. This study tests the hypothesis that patients who are harmful or hazardous drinkers will respond differentially to clinical interventions that focus on motivational factors or skills acquisition, depending on level of motivation. 4. Elder-Specific Addictions Programming. This study tests the matching hypothesis that treatments specifically tailored to different patterns of substance abuse among elderly patients result in a more positive treatment outcome than a generic treatment. 5. A Causal Model of Addiction Treatment Outcome. This study develops and tests an expanded causal model of treatment outcome, examining the interactions among patient characteristics, treatment processes, and post-treatment environment in predicting treatment outcome. 6. Alcoholic Subtypes as Predictors of Treatment Outcome. This study draws data from the five core treatment outcome studies, and tests specific questions about the contribution of psychopathology, family history, substance abuse pattern, and personality to treatment outcome. 7. Neuropsychological Functioning and Pattern of recovery over Time as Predictors of Treatment Outcome. This study also draws data from the five core treatment outcome studies, and tests the relative strength of, and interaction between level of impairment at the start of treatment and extent of recovery over time in predicting outcome.

Rutgers University is proposing an Alcohol Research Center devoted to research on the treatment of alcoholism. The application is a collaborative effort among the Rutgers Center of Alcohol Studies, the Rutgers Alcohol Behavior Research Lab, Carrier Foundation and the Stonington Institute. The theme of the center is the linking of treatment studies to recent findings in the psychological and biological sciences. The first grant period will test models of recent findings in the areas of psychosocial treatment, subtyping and the psychophysiology of alcoholism. The Center includes the following components: 1. Cue Exposure Treatment of Alcoholism. This study tests the comparative effectiveness of cue exposure and control treatment among alcoholics of different levels of alcohol dependence. The study also investigates rival theories of the therapeutic mechanisms underlying cue exposure treatment. 2. A Serotonin Re-uptake Inhibitor and Cue Exposure in Reducing Craving. This study tests the relative effectiveness of two different approaches to reducing craving among alcoholics - a serotonin reuptake inhibitor or cue exposure treatment. 3. Medical Patients: Matching consultation to Stage of Change. This study tests the hypothesis that patients who are harmful or hazardous drinkers will respond differentially to clinical interventions that focus on motivational factors or skills acquisition, depending on level of motivation. 4. Elder-Specific Addictions Programming. This study tests the matching hypothesis that treatments specifically tailored to different patterns of substance abuse among elderly patients result in a more positive treatment outcome than a generic treatment. 5. A Causal Model of Addiction Treatment Outcome. This study develops and tests an expanded causal model of treatment outcome, examining the interactions among patient characteristics, treatment processes, and post-treatment environment in predicting treatment outcome. 6. Alcoholic Subtypes as Predictors of Treatment Outcome. This study draws data from the five core treatment outcome studies, and tests specific questions about the contribution of psychopathology, family history, substance abuse pattern, and personality to treatment outcome. 7. Neuropsychological Functioning and Pattern of recovery over Time as Predictors of Treatment Outcome. This study also draws data from the five core treatment outcome studies, and tests the relative strength of, and interaction between level of impairment at the start of treatment and extent of recovery over time in predicting outcome.

The Rutgers Center of Alcohol Studies (CAS) requests funding to continue its predoctoral training program. The program training clinical psychologists in the issues and methods of clinical alcohol research, including nosological research, randomized clinical trials, program evaluation research, and health services research. Trainees are drawn from two very strong programs at Rutgers University-the Clinical Psychology Training Program in the Psychology program (Ph.D. candidates), and the Graduate School of Applied and Professional Psychology (GSAPP) (Psy.D. candidates). Six predoctoral trainees are included in the training program. Trainees' backgrounds vary, with some entering directly after completing their undergraduate degree requirements, while others have had more extensive clinical and research experiences and may have obtained a Masters' degree prior to entering the Rutgers program. Trainees are staggered in their year in the program, with an ideal balance including on Ph.D. clinical psychology student at each of the first, second, third and fourth years, and two Psy.D. candidates. Ph.D. students are supported for four years; Psy.D. students are supported for two years, typically in the third and fourth years. During the years they are supported the Psy.D. students learn program evaluation methods and complete an applied program evaluation study for their doctoral dissertation. Faculty are drawn from several units of the University. The nine Core faculty are psychologists with the experience and expertise to serve as primary research mentors to trainees. The five Contributing Faculty include researchers and clinicians with primary expertise in sociology, statistics and measurement, and delivery of clinical services. All have expertise in addictions-related research topics. The primary training facilities are the Center of Alcohol Studies, the Department of Psychology, and the Graduate School of Applied and Professional Psychology. Trainees participate directly in ongoing clinical research studies, take courses offered jointly by the Center of Alcohol Studies and the Psychology Department and participate in a weekly Addictions Seminar that focuses on special topics in addictions research and serves as a venue for trainee presentations. Trainees learn a core of clinical research skills related to data collection methodologies and techniques, data management and data analysis.

Rutgers University is proposing an Alcohol Research Center devoted to research on the treatment of alcoholism. The application is a collaborative effort among the Rutgers Center of Alcohol Studies, the Rutgers Alcohol Behavior Research Lab, Carrier Foundation and the Stonington Institute. The theme of the center is the linking of treatment studies to recent findings in the psychological and biological sciences. The first grant period will test models of recent findings in the areas of psychosocial treatment, subtyping and the psychophysiology of alcoholism. The Center includes the following components: 1. Cue Exposure Treatment of Alcoholism. This study tests the comparative effectiveness of cue exposure and control treatment among alcoholics of different levels of alcohol dependence. The study also investigates rival theories of the therapeutic mechanisms underlying cue exposure treatment. 2. A Serotonin Re-uptake Inhibitor and Cue Exposure in Reducing Craving. This study tests the relative effectiveness of two different approaches to reducing craving among alcoholics - a serotonin reuptake inhibitor or cue exposure treatment. 3. Medical Patients: Matching consultation to Stage of Change. This study tests the hypothesis that patients who are harmful or hazardous drinkers will respond differentially to clinical interventions that focus on motivational factors or skills acquisition, depending on level of motivation. 4. Elder-Specific Addictions Programming. This study tests the matching hypothesis that treatments specifically tailored to different patterns of substance abuse among elderly patients result in a more positive treatment outcome than a generic treatment. 5. A Causal Model of Addiction Treatment Outcome. This study develops and tests an expanded causal model of treatment outcome, examining the interactions among patient characteristics, treatment processes, and post-treatment environment in predicting treatment outcome. 6. Alcoholic Subtypes as Predictors of Treatment Outcome. This study draws data from the five core treatment outcome studies, and tests specific questions about the contribution of psychopathology, family history, substance abuse pattern, and personality to treatment outcome. 7. Neuropsychological Functioning and Pattern of recovery over Time as Predictors of Treatment Outcome. This study also draws data from the five core treatment outcome studies, and tests the relative strength of, and interaction between level of impairment at the start of treatment and extent of recovery over time in predicting outcome.

APPLICANT S ABSTRACT: This 5-year project continues a broad program of research to develop conjoint models of treatment for alcohol abuse/dependence. The proposed research is intended to accomplish four specific aims: (1) To obtain detailed descriptive data about the nature of relationships between women with alcohol abuse/dependence and their male partners; (2) To modify the investigators' existing Alcohol-related Behavioral Couples Therapy with Relapse Prevention (RP/ABCT) approach to incorporate current knowledge about women with alcohol abuse/dependence and their male partners; (3) To test the effectiveness of manualized ABCT for women compared to an individually-oriented women's treatment using a randomized clinical trial with an 18-month follow-up; (4) To assess the relative contribution to the prediction of treatment outcome of individual psychopathology, partner psychopathology, quality of the intimate relationship, and functioning of other parts of the woman's social network. One hundred and twenty women with alcohol abuse/dependence and their male partners will be recruited from existing community treatment programs and through direct advertising. Subjects will be randomly assigned to RP/ABCT or individual cognitive-behavioral treatment. Twenty outpatient treatment sessions will be provided. Couples will be assessed in-person at baseline, and 6, 12, and 18 months after baseline, and each partner will be interviewed by telephone 3, 9, and 15 months after baseline. Subjects will be assessed in multiple areas of functioning: alcohol and drug use, individual psychological functioning of each partner, marital functioning, and the extent and quality of the woman's social network.

DESCRIPTION (provided by applicant): The central aim of the proposed UNM Training Program, "Alcohol Research Training;Change Methods &Mechanisms," is to provide multidisciplinary pre- and post-doctoral training to prepare future scientists to conduct research to elucidate the processes of change in drinking behavior, develop and test effective methods to effect change through improved approaches to treatment and indicated prevention, and develop and test models of disseminate knowledge of effective interventions to diverse populations. Central questions that trainees will address include: (1) What factors stimulate change in at-risk and clinical populations? (2) What psychological, social, and biological mechanisms underlie successful change at the individual level? (3) How does modeling of different trajectories of change contribute to understanding change processes? (4) What types of interventions are more and less effective in creating long-term behavior change, and, equally important, what specific aspects of treatments account for their effectiveness? (5) How does the study of risk profiles (e.g. genetic, neurobiological, psychological, socio-environmental) contribute to understanding change processes and improving efforts to tailor interventions to groups with different risk profiles? (6) How do change processes and interventions vary based on individual differences (e.g. genetic profiles, socio-demographic characteristics, co-morbidity, social/cultural environment)? (7) What are effective and efficient approaches to disseminate knowledge about change? The proposed training program would support 4 pre-doctoral fellows, drawn from the Department of Psychology at the University of New Mexico. Four post-doctoral fellows, phased in over the first 3 years of the grant, will come from disciplines relevant to the goals of the training program, including psychology, sociology, communication, psychiatry, social work, and health economics. The program will be directed and run by the Center on Alcoholism, Substance Abuse, and Addictions (CASAA), a multidisciplinary center devoted to treatment, prevention, and epidemiological research on alcohol and other substance use disorders. The Mind Research Network (MRN), a private, non-profit neuroimaging center on the UNM campus, is an important contributing partner. CASAA investigators have a strong record of research on effective models for prevention and treatment to reduce alcohol-related harm, research on active ingredients of treatment and underlying mechanisms of change, and dissemination/diffusion research. The strong human neuroscience group at the MRN brings complementary research skills to the training program. RELEVANCE (See instructions): Heavy drinking and alcohol use disorders are major concerns for health and safety. Research has led to better prevention and treatment approaches, but outcomes are less than optimal. The proposed training grant draws upon multiple disciplines to prepare researchers to investigate the psychological, social, and biological mechanisms that underpin the process of change;apply this knowledge to developing and testing new models for prevention and treatment;and apply these models to underserved populations.

DESCRIPTION (provided by applicant): Social support is an important factor in recovery from alcohol use disorders (AUDs). In particular, involving a concerned significant other (CSO) in treatment, leads to more positive outcomes. A specific form of CSO-involved treatment, Alcohol Behavioral Couple Therapy (ABCT), has strong empirical support for its efficacy. Little is known, however, about how and why ABCT leads to better outcomes of treatment. The overall objective of the proposed study is to better understand the mechanisms by which CSO-involved treatment is effective. Study aims are: (1) To see if CSO and dyadic behaviors at the beginning of ABCT predict Identified Patient (IP) drinking during treatment;(2) To see if CSO and dyadic behaviors change during ABCT;(3) To see if changes in CSO and dyadic behavior are associated with changes in IP drinking behavior during treatment;(4) To see if changes in CSO and dyadic behavior during treatment predict post-treatment IP drinking;(5)To see whether therapist behaviors predict drinking outcomes;(6) To test the effects of pretreatment and within treatments variables, including IP sex, baseline relationship functioning, and treatment compliance (attendance and homework) on treatment outcome. To accomplish these aims, existing audiotapes of 186 first session and 136 mid- treatment sessions from four randomized clinical trials of ABCT will be coded. Additional data on IP, CSO, and couple baseline characteristics, and within treatment and one-year follow-up data are available for all studies. Tapes will be coded using the Motivational Interviewing with Significant Others coding system to rate CSO and couple-level behavior;and the Treatment Integrity Rating System for ABCT to code therapist behavior. Results should contribute to improved treatment for patients with AUDS by: (1) providing information to clinicians to identify particularly positive or toxic behaviors at the start of treatment that would guide decisions about CSO-involvement in later sessions;and (2) providing information to clinicians about behaviors to target in CSO-involved treatment to maximize positive outcomes. PUBLIC HEALTH RELEVANCE: Alcohol use disorders exact a toll on the individual, family, and society. Development of more effective treatments is an important research goal. One promising approach is to involving family members in treatment - research consistently shows that family involvement leads to better outcomes. The proposed research is designed to provide better knowledge about of why family involvement is helpful in treatment, knowledge that should help clinicians to be more effective when families are involved in alcoholism treatment.

DESCRIPTION (provided by applicant): The central aim of the proposed UNM Training Program, Alcohol Research Training; Change Methods & Mechanisms, is to provide multidisciplinary pre- and post-doctoral training to prepare future scientists to conduct research to elucidate the processes of change in drinking behavior, develop and test effective methods to effect change through improved approaches to treatment and indicated prevention, and develop and test models of disseminate knowledge of effective interventions to diverse populations. Central questions that trainees will address include: (1) What factors stimulate change in at-risk and clinical populations? (2) What psychological, social, and biological mechanisms underlie successful change at the individual level? (3) How does modeling of different trajectories of change contribute to understanding change processes? (4) What types of interventions are more and less effective in creating long-term behavior change, and, equally important, what specific aspects of treatments account for their effectiveness? (5) How does the study of risk profiles (e.g. genetic, neurobiological, psychological, socio-environmental) contribute to understanding change processes and improving efforts to tailor interventions to groups with different risk profiles? (6) How do change processes and interventions vary based on individual differences (e.g. genetic profiles, socio-demographic characteristics, co-morbidity, social/cultural environment)? (7) What are effective and efficient approaches to disseminate knowledge about change? The proposed training program would support 4 pre-doctoral fellows, drawn from the Department of Psychology at the University of New Mexico. Four post-doctoral fellows, phased in over the first 3 years of the grant, will come from disciplines relevant to the goals of the training program, including psychology, sociology, communication, psychiatry, social work, and health economics. The program will be directed and run by the Center on Alcoholism, Substance Abuse, and Addictions (CASAA), a multidisciplinary center devoted to treatment, prevention, and epidemiological research on alcohol and other substance use disorders. The Mind Research Network (MRN), a private, non-profit neuroimaging center on the UNM campus, is an important contributing partner. CASAA investigators have a strong record of research on effective models for prevention and treatment to reduce alcohol-related harm, research on active ingredients of treatment and underlying mechanisms of change, and dissemination/diffusion research. The strong human neuroscience group at the MRN brings complementary research skills to the training program. RELEVANCE (See instructions): Heavy drinking and alcohol use disorders are major concerns for health and safety. Research has led to better prevention and treatment approaches, but outcomes are less than optimal. The proposed training grant draws upon multiple disciplines to prepare researchers to investigate the psychological, social, and biological mechanisms that underpin the process of change; apply this knowledge to developing and testing new models for prevention and treatment; and apply these models to underserved populations.

DESCRIPTION (provided by applicant): Since joining the NIDA Clinical Trials Network in 2002, the Southwest Node has made a substantial and singular contribution to the research activities of the CTN. The Southwest Node has successfully completed six multi-site trials, as well two studies focusing on Native Americans, two survey studies, and several ancillary and platform Studies. We are currently serving as Lead Node for CTN 0047, Screening, Motivational Assessment, and Referral for Treatment in Emergency Departments (SMART-ED). Beyond participation in protocols, the Node has been highly productive in the areas of protocol development, training, committee work, and dissemination. The Node has made an outstanding contribution to advancing the clinical science of addictions treatment in minority and other underserved populations. Of the multi-site trial participants recruited at the Southwest Node, 71% were Hispanic and 7% were Native American, not counting 427 participants thus far in the two Native American protocols. The Node has managed grant funds prudently and efficiently, requesting and spending only what is necessary to achieve our scientific objectives. For the renewal period, the Southwest Node will consist of its RRTC, the University of New Mexico Center on Alcoholism, Substance Abuse, and Addictions (CASAA), and affiliated investigators at the University of New Mexico; 5 primary CTPs, all of which have already collaborated extensively with Node investigators; and 6 secondary CTPs representing a wide range of medical, dental, and psychiatric treatment settings. Strengths of the Southwest Node include: 1) a well-established track record of clinical trials with both behavioral treatments and pharmacotherapies; 2) longstanding experience in the development and evaluation of innovative treatments for addictions; 3) extensive experience with minority and other underserved populations, and demonstrated ability to recruit them; 4) expertise in research on dissemination and training; and 5) geographic representation of the American Southwest. Our agenda for the renewal period will build on our strengths, with four proposed foci of research leadership: 1) implementing addiction treatment in medical settings; 2) optimizing addiction treatment for minority populations; 3) using the family to enhance treatment outcome; and 4) pharmacologic treatment of opioid dependence.

DESCRIPTION (provided by applicant): The overall aim of this treatment development study is to develop an efficacious, brief, family-involved treatment that can be used flexibly in on-goin alcohol treatment settings to advance the dissemination of evidence-based treatment. The treatment to be developed and tested in this grant, B-FIT (Brief Family- Involved Treatment), builds on the PI's earlier NIAAA-supported efficacy trials and studies of mechanisms of change in Alcohol Behavioral Couple Therapy (ABCT) and is designed as an add-on to community-based substance abuse treatment-as-usual (TAU). B-FIT uses family involvement to enhance patient treatment adherence and outcomes by improving family functioning and increasing family-provided incentives for treatment adherence and abstinence. Study aims are carefully sequenced to develop the B-FIT approach and to judge its merits through a rigorous set of fidelity analyses, a small-scale clinical trial, and prospective tests of potential active ingrediets, mediators, and moderators of treatment response. Specific aims are to: (1) modify ABCT to make it (a) appropriate for any concerned family member, (b) shorter, (c) focused on key mechanisms of change, (d) appropriate for use as part of an on-going alcohol treatment program, and (e) more efficacious by incorporating behavioral contracting procedures; (2) conduct a small-scale clinical trial of B-FIT; and (3) finalize materials for a larger-scale RCT. T accomplish study aims, a stage 1A successive cohort treatment development approach followed by a stage 1B small randomized clinical trial (RCT) will be completed. In the 1A stage, key interventions in B-FIT will be identified and integrated into the preliminary version of the treatment manual. Then, in the 1B stage B-FIT will be tested in an RCT to determine feasibility and preliminary efficacy. The project includes six phases: (1) focus groups with service providers, patients, and concerned family members (CFMs) of patients to obtain feedback about the B-FIT content and materials; (2) modification of the B-FIT protocol in response to the focus group feedback; (3) clinician training in the B-FIT protocol followed by pilot testing with six patients and their CFMs. Each clinician, patient and CFM will be debriefed after the treatment to assess the B-FIT intervention. (4) Further modifications to the B-FIT materials in response to feedback from the pilot study as well as a second set of focus groups used to obtain feedback on the B-FIT written materials in terms of readability, relevance, and ease of use. (5) Structured didactic and experiential training for clinicians on the B-FIT treatment. (6) A small-scale, randomized clinical trial of TAU versus B-FIT + TAU will be conducted with 60 ASAP patients and their CFMs to (a) test the feasibility of B-FIT and impact on patient treatment retention, (b) obtain effect size estimates for pre-post changes in drinking, CFM, and family functioning; (c) assess therapist fidelity; (d) measure hypothesized active ingredients in the treatment; and (e) conduct initial moderator analyses. In parallel with phases 1-5 all measures and study procedures will be finalized. Three month follow-up data will be collected as part of the clinical trial.

Description: Although modestly effective treatments exist for alcohol use disorders (AUD), many individuals relapse to heavy alcohol use after completing treatment, suggesting the need for a better understanding of factors that contribute to successful outcomes. Whereas much of the focus in past studies has been on identifying what treatments work for AUDs, only recently has there been a focus on why particular treatments work, and the mechanisms by which treatment leads to changes in drinking. This focus on mechanisms of behavior change (MOBCs) has the potential to not only allow for an accumulation of knowledge about the process by which treatment leads to better outcomes, but also may lead to the development of new treatments or modifications of existing treatment approaches that target empirically supported mechanisms known to lead to change. Existing research has focused on potential mechanisms including alcohol cue reactivity, affect regulation, and behavioral control, but these constructs have largely been tested using self-report measures, and there is a noticeable paucity of studies that examine these mechanisms from a neurocognitive perspective. To address this gap in knowledge, the proposed study will examine MOBC at multiple levels including self- report, behavioral performance, and neural network engagement, with a focus on the function of the lateral and medial frontal control networks, striatal based reward networks, and amygdala networks underlying emotional reactivity. One hundred eighty treatment-seeking individuals with an AUD will be randomized to receive either 8 weeks of Cognitive Behavioral Treatment (CBT) or Mindfulness Based Treatment (MBT) after receiving 4 weeks of a platform treatment that focuses on enhancing motivation to change. To establish the temporal relationship between changes in drinking and changes in these MOBCs, patients will be assessed at: (a) baseline; (b) four weeks into treatment; (c) immediately post-treatment; and (d) 9- and 15-months post- baseline. Self-report measures and behavioral tasks will be administered at monthly intervals during treatment; and fMRI will be collected at baseline, and at 3, and 9-months post baseline. Relationships between changes in drinking and changes in the proposed MOBCs will be examined using advanced mixed modeling techniques that have been pioneered by the research team. Further, the project will leverage data collected in a separate project examining MOBC in a non-treatment seeking sample using the same measures collected at similar timepoints. By identifying MOBCs of CBT or MBT that differentially contribute to changes in drinking, the proposed project will not only derive a deeper understanding of successful behavior change, but also may inform the development of novel treatments for AUD. In addition, by identifying neurocognitive factors predictive of successful change, it may be possible to utilize this knowledge to match specific treatments with particular patient neurocognitive profiles.

Project Summary/Abstract This application requests five more years of support for a highly successful training program at the University of New Mexico (UNM) Center on Alcoholism, Substance Abuse, and Addictions (CASAA). The program, initiated in 2010, has trained 26 pre- and postdoctoral trainees for careers in alcohol research. Support is requested for 4 pre-doctoral trainees, drawn from the Department of Psychology, and 3 post-doctoral trainees from disciplines relevant to the goals of the training program, such as psychology, sociology, psychiatry, social work, population health, and economics. The training program prepares future scientists to develop and test effective models for impacting change in alcohol use through improved approaches to treatment and indicated prevention, to conduct research on processes of change in drinking behavior, and to develop and test models to disseminate knowledge of effective interventions and change processes to diverse populations. Central questions that trainees address include: (1) What factors stimulate change in at-risk and clinical populations? (2) What psychological, social, and neurobiological mechanisms underlie successful change at the individual level? (3) How does modeling of different trajectories of change contribute to understanding change processes? (4) What types of interventions are more and less effective in supporting recovery from alcohol use disorder (AUD), and, equally important, what specific aspects of treatments account for their effectiveness? (5) How do change processes and interventions vary based on individual differences (e.g., genetic profiles, sociodemographic characteristics, co-morbidity, social/cultural environment) and how can examination of individual differences inform precision medicine for AUD? (6) What are effective and efficient approaches to disseminate evidence-based interventions and knowledge about change processes to practitioners and diverse populations? The program is directed and run at the Center on Alcoholism, Substance Abuse, and Addictions (CASAA), a multidisciplinary center devoted to treatment, prevention, and epidemiological research on alcohol and other substance use. The UNM Department of Psychology and the Mind Research Network, a private, non-profit neuroimaging center on the UNM campus, are important contributing partners. Ten core faculty serve as primary preceptors for trainees. These faculty members have strong records of mentorship and research on effective models of prevention and treatment to reduce alcohol-related harm, research on neurocognitive and behavioral mechanisms of behavior change, studies with diverse populations, and dissemination research. The 15 contributing faculty bring complementary expertise in neurobiology and neurocognition, emerging methodologies in alcohol research, behavioral interventions, diverse populations, and dissemination science, and provide content expertise and opportunities for secondary research experiences.