Department of Psychiatry
Penn Behavioral Health

Center on the Continuum of Care

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NIH Funded Grants

Extended Treatment for Drug Dependence
(J. McKay, PI)

This National Institute on Drug Abuse (NIDA)-funded R01 grant tests two 24-month adaptive continuing care interventions for drug dependent patients who have become engaged in intensive outpatient treatment (IOP). These interventions are provided over the telephone, and also through in-person counseling visits when a patient’s level of risk for relapse increases. One of these interventions includes incentives for sustained participation and compliance with stepped care over the first year (e.g., gift certificates to popular businesses). The purpose of the interventions is to increase rates of sustained, successful recovery from cocaine dependence. Participants in the study are randomly assigned to receive standard care at the IOP, or standard care plus one of the two extended continuing care interventions. Patients with cocaine dependence in treatment at several community treatment programs in Philadelphia are eligible for this study. Research follow-ups are conducted at either 3 or 6 month intervals over 2 years. Individuals interested in participating can contact Megan Long at 215-746-7712.

We recently received a supplement to this grant, from ARRA Stimulus funds. The new project makes use of paraprofessional recovery support staff to deliver continuing care services.


Enhanced Adaptive Continuing Care Model for Cocaine Dependence

(J. McKay, PI)

This new RC1 challenge grant tests an enhanced version of our telephone-based continuing care model. In this study, patients enter shortly after beginning treatment, in order to reduce rates of early drop out. Patients also receive incentives for completing continuing care contacts, cell phones if needed, and additional efforts to link them with community supports and resources.


Adaptive Treatment for Cocaine Dependence

(J. McKay, PI)

This Program Project grant from Dr. Charles O’Brien’s NIDA-funded P60 uses experimental methods to develop an optimal adaptive algorithm to promote higher rates of initial engagement and sustained participation in treatment. A novel feature of the study is that it tests whether allowing patients to choose a preferred intervention from a menu of possible options increases engagement and retention. Patients who do not become engaged during the first two weeks of treatment will be randomized to two different telephone-based motivational interventions, one which attempts to engage them in standard treatment, and the other which attempts to engage them in one of several treatment options. Individuals interested in participating can contact Dr. Michelle Drabkin at 215-746-2098.


Disease Management for Chronic Drug Abuse

(J. Morgenstern, PI; J. McKay, Consultant)

This NIDA-funded R01 is testing an innovative disease management intervention for chronic addiction (DM-CA) in New York State. The Chronic Care Model framework will be used to develop a system-level intervention for frequent utilizers of high cost AOD treatment. DM-CA will be designed to improve monitoring and coordination of care in order to avert crisis events (e.g., emergency room visits) and help engage clients in stabilizing outpatient services, thereby reducing health care costs. Study personnel will identify 1,700 high cost AOD disordered clients (those using more than $10,000 of services in the prior year) and then randomly assign them within county to DM-CA or a control condition of usual care (UC). Dr. McKay and colleagues are collaborating on the development and implementation of telephone-based continuing care for this study.


Center on Adaptive Treatments for Alcoholism

(J. McKay, PI)

In July of 2008, Dr. McKay and co-investigators in the Center on the Continuum of Care in the Addictions were awarded a P01 Center grant from the National Institute on Alcohol Abuse and Alcoholism. This 5-year grant is entitled "Center on Adaptive Treatments for Alcoholism." This new grant provides core funding to support further work on the development of algorithms that specify effective modifications to treatment when patients are not making good progress toward recovery from their alcohol use disorder. In addition, the grant funds three new studies in this area. The first study compares two approaches to providing treatment to patients in Penn primary care medical practices who receive a diagnosis of alcohol dependence, traditional treatment vs. pharmacotherapy-based medical management. The second study compares two methods for increasing initial engagement and sustained participation in specialty care addiction treatment. Both of these studies also examine the role of patient choice or preference in the selection of treatment, particularly when an initial intervention has not produced good results. The third study is an initial evaluation of a web-based recovery support program that can arrange for increased contact with counselors when patients experience difficulties in their recoveries. The faculty for this new center includes investigators from Penn, the Treatment Research Institute, and other major research universities, along with community treatment providers in Philadelphia.


Extended Telephone Continuing Care for Alcohol Dependence

(J. McKay, PI)

This National Institute on Alcohol Abuse and Alcoholism (NIAAA)-funded R01 is testing the effectiveness and benefit-cost of two 18-month telephone-based continuing care protocols for alcohol dependent patients. One of these is an adaptive protocol that provides in-person counseling sessions in addition to the telephone contact when patients are at heightened risk for relapse. The purpose of the interventions is to increase rates of sustained, successful recovery from alcohol dependence. Participants in the study are randomly assigned to receive standard care at their treatment facility, or standard care plus one of the two extended continuing care interventions. Patients with alcohol dependence who are in treatment at several community treatment programs in Philadelphia are eligible for this study. Research follow-ups are conducted every 3 months for 2 years.


Component Analysis of Motivational Interviewing

(J. Morgenstern, PI; J. McKay, Co-PI)

This NIAAA-funded R21 will disaggregate Motivational Interviewing (MI) into its component parts and test full MI compared to MI without its directive strategies. This will test whether the directive elements of MI are critical or whether MI effects may be attributable solely to its non-directive components, such as therapist empathy and genuineness. In addition, this study will examine whether non-specific therapy factors alone - placebo expectancy effects and MI spirit - significantly reduce drinking when compared to a comparison condition that controls for non-therapy factors. Further analyses will test for mediation effects. The grant utilizes a number of new data collection methodologies to provide better measures of treatment process and mechanisms of action.


Adaptive Approach to Naltrexone Treatment for Alcoholism

(D. Oslin, PI)

This NIAAA-funded R01 is examining ways to improve outcomes for two groups of patients: those who have a good initial response to naltrexone, and those who do not. Patients who continue to drink during the first eight weeks on naltrexone all receive a more intensive behavioral treatment (i.e., “stepped care”) and are randomized to continue or not continue on naltrexone. Patients who respond well to naltrexone are randomized to receive or not receive subsequent telephone disease management. One of the novel features of this study is that experimental methods are used to compare the impact on treatment outcomes of two different definitions of “non response” to naltrexone.