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Association for Behavior Analysis International

The Association for Behavior Analysis International® (ABAI) is a nonprofit membership organization with the mission to contribute to the well-being of society by developing, enhancing, and supporting the growth and vitality of the science of behavior analysis through research, education, and practice.

Newsletter

Volume 28 | 2005 | Number 2

 

Getting Funding from the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism

Kenneth Silverman, Ph.D., Johns Hopkins University School of Medicine

 

The National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) are ideal homes for behavior analysts. Operant laboratory models of drug and alcohol addiction are widely recognized, and operant treatments have been recognized as effective and are becoming increasingly accepted. The literature on the operant analysis and treatment of addiction can serve as a foundation for behavior-analytic grant applications, both because of the scientific background it provides and because of its familiarity to many grant reviewers. In this article, I describe some of my experiences seeking extramural funding to develop an operant treatment for cocaine and heroin addiction (see Silverman, 2004 for a description of this research). These experiences are organized around the five dimensions on which NIH grants are evaluated: Investigator, Environment, Innovation, Significance, and Approach.

 

Investigator and Environment

Grant reviewers assess the extent to which the investigator has the relevant experience and skills to achieve the grant's objectives. I had the good fortune to obtain my initial experience conducting operant treatment research at NIDA's intramural program, with Kenzie L. Preston, Charles R. Schuster, and others. Supported by intramural funds, we conducted studies that showed that arranging monetary vouchers contingent on cocaine-free urine samples could increase cocaine abstinence in injection drug users who persisted in using cocaine despite exposure to standard methadone treatment services.

 

To begin extramural research, I moved to Johns Hopkins University and worked under the guidance of Maxine Stitzer and George Bigelow. Maxine and George were pioneers in the use of contingency management interventions to treat drug addiction and were experienced extramural researchers. They were perfect mentors to introduce me to the world of grant writing. My first application proposed to conduct studies on voucher reinforcement of cocaine abstinence in injection drug users enrolled in methadone treatment. Fortunately for me, that application was a component of an NIH Research Center for which Maxine Stitzer was the principal investigator.

 

During the grant writing process, Maxine and George began to teach me that grant writing follows a unique set of rules. I learned, for example, that you shouldn't ignore a limitation in your research approach, hoping that it will go unnoticed in the review process. Where alternative approaches are possible, discuss them, and explain why your approach is superior to the alternative(s). I believe that NIH grant writing is a unique type of writing, which probably is learned best with some guidance and feedback from experienced investigators.

 

With the guidance and credibility provided by Maxine and George, the application was funded. My prior research experience was probably relevant, but I believe that Maxine's long history of extramural research, along with the research environment that she and George had created, provided firm evidence that we could accomplish the goals of the grant, and thus were critical to funding. At a substantial cost and proposing some extreme studies (e.g., studying the effects of providing $3,000 in vouchers to promote abstinence in treatment-resistant patients), I believe that the application would not have been funded if I had submitted it on my own.

 

Innovation

I later wrote my first R01 application to develop a novel treatment that I hoped would be a practical application of the voucher-based abstinence reinforcement technology. Under this intervention, which we called a therapeutic workplace, we hoped to create a model business, hire drug abuse patients to work in that business, and use the wages that the participants would earn for work to reinforce drug abstinence. The intervention included an initial training phase in which participants would receive basic academic and job-skills training prior to regular employment. The original application received a terrible priority score and was not funded. The intervention was innovative, which is good; but its novelty raised surprising concerns. We had proposed to teach participants prerequisite academic skills using Direct Instruction and Precision Teaching. Reviewers raised Human Subjects concerns, suggesting, "the research does not adequately consider the difficulty of training the subject group, who have limited intellectual capabilities, …do not have the mental capacity to achieve study expectations (with respect to basic skills or specific job skills training), …and may feel frustrated and experience a sense of failure." The grant application had cited relevant research on Direct Instruction and Precision Teaching, but that was not sufficient. Over the next months, we conducted two small studies to show that the intended population was interested in learning the job skills we had planned to teach, and that they could acquire those skills relatively easily and without "frustration" (Silverman, Chutuape, Bigelow and Stitzer, 1996; Silverman, Chutuape, Svikis, Bigelow and Stitzer, 1995). The process of getting this grant was long and painful, but the third revision of the application was funded. This experience showed me that innovation is important, but strong pilot or preliminary data are critical to a successful application.

 

Significance and Approach

Behavior-analytic approaches have been effective at addressing important social problems that other disciplines have failed to address successfully, and they have considerable potential in the treatment of drug and alcohol addiction. Available treatments for drug and alcohol addiction have failed to address a number of important problems adequately. Those unsolved problems are ideal targets for behavior analytic approaches. Much of my research and grant applications have focused on the treatment of injection drug users who persist in using cocaine during standard methadone treatment. This target has been important for a few reasons: 1) cocaine use by injection drug using methadone patients has been recognized as an important health problem, which has been associated with an increased risk of HIV infection; 2) available treatments have shown limited effectiveness in addressing the problem; and 3) there is a strong empirical basis to expect that the operant approach can be effective in addressing this problem.

 

In my one application to NIAAA, I followed a similar strategy and proposed to evaluate the effectiveness of the therapeutic workplace to address an important problem that other approaches had failed to address successfully: the chronic unemployment and persistent alcohol use of homeless, alcohol-dependent adults. I assumed that reviewers would recognize readily that conventional counseling approaches would be insufficient to address these problems and that an intensive intervention like the therapeutic workplace would be warranted. The written reviews and ultimate funding of the application seemed to confirm my suspicions.

 

In general, my successful grant applications have had similar characteristics: they have addressed a problem of considerable and obvious social significance; they have addressed an intractable problem that other available approaches had failed to address successfully; and they have proposed to apply an empirically-based and powerful operant approach.

 

Prospects for Success

In my experience, program staff members at NIDA and NIAAA have been extremely supportive and helpful, and review committees have been open to sound behavior analytic proposals. I and other behavior analysts have maintained active research programs through NIDA and NIAAA funding, and I expect that many other behavior analysts could experience similar success.

 

References

Silverman, K. (2004). Exploring the limits and utility of operant conditioning in the treatment of drug addiction.

 

The Behavior Analyst. 27, 209-230.

 

Silverman, K., Chutuape, M. D., Bigelow, G. E., & Stitzer, M. L. (1996). Voucher-based reinforcement of attendance by unemployed methadone patients in a job skills training program. Drug and Alcohol Dependence, 41, 197-207.

 

Silverman, K., Chutuape, M. D., Svikis, D. S., Bigelow, G. E., & Stitzer, M. L. (1995). Incongruity between occupational interests and academic skills in drug abusing women. Drug and Alcohol Dependence, 40, 115-123.

 

 

 

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