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.