Division of Treatment and Recovery (DTR)

The Division of Treatment and Recovery (DTR) is an extramural NIAAA Division that focuses on developing treatments for alcohol use disorder (AUD), increasing their use in real-word settings, and understanding the process of recovery as individuals make progress in overcoming AUD. The Division is comprised of two branches: the Medications Development Branch (MDB) and the Treatment, Health Services, and Recovery Branch (THSRB).

Medications Development Branch:

The Medications Development Branch (MDB) plans, stimulates, develops, and supports pharmacotherapy research to AUD. This includes advancing promising medications through the drug development pipeline: identifying lead compounds and optimizing their structure for potency, stability, selectivity/specificity, bioavailability, testing for preclinical efficacy (e.g., alcohol animal models), completing IND requirements (pharmacokinetic evaluations, toxicology, and formulation/manufacturing), supporting phase 1 studies (pharmacokinetic evaluations, pharmacodynamics/target engagement, safety, alcohol interaction, and abuse liability), conducting human laboratory studies and clinical trials, and directing secondary analyses to improve methodology of pharmacotherapy clinical trials for the treatment of AUD. MDB is also committed to research precision medicine to predict favorable responders (both efficacy and safety) to a specific medication, alcohol/psychiatric comorbidity, especially post-traumatic stress disorder, internal and external collaborations to advance the development of medications for AUD, and training programs to assure that adequate numbers of highly competent scientists are engaged in current and future research on medications development.

High priority MDB activities include:

• developing and testing novel and repurposed medications for the treatment of AUD;
• advancing precision medicine by identifying  subgroups who respond favorably to experimental compounds. This includes developing novel computational analytical approaches using a combination of patient characteristics and biomarkers. Discovering new biomarkers is a high priority that includes the integration of “multi-omics” signature profiles involving expression of genes, RNA, proteins, and metabolites; brain endogenous metabolites, electrophysiological variation, individual cell imaging and other biological mechanisms such as hiPSC-based neuronal models 
• developing new pharmacological treatments to treat patients with AUD and psychiatric comorbidity (e.g., post-traumatic stress disorder); 
• stimulating research that develops and evaluates alcohol biosensors for the purpose of objectively measuring real-time alcohol intake;
• developing and implementing a standardized human laboratory paradigms program for screening/testing promising medications; and
• promoting the initial evaluation of promising new compounds in human patients via the NIAAA SBIR Investigational New Drug (IND)-enabling program.

Treatment, Health Services, and Recovery Branch:

The Treatment, Health Services, and Recovery Branch (THSRB) stimulates and supports research in broad categories such as health services, behavioral therapies and mechanisms of behavioral change, recovery, translational research, and innovative methods and technologies for AUD treatment and sustaining recovery. Other areas of interest include topics focusing on special-emphasis and underserved populations, including HIH-designated US health disparity populations, as well as those with co-occurring disorders, and fetal alcohol spectrum disorders (FASD). In all studies, at all levels from FASD to elderly, efforts are made to include participants that reflect the diversity of the population at large.  High priority THSRB activities include:

• Improving health services research: focusing on four main areas: 1) make evidence-based treatment more accessible to patients; 2) make treatment settings more appealing to patients; 3) make treatments more affordable; and 4) disseminate and implement evidence-based behavioral and pharmacological treatments into professional healthcare practices. Other areas include:
  • Improve access to evidence-based treatments by identifying and developing strategies to reduce the barriers (personal and structural) that prevent people with AUD and alcohol misuse from seeking and receiving appropriate care
  • Explore the treatment gap as it relates to gender, age (from adolescence through older adulthood), race/ethnicity, socio-economic status, immigration status, and health literacy, and improve service delivery systems and innovations to facilitate access to care
  • Remove the stigma of AUD and integrate AUD treatment into mainstream health care
• Improving the effectiveness of behavioral interventions:
  • Evaluate evidence-based behavioral therapies in real world treatment settings, especially for culturally diverse and special emphasis and underserved populations
  • Disseminate clinical practice findings from mechanism of behavioral change studies that have shown promise in enhancing the effectiveness of behavioral therapies
  • Use dynamic and person-centered statistical modeling approaches to evaluate how heterogeneity impacts alcohol use behavior within specific AUD treatments
• Understanding the dynamics of post-treatment recovery (see NIAAA’s research definition of recovery) :
  • Explore the neurobiological, psychological, environmental, and social factors that influence post-treatment recovery
  • Determine trajectories of recovery in subgroups of people with different cultural and socioeconomic backgrounds, cognitive abilities, and medical histories
  • Identify factors associated with so-called natural recovery and how these factors can be applied to change the behavior of those in treatment
  • Explore continuing care treatments that aim to support long-term recovery   
• Understanding how the social determinants of health (i.e., environmental, social, cultural, and economic factors) influence outcomes and sustainability in health disparities:
  • Remove barriers that keep racial, ethnic, and sex/gender minorities from seeking and receiving appropriate health care
  • Implement effective treatments that are tailored for these populations in diverse clinical and other settings
  • Determine how social/cultural factors influence treatment accessibility, effectiveness, and long-term recovery
  • Develop measures to assess care delivery models to better address the issues underlying health disparities
• Improving treatments for co-occurring PTSD, anxiety, depression, and AUD:
  • Integrate treatments for co-occurring AUD and mental health conditions to address the heterogeneity that exists among patients
  • Identify which types of services, service providers, and treatment settings work best for which subgroups
  • Determine how the treatment of one disorder can influence the risks, progression, and outcome for the other disorder
• Harnessing new technology (e.g., mobile, computer, web-based applications, artificial intelligence/machine learning, geo-locations, and robotics) to increase the accessibility and effectiveness of a variety of treatments:
  • Use new technologies to disseminate evidence-based behavioral treatments among hard-to-reach populations, improve effectiveness of telemedicine, and enhance the continuum of care  
  • Investigate new digital technology ways of capturing real-time data in clinical trials and treatment protocols
• Improving clinical research methods:
  • Develop efficient, adaptive clinical trial designs and statistical analyses that allow treatment adjustments based on the changing disease status of the patient
  • Explore new statistical models and methods for evaluating treatment effectiveness and recovery
  • Investigate statistical approaches that capture changes in outcomes over time and convey results that are more clinically intuitive.
• Improving alcohol treatment outcomes for women:
  • Compare effectiveness of standard treatment approaches, such as group counseling and relapse prevention, in single-gender vs. mixed-gender groups   
  • Develop new strategies for alcohol screening, diagnosis, and interventions and tailor them to women in diverse settings, including prenatal care and specialty health care  
  • Understand the impact of coexisting conditions, including other substance use and mental health disorders, on alcohol-related health care, illness, and death among girls and women  
  • Examine the effects of stress, early childhood trauma, childhood adverse events, and co-occurring disorders on women’s drinking  
• Increasing the number of behaviorally-oriented clinical researchers (primarily clinical psychologists) who receive NIAAA training and career development grants (F’s, K’s—especially, the K99/00).

• The University of Connecticut Alcohol Research Center  (5P50AA027055-03): This alcohol research center program addresses risk factors in the etiology of alcohol use disorders (AUDs), in addition to behavioral and pharmacological treatment of alcohol misuse and AUDs. 

• Zambia Alabama HIV Alcohol Comorbidities Program (ZAMBAMA) (1P01AA029540-01): The central theme of this Center is that, among people with HIV and unhealthy alcohol use, integrated screening and treatment of common behavioral and mental health comorbidities will lower unhealthy alcohol use and improve HIV treatment outcomes.  The Zambia Alabama HIV Alcohol Comorbidities Program (ZAMBAMA) is testing the effectiveness of a transdiagnostic model, Common Elements Treatment Approach (CETA), to reduce unhealthy alcohol use and improve HIV clinical outcomes in under-resourced HIV clinics, and evaluating the mechanisms through which CETA impacts HIV outcomes.

• Alcohol Research Consortium in HIV (Hopkins ARCH): Ending the HIV Epidemic through interventions and Epidemiology at the intersection of the alcohol and HIV care Continua (1P01AA029544-01): The overarching theme of the Johns Hopkins University Alcohol Research Consortium is to expand scientific knowledge and treatment interventions at the intersection of the Alcohol-Care Continuum (Alc-CC), HIV-CC and HIV related comorbidities across the full spectrum of alcohol use, with particular attention to individual context and social determinants of health. Using epidemiological and implementation research, the Center will accelerate the implementation of evidence-based alcohol interventions (EBI) across the alcohol use spectrum among people with HIV/AIDS (PWH) and examine how multi-level contextual factors impact the alcohol use spectrum, the Alc-CC and HIV-CC, comorbidities, and intervention responses among PWH.

• Boston Alcohol Research Collaboration on HIV/AIDS - Comorbidity Center (Boston ARCH CC) (1P01AA029546-01):  The Boston Alcohol Research Collaboration on HIV/AIDS is conducting state-of-the-art e-health clinical trials research on scalable approaches to address chronic pain and physical inactivity in people living with HIV/AIDS and unhealthy alcohol use. By recruiting, assessing, and intervening with participants outside of standard medical visits, through entirely online e-health procedures, these trials will address unhealthy drinking in the care of people living with HIV and complex comorbidities.

• SHARE Program: Innovations in Translational Behavioral Science to Improve Self-management of HIV and Alcohol Reaching Emerging adults (1P01AA029547-01):  The overarching goal of the SHARE Center is to utilize advances in translational behavioral science to optimize behavioral interventions and define new developmentally- and culturally-appropriate intervention targets to improve self-management of alcohol and HIV in young people living with HIV/AIDS (YPLWH). Research aims are organized around three key themes; 1) Emerging adulthood (ages 18 -29); 2) Self-management of HIV and alcohol; and 3) Translational behavioral science. 

• Addressing alcohol misuse in HIV prevention and care: The Brown University Alcohol Research Center on HIV (ARCH) (5P01AA019072-12):  The Brown Alcohol Research Center on HIV is organized around the central theme that in order to achieve population impact, interventions addressing alcohol misuse in HIV prevention and care need to be evaluated with an emphasis on real-world effectiveness, scalability, and sustainability, according to the principles of implementation science.  Accordingly, the research aims of this Center are organized around three key related themes: 1) training professionals in alcohol misuse interventions;  2) utilizing video counseling and telehealth as scalable means of reaching populations and providing continuing care; and 3) utilizing behavioral intervention technologies to provide alcohol interventions and ongoing support for change.

• Native Center for Alcohol Research and Education (5P60AA026112-04): The Native Center for Alcohol Research and Education (NCARE) at Washington State University, with its partners at the University of Colorado Denver and the University of Washington, offers coordinated efforts to mitigate and ultimately eliminate the alcohol-related devastation experienced by American Indian and Alaska Native (AI/AN) peoples through theory-based application of strategic and sustainable interventions. Achieving this goal will reduce the profound alcohol-related health disparities experienced by this underserved population.

What is the process for applying for funding?  

See the NIAAA application process homepage for information about grant applications, the peer review process, and understanding how applications are selected for funding.  You can also find instructions in the Notice of Funding Opportunity to which you are applying.  

Who should I contact within the Division about my research proposal?

Plan to talk with a Program Director as you start your process, well before submitting an application. This is a good way to learn about programmatic priorities and steps in the application process. See the names and focus areas below to find the appropriate staff member (or the contacts for the funding opportunities above) and send an email to request setting up a call.  Before talking with the NIAAA contact, craft a 1-page prospectus to shape your thinking and help you and the Director discuss your idea.  Describe your research proposal, why you find it interesting, and the link between your proposed research methods and getting to the answers you hope to reach.  

Does NIAAA support secondary analysis projects?

Yes. There are a number of important questions related to treatment development and treatment delivery that can be addressed through secondary analysis of existing data sets.  Such projects must demonstrate innovation as well as the potential to inform clinical or treatment services research questions with meaningful public health impact. 

Can an NIAAA grant fund the delivery of treatment services?

NIAAA funds hypothesis-driven scientific research on the causes, consequences, prevention, and treatment of AUD.  As a general rule, grant funds cannot be used to support the delivery of treatment services outside the context of the research study (e.g., as an arm of a clinical trial).  Researchers should contact a Program Director to discuss the specifics of proposals.  Treatment programs seeking operational support should contact one of our sister agencies: The Substance Abuse and Mental Health Services Administration (SAMHSA) or the Health Resources and Services Administration (HRSA). 

1. Medications Development to Treat Alcohol Use Disorder. A summary laying out NIAAA’s vision (i.e., long-range goals and key objectives) for ensuring the development and delivery of new and more efficacious medications to treat AUD over the next decade

2. Discovery, Development, and Adoption of Medications to Treat Alcohol Use Disorder: Goals for the Phases of Medications Development. A description of the phases of medication development as they apply to AUD, and specific goals of each phase, to advance medications for the next decade. This aim of this article is to provide a guide that will aid the alcohol research community in planning, testing, and developing medications for AUD.

3. Alcohol Medications Development: Advantages and Caveats of Government/Academia Collaborating with the Pharmaceutical Industry. A discussion of how collaborations-building partnerships among various stakeholders (e.g., government, academia, pharmaceutical and biotechnology companies) can expedite the medication development process for AUD.

4. Research Opportunities for Medications to Treat Alcohol Use Disorder. A commentary posing a number of issues (research opportunities) that must be addressed in order to advance the alcohol research field and to make medications a mainstream treatment for problematic drinking. These issues are framed from the perspective of the various stakeholders involved, including clinicians, patients, regulatory agencies, the pharmaceutical industry, and third-party payers.

5. Heterogeneity of alcohol use disorder: understanding mechanisms to advance personalized treatment. A review of past and new approaches for characterizing various phenotypes and mechanisms underlying AUD, and an introduction to a new classification system to guide future research.

6. Potential Medications for the Treatment of Alcohol Use Disorder: An Evaluation of the Clinical Efficacy and Safety. A review of potential (non-FDA-approved) medications being used off-label by clinicians to treat AUD.