This Program Announcement expires on March 31, 2004, unless reissued.


Release Date:  February 27, 2001

PA NUMBER:  PA-01-058

National Institute on Alcohol Abuse and Alcoholism



The National Institute on Alcohol Abuse and Alcoholism (NIAAA) invites 
applications to support studies of the adoption in clinical practice of 
scientific advances in the treatment of alcohol dependence and abuse.  It is 
hoped that a better understanding of these adoption processes will strengthen 
effective communication between researchers and providers, thereby 
facilitating the adoption of emergent research-based advances.  Specific 
areas of research encouraged herein include: studies that prepare findings 
from efficacy trials for real-world clinical adoption, studies of 
communication channels between the scientific community and the provider 
community, studies of adoption trials, naturalistic studies of knowledge 
adoption, contributions toward the theory of the adoption process, studies of 
organizational change, and studies of the resources required for the adoption 
of treatment improvements.


The Public Health Service (PHS) is committed to achieving the health 
promotion and disease prevention objectives of "Healthy People 2010," a PHS 
led national activity for setting priority areas. This Program Announcement 
(PA), Adoption of Alcohol Research Findings in Clinical Practice, is related 
to one or more of the priority areas. Potential applicants may obtain a copy 
of "Healthy People 2010" at


Applications may be submitted by domestic and foreign, for-profit and non-
profit organizations, public and private, such as universities, colleges, 
hospitals, laboratories, units of State and local governments, and eligible 
agencies of the Federal Government. Racial/ethnic minority individuals, 
women, and persons with disabilities are encouraged to apply as principal 


This PA will use the National Institutes of Health (NIH) research project 
grant (R01) and exploratory/developmental grant (R21) award mechanisms. 
Responsibility for the planning, direction, and execution of the proposed 
project will be solely that of the applicant.  Applications for R01s may 
request support for up to 5 years.  Facilities and Administrative (F&A) costs 
will be awarded based on the negotiated rate at the time of the award.  More 
detailed information on the R21 mechanism can be found at 
Exploratory/developmental grants cannot be renewed: however, a no-cost 
extension of up to one year may be granted prior to expiration of the project 
period.  Investigators are encouraged to seek continued support after 
completing an exploratory/developmental grant project through a research 
project grant (R01).

Specific application instructions have been modified to reflect "MODULAR 
GRANT" and "JUST-IN-TIME" streamlining efforts being examined by the NIH. 
Complete and detailed instructions and information on Modular Grant 
applications can be found at



A gap in communication between alcoholism treatment providers and alcoholism 
treatment researchers has become a significant concern.  On the one hand, 
research advances have not been transmitted to practitioners in such a way 
that routine adoption into clinical practice can be assumed.  On the other 
hand, research projects are designed and conducted without the participation 
of non-academically based providers, who consequently have little influence 
on the research agenda.  

This gap was the subject of an influential Institute of Medicine Report (Lamb 
et al. 1998) and has prompted constructive responses from several Federal 
agencies.  For example, the recently released National Treatment Plan of the 
Center for Substance Abuse Treatment (CSAT) devotes a major section to 
“Connecting Services and Research,” in which a new mechanism for improved 
coordination among CSAT, NIAAA, the National Institute on Drug Abuse (NIDA), 
and relevant State and local partners is proposed (CSAT 2000).  Such programs 
as CSAT’s Addiction Technology Transfer Centers and its Practice Research 
Collaboratives, NIAAA’s Research to Practice Forums and its Researcher in 
Residence Program, and NIDA’s Clinical Trials Network all have been 
established to address one or another aspect of the overall problem.

Yet an understanding of a key piece of this problem, the process by which 
research advances become adopted in clinical practice, has a weak scientific 
base, being little studied within the context of alcoholism and drug abuse 
treatment.  In more general contexts, studies of research dissemination, 
knowledge adoption, and technology transfer have an established history.  
Readers can trace this history in Backer (1988 and 1991), Dunn and Holzner 
(1988), Glaser et al. (1983), NIDA (1995), Rogers (1983), and Zaltman (1973). 
Two basic lessons have emerged from this work.  First, it has become 
recognized that a focus on organizational change was an important complement 
to a focus on change at the individual level (change in the behavior of 
targeted individual clinicians).  Second, it has been recognized that 
research dissemination strategies that relied on the spread of written 
materials alone might not be effective and that other personal contact might 
be needed in addition.  

Despite these advances, validated models of the research adoption process in 
the alcoholism and drug abuse fields have yet to emerge.  Brown’s recent 
review of the topic (2000) suggests six factors (relevance, timeliness, 
clarity, credibility, replicability, and reduction of staff concerns) that 
should be related to effective knowledge transfer, but empirical tests of 
this nascent theory have not yet been conducted.  

The purpose of this announcement is to stimulate a program of research on the 
process of adopting research findings in treatment practice, which should 
provide essential guidance to efforts to improve the delivery of alcohol 
treatment services.


Studies are encouraged in seven areas under the terms of this announcement:

o  Studies that prepare the findings from efficacy trials for real-world 
clinical adoption.  Moving knowledge from efficacy studies into effectiveness 
studies is a principal goal of health services research (NIAAA 1997).  
Clinical trials often exclude subjects seeking repeated episodes of treatment 
or having compounding drug abuse or mental health comorbidities.  In 
consequence, clinical subject populations are often not representative of 
typical client populations.  Similarly, clinical trials subjects typically 
must agree to random assignment to treatment condition; whereas, clinic 
patients typically self-select among treatment options.  These differences 
can have implications for the generalizability of research findings (see 
Weisner et al. 2000).  Similar differences emerge because clinical trials 
tend to be conducted in academic treatment clinics and because treatment 
protocols may focus on individual rather than group delivery of therapy.
o  Studies of communication channels between the scientific community and the 
provider community.  Publishing findings in scientific journals alone has not 
proven an effective way to communicate those results to treatment providers.  
Processes by which knowledge is transmitted between the scientific and the 
provider community require further study.  It is important to note, in this 
regard, that communications ideally should flow between these communities in 
both directions (Lamb et al. 1998).  Researchers need to hear from clinicians 
about clinical problems and emerging trends in care delivery that require 
examination.  Studies are needed to assess how effectively these channels of 
communication operate, whether there are significant barriers to 
communication, and whether effective means to reduce these barriers can be 

o  Studies of adoption trials.  A significant need is the need for 
evaluations of specific efforts to stimulate clinical adoption of improved 
treatment practices.  Ultimately, progress in this field will be built 
through a case-by-case accretion of successes and failures as different 
approaches are tried and their outcomes are observed, over both the short and 
long term.  Studies of this sort might include such things as: “horse race” 
comparisons between specific approaches; comparisons between “literature 
only” and “personal instruction” approaches; comparisons between consultant 
approaches and workshop approaches (Brown 2000); studies of the effectiveness 
of specific manuals, videotapes, or other tools; and studies of the relative 
effectiveness of instruction provided by clinicians versus instruction 
provided by researchers.
o  Naturalistic studies of knowledge adoption.  While experimental or quasi-
experimental trials to conduct studies described in the above section hold 
the greatest promise for moving this field forward, the paucity of current 
knowledge makes it likely that naturalistic studies could also make important 
contributions.  These might include descriptive studies of natural variation 
in treatment innovativeness as well as the networks and processes of 
diffusion, adoption, and communication.  Also important would be comparisons 
between early adopters and late adopters. 

o  Contributions toward the theory of the adoption process.  Ultimately, the 
field hopes to build a theory of the adoption process.  This theory will, in 
turn, help us design more effective adoption strategies.  Studies might test 
the adequacy of general theories of the adoption process.  For example, they 
might test the implicit theory suggested by Brown (2000), which identifies 
six factors as key influences on adoption: relevance, timeliness, clarity, 
credibility, replicability, and reduction of staff concerns.  Other models 
can be found in Green et al. (1987) and Oldenburg et al. (1997).  The field 
could also benefit from more modest studies that focus on one or two factors 
thought to either facilitate or impede adoption.

o  Studies of organizational change.  Most successful practice improvements 
go beyond the level of changing the knowledge or skill of individual 
clinicians and also require changes in the operation of the treatment 
organization.  Studies here could address how organizational change to 
facilitate practice improvement is best accomplished and managed.  Included 
would be studies that identify which organizational forms or management 
approaches do the best job of facilitating innovativeness. 

o  Resources and treatment finance.  We can not expect that improvements in 
treatment will be free.  Significant time and resource expenditures will be 
needed.  Studies are needed of the availability and adequacy of resources to 
support practice improvement.  Also relevant are studies of the role and 
functioning of incentives to improve practice, studies that estimate the 
financial arrangements most facilitative of practice improvement, studies 
estimating the size of resource barriers to treatment improvement, and 
studies of how innovation can be secured for the least cost (cost 
effectiveness studies).  Similarly, studies estimating the potential cost 
savings or increased cost effectiveness (or cost offsets) of treatment due to 
the adoption of particular treatment improvements are encouraged.


It is the policy of the NIH that women and members of minority groups and 
their sub-populations must be included in all NIH-supported biomedical and 
behavioral research projects involving human subjects, unless a clear and 
compelling rationale and justification are provided indicating that inclusion 
is inappropriate with respect to the health of the subjects or the purpose of 
the research. This policy results from the NIH Revitalization Act of 1993 
(Section 492B of Public Law 103-43).

All investigators proposing research involving human subjects should read the 
UPDATED "NIH Guidelines for Inclusion of Women and Minorities as Subjects in 
Clinical Research," published in the NIH Guide for Grants and Contracts on 
August 2, 2000 
a complete copy of the updated Guidelines are available at  The 
revisions relate to NIH defined Phase III clinical trials and require: a) all 
applications or proposals and/or protocols to provide a description of plans 
to conduct analyses, as appropriate, to address differences by sex/gender 
and/or racial/ethnic groups, including subgroups if applicable; and b) all 
investigators to report accrual, and to conduct and report analyses, as 
appropriate, by sex/gender and/or racial/ethnic group differences.


It is the policy of NIH that children (i.e., individuals under the age of 21) 
must be included in all human subjects research, conducted or supported by 
the NIH, unless there are scientific and ethical reasons not to include them. 
This policy applies to all initial (Type 1) applications submitted for 
receipt dates after October 1, 1998.

All investigators proposing research involving human subjects should read the 
"NIH Policy and Guidelines on the Inclusion of Children as Participants in 
Research Involving Human Subjects" that was published in the NIH Guide for 
Grants and Contracts, March 6, 1998, and is available at the following URL 

Investigators also may obtain copies of these policies from the program staff 
listed under INQUIRIES. Program staff may also provide additional relevant 
information concerning the policy.


All applications and proposals for NIH funding must be self-contained within 
specified page limitations. Unless otherwise specified in an NIH 
solicitation, internet addresses (URLs) should not be used to provide 
information necessary to the review because reviewers are under no obligation 
to view the Internet sites. Reviewers are cautioned that their anonymity may 
be compromised when they directly access an Internet site.


Applications are to be submitted on the grant application form PHS 398 (rev. 
4/98) and will be accepted at the standard application deadlines as indicated 
in the application kit. Application kits are available at most institutional 
offices of sponsored research and may be obtained from the Division of 
Extramural Outreach and Information Resources, National Institutes of Health, 
6701 Rockledge Drive, MSC 7910, Bethesda, MD 20892-7910, telephone 301/710-0267, email:

Applicants planning to submit an investigator-initiated new (type 1), 
competing continuation (type 2), competing supplement, or any amended/revised 
version of the preceding grant application types requesting $500,000 or more 
in direct costs for any year are advised that he or she must contact the 
Institute or Center (IC) program staff before submitting the application, 
i.e, as plans for the study are being developed. Furthermore, the application 
must obtain agreement from the IC staff that the IC will accept the 
application for consideration for award. Finally, the applicant must 
identify, in a cover letter sent with the application, the staff member and 
Institute or Center who agreed to accept assignment of the application. 

This policy requires an applicant to obtain agreement for acceptance of both 
any such application and any such subsequent amendment. Refer to the NIH 
Guide for Grants and Contracts, March 20, 1998 at

The modular grant concept establishes specific modules in which direct costs 
may be requested as well as a maximum level for requested budgets. Only 
limited budgetary information is required under this approach. The just-in-
time concept allows applicants to submit certain information only when there 
is a possibility for an award. It is anticipated that these changes will 
reduce the administrative burden for the applicants, reviewers and Institute 
staff. The research grant application form PHS 398 (rev. 4/98) is to be used 
in applying for these grants, with the modifications noted below.



Modular Grant applications will request direct costs in $25,000 modules, up 
to a total direct cost request of $250,000 per year. (Applications that 
request more than $250,000 direct costs in any year must follow the 
traditional PHS 398 application instructions.) The total direct costs must be 
requested in accordance with the program guidelines and the modifications 
made to the standard PHS 398 application instructions described below:

PHS 398

o FACE PAGE: Items 7a and 7b should be completed, indicating Direct Costs (in 
$25,000 increments up to a maximum of $250,000) and Total Costs [Modular 
Total Direct plus Facilities and Administrative (F&A) costs] for the initial 
budget period Items 8a and 8b should be completed indicating the Direct and 
Total Costs for the entire proposed period of support.

of the PHS 398. It is not required and will not be accepted with the 

categorical budget table on Form Page 5 of the PHS 398. It is not required 
and will not be accepted with the application.

o NARRATIVE BUDGET JUSTIFICATION - Prepare a Modular Grant Budget Narrative 
page. (See for 
sample pages.) At the top of the page, enter the total direct costs requested 
for each year. This is not a Form page.

o Under Personnel, list all project personnel, including their names, percent 
of effort, and roles on the project. No individual salary information should 
be provided. However, the applicant should use the NIH appropriation language 
salary cap and the NIH policy for graduate student compensation in developing 
the budget request.

For Consortium/Contractual costs, provide an estimate of total costs (direct 
plus facilities and administrative) for each year, each rounded to the 
nearest $1,000. List the individuals/organizations with whom consortium or 
contractual arrangements have been made, the percent effort of all personnel, 
and the role on the project. Indicate whether the collaborating institution 
is foreign or domestic. The total cost for a consortium/contractual 
arrangement is included in the overall requested modular direct cost amount. 
Include the Letter of Intent to establish a consortium.

Provide an additional narrative budget justification for any variation in the 
number of modules requested.

o BIOGRAPHICAL SKETCH - The Biographical Sketch provides information used by 
reviewers in the assessment of each individual's qualifications for a 
specific role in the proposed project, as well as to evaluate the overall 
qualifications of the research team. A biographical sketch is required for 
all key personnel, following the instructions below. No more than three pages 
may be used for each person. A sample biographical sketch may be viewed at:

- Complete the educational block at the top of the form page:
- List position(s) and any honors;
- Provide information, including overall goals and responsibilities, on 
research projects ongoing or completed during the last three years.
- List selected peer-reviewed publications, with full citations;

o CHECKLIST - This page should be completed and submitted with the 
application.  If the F&A rate agreement has been established, indicate the 
type of agreement and the date.  All appropriate exclusions must be applied 
in the calculation of the F&A costs for the initial budget period and all 
future budget years.

o The applicant should provide the name and phone number of the individual to 
contact concerning fiscal and administrative issues if additional information 
is necessary following the initial review.

The title and number of the program announcement must be typed on line 2 of 
the face page of the application form and the YES box must be marked.

Submit a signed, typewritten original of the application, including the 
Checklist, and five signed photocopies in one package to:

BETHESDA, MD 20892-7710
BETHESDA, MD 20817 (for express/courier service)


Applications will be assigned on the basis of established PHS referral 
guidelines. Applications will be evaluated for scientific and technical merit 
by an appropriate scientific review group convened in accordance with the 
standard NIH peer review procedures. As part of the initial merit review, all 
applications will receive a written critique and undergo a process in which 
only those applications deemed to have the highest scientific merit, 
generally the top half of applications under review, will be discussed, 
assigned a priority score, and receive a second level review by the 
appropriate national advisory council or board.

Review Criteria

The goals of NIH-supported research are to advance our understanding of 
biological systems, improve the control of disease, and enhance health. In 
the written comments reviewers will be asked to discuss the following aspects 
of the application in order to judge the likelihood that the proposed 
research will have a substantial impact on the pursuit of these goals. Each 
of these criteria will be addressed and considered in assigning the overall 
score, weighting them as appropriate for each application. Note that the 
application does not need to be strong in all categories to be judged likely 
to have major scientific impact and thus deserve a high priority score. For 
example, an investigator may propose to carry out important work that by its 
nature is not innovative but is essential to move a field forward.

(1) Significance: Does this study address an important problem? If the aims 
of the application are achieved, how will scientific knowledge be advanced? 
What will be the effect of these studies on the concepts or methods that 
drive this field?

(2) Approach: Are the conceptual framework, design, methods, and analyses 
adequately developed, well-integrated, and appropriate to the aims of the 
project? Does the applicant acknowledge potential problem areas and consider 
alternative tactics?

(3) Innovation: Does the project employ novel concepts, approaches or method? 
Are the aims original and innovative? Does the project challenge existing 
paradigms or develop new methodologies or technologies?

(4) Investigator: Is the investigator appropriately trained and well suited 
to carry out this work? Is the work proposed appropriate to the experience 
level of the principal investigator and other researchers (if any)?

(5) Environment: Does the scientific environment in which the work will be 
done contribute to the probability of success? Do the proposed experiments 
take advantage of unique features of the scientific environment or employ 
useful collaborative arrangements? Is there evidence of institutional 

In addition to the above criteria, in accordance with NIH policy, all 
applications will also be reviewed with respect to the following:

o  The adequacy of plans to include both genders, minorities and their 
subgroups, and children as appropriate for the scientific goals of the 
research. Plans for the recruitment and retention of subjects will also be 

o  The reasonableness of the proposed budget and duration in relation to the 
proposed research.

o  The adequacy of the proposed protection for humans, animals or the 
environment, to the extent they may be adversely affected by the project 
proposed in the application.

Additional consideration pertinent to the review of Exploratory/Developmental 
Grant (R21) applications:

Pilot feasibility studies may contain little or no preliminary data.  Review 
should focus on whether the rationale for the study is well developed and 
whether the proposed research is likely to generate data that will lead to a 
regular research project grant or full-scale clinical trial.  Adequate 
justification for the proposed work may be provided through literature 
citations, data from other sources, or investigator-generated data.


Applications will compete for available funds with all other recommended 
applications. The following will be considered in making funding decisions: 
Quality of the proposed project as determined by peer review, availability of 
funds, and program priority.


Inquiries are encouraged. The opportunity to clarify any issues or questions 
from potential applicants is welcome.

Direct inquiries regarding programmatic issues to:

Mike Hilton, Ph.D.
Division of Clinical and Prevention Research
National Institute on Alcohol Abuse and Alcoholism
Willco Building, Suite 505
6000 Executive Blvd., MSC 7003
Bethesda, MD 20892-7003
Telephone: 301-443-8753
FAX: 301- 443-8774

Direct inquiries regarding fiscal matters to:

Edward Ellis
Grants Management Branch
National Institute on Alcohol Abuse and Alcoholism
Willco Building, Suite 504
6000 Executive Blvd., MSC 7003
Bethesda, MD 20892-7003
Telephone: 301-443-4703
FAX: 301- 443-0788


This program is described in the Catalog of Federal Domestic Assistance No. 
93.273. Awards are made under authorization of sections 301 and 405 of the 
Public Health Service Act as amended (42 USC 241 and 284) and administered 
under NIH grants policies and Federal Regulations 42 CFR 52 and 45 CFR Parts 
74 and 92. This program is not subject to the intergovernmental review 
requirements of Executive Order 12372 or Health Systems Agency review.

The PHS strongly encourages all grant and contract recipients to provide a 
smoke-free workplace and promote the non-use of all tobacco products. In 
addition, Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking 
in certain facilities (or in some cases, and portion of a facility) in which 
regular or routine education, library, day care, health care or early 
childhood development services are provided to children. This is consistent 
with the PHS mission to protect and advance the physical and mental health of 
the American people.


Backer TE.  Drug Abuse Technology Transfer.  DHHS Publication No. (ADM) 91-
1764, Rockville, MD: National Institute on Drug Abuse, 1991.

Backer TE.   “Research utilization and managing innovation in rehabilitation 
organizations.”  Journal of Rehabilitation, 54:18-22, 1988.

Brown BS.  “From research to practice: The bridge is out and the water’s 
rising.”  Pp. 345-365 in Levy JA, Stephens RC, and McBride DC, Advances in 
Medical Sociology, Volume 7.  Greenwich, CT: JAI Press, 2000.

Center for Substance Abuse Treatment.  Improving Substance Abuse Treatment: 
The National Treatment Plan Initiative.  DHHS Publication No. (SMA) 00-3479, 
Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and 
Mental Health Services Administration, 2000.

Dunn WN and Holzner B.  “Anatomy of an emergent field.”  Knowledge in Society 
1:3-26, 1988.

Glaser EM, Ableson H, and Garrison KN.  Putting Knowledge to Use.  San 
Francisco, CA: Jossey-Bass, 1983.

Green LW, Gottleib NH, and Parcel GS.  “Diffusion Theory Extended and 
Applied.”  Pp. 91-117 in Ward WB (ed.) Advances in Health Education and 
Promotion.  Greenwich, CT: JAI Press, 1987.

Lamb S, Greenlick MR, and McCarty, D. (eds.).  Bridging the Gap Between 
Practice and Research: Forging Partnerships with Community-Based Drug and 
Alcohol Treatment.  Institute of Medicine.  Washington, DC: National Academy 
Press, 1998.

National Institute on Drug Abuse.  Reviewing the Behavioral Science Knowledge 
Base on Technology Transfer.  NIH Publicatoin No. 95-4035.  Rockville, MD:  
National Institute on Drug Abuse, National Institutes of Health, Public 
Health Service, 1995.

National Institute on Alcohol Abuse and Alcoholism.  Improving the Delivery 
of Alcohol Treatment and Prevention Services: A National Plan for Alcohol 
Health Services Research.  NIH Publication No. 97-4223.  Rockville, MD: 
National Institute on Alcohol Abuse and Alcoholism, National Institutes of 
Health, Public Health Service, 1997.

Oldenburg B, Hardcastle DM, and Kok G.  “Diffusion of Innovations.”  Pp. 270-
286 in Glantz K and Lewis FM (eds.).  Health Behavior and Health Education.  
San Francisco, CA: Jossey-Bass, 1997.

Rogers EM.  Diffusion of Innovations.  New York: Free Press, 1983.

Weisner C, Mertens J, Parthasarathy S, Moore C, Hu TW, Hunkeler E, and Selby 
J.  “Outcome and cost of alcohol and drug treatment in an HMO: Day hospital 
versus traditional outpatient.”  Health Services Research, 35:791-810, 2000.

Zaltman G, Duncan R, and Holbek J.  Innovations and Organizations.  New York: 
Wiley, 1973.

Return to Volume Index

Return to NIH Guide Main Index

Office of Extramural Research (OER) - Home Page Office of Extramural
Research (OER)
  National Institutes of Health (NIH) - Home Page National Institutes of Health (NIH)
9000 Rockville Pike
Bethesda, Maryland 20892
  Department of Health and Human Services (HHS) - Home Page Department of Health
and Human Services (HHS) - Government Made Easy

Note: For help accessing PDF, RTF, MS Word, Excel, PowerPoint, Audio or Video files, see Help Downloading Files.