Release Date:  March 13, 1998

RFA:  AA-98-003


National Institute on Alcohol Abuse and Alcoholism
SAMHSA Center for Substance Abuse Treatment

Letter of Intent Receipt Date:  May 8, 1998
Application Receipt Date:  June 12, 1998


The National Institute on Alcohol Abuse and Alcoholism (NIAAA), in conjunction
with the Center for Substance Abuse Treatment (CSAT) of the Substance Abuse and
Mental Health Services Administration (SAMHSA), seeks applications that propose
research which will contribute to the identification and development of
efficacious treatment interventions and services for adolescent alcohol abusers
and alcoholics.  Two types of treatment studies may  be submitted under this RFA:
(1) those that are theory driven and based on experimental design (efficacy
studies) and (2) those that assess practice as usual in health service settings
(effectiveness studies).  The primary aim is to develop a knowledge base derived
from efficacy research, i.e., manualized, theory-driven, randomized controlled
clinical trials of adolescent treatment interventions.  An important secondary
aim is to assess the effectiveness of standard adolescent treatment practice
utilizing an equally rigorous approach.  Projects also may identify, develop,
and/or test related screening, assessment, and diagnostic instruments or may
propose pretrial studies that investigate, for example, predictors of treatment
outcomes in specific subgroups of adolescents.


The Public Health Service (PHS) is committed to achieving the health promotion
and disease prevention objectives of "Healthy People 2000," a PHS-led national
activity for setting priority areas.  This Request for Applications (RFA) is
related to the priority areas of alcohol abuse reduction and alcoholism
treatment.  Potential applicants may obtain a copy of Healthy People 2000 (Full
Report: Stock No.017-001-00474-0 or Summary Report: Stock No. 017-001-00473-1)
through the Superintendent of Documents, Government Printing Office, Washington,
DC 20402-9325 (telephone 202-512-1800).


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 Investigators.


Because the nature and scope of the research proposed in response to this RFA may
vary from pilot studies and secondary analyses to clinical trials, it is
anticipated that mechanisms of support will vary also.  Research support may be
obtained through applications for a regular research project grant (R01) up to
five years.  Applicants may also submit Investigator-Initiated Interactive
Research Project Grants under this RFA.  Interactive Research Project Grants
require the coordinated submission of related regular research project grant
applications from investigators who wish to collaborate on research.  Program
Project Grant applications (P01) will not be accepted under this RFA.

Research support may also be obtained through Exploratory/Developmental grants
(R21) and Small Grants (R03), which are limited to two years for up to $70,000
per year and $50,000 per year, respectively, for direct costs.  In addition to
citing the above RFA number in their applications, R21 or R03 applicants also
need to cite the program announcement number (PA-91-89) for
Exploratory/Developmental Grants for Alcoholism Treatment Assessment Research or
the program announcement number (PA-91-008) for Small Grants.

Potential applicants for Exploratory/Developmental Grants, Small Grants, or
Investigator-Initiated Interactive Research Project Grants may obtain copies of
the specific announcements from the NIAAA Home Page at
or from the Office of Scientific Affairs, NIAAA, Willco Building, Suite 409, 6000
Executive Boulevard MSC 7003, Bethesda, Maryland 20892-7003, telephone: 301-443-
4375 or FAX 301-443-6077. Further information on grant mechanisms and areas of
research interest may be obtained from program staff listed in the Inquiries
section of this RFA.


It is estimated that nearly $4 million in total costs will be available to
support approximately 15 to 18 grants under this RFA.  This level of support is
dependent on receipt of a sufficient number of applications of high scientific
merit.  Although this program is provided for in the financial plan of NIAAA, the
award of grants pursuant to this RFA also is contingent upon the availability of

Investigators who wish to submit an application that exceeds $500,000 for direct
costs in any one year must obtain written approval from NIAAA  prior to
submitting an application.



Alcohol is often abused by adolescents and frequently results in adverse
consequences.  It has been implicated, for example, in adolescent traffic deaths,
suicides, homicides, and other fatal injuries.  Risk for alcohol-related
consequences increases with each grade in school.  School-based 1996 Monitoring
the Future data (Johnston et al., In press) indicate that the prevalence of 
adolescents who had consumed five or more drinks consecutively during the
previous two weeks increased with grade: 17 percent of boys and 15 percent of
girls in the 8th grade; 27 percent of boys and 22 percent of girls in the 10th
grade; and 37 percent of boys and 24 percent of girls in the 12th grade.

A 13-year longitudinal study of New Jersey suburban adolescents identified three
distinctive patterns of substance use among youth: (1) consistently low use; (2)
heavy alcohol and/or drug use followed by low use at 21 years of age; and (3)
heavy alcohol and/or drug use in adolescence that persists at 21 years (Bates &
Labouvie, 1995).  By 21 years of age, 53 percent of the New Jersey sample
manifested no problems with alcohol, drugs, or depression.  Of the remainder,
however, 35 percent received an alcohol abuse or dependence diagnosis; 14 percent
were positive for marijuana or cocaine abuse or dependence, 18 percent for
depression, 9 percent for adult antisocial behavior; 16 percent were comorbid for
some combination of these (Johnson, 1995).  Other general population surveys
(Kessler 1996; Grant, 1997) as well as an inpatient treatment study (Stewart and
Brown, 1995) reveal unexpectedly high and possibly increasing levels of alcohol
abuse or dependence among adolescents.  Particularly germane to the importance
of providing effective alcohol treatment to adolescents is the recent finding
that the earlier the age of onset of first alcohol use, the greater the
probability of developing alcohol dependence during the life course.  The
prevalence of lifetime alcohol dependence was found to steadily increase with
decreasing age of onset of first alcohol use.  For example, 47 percent of
respondents in a national household survey who first used alcohol at 13 years of
age met DSM-IV criteria for lifetime alcohol dependence as compared with only 11
percent of respondents who reported first alcohol use at age twenty (Grant &
Dawson, 1997).  In light of these findings, NIAAA and CSAT have initiated a
program of extramural research to develop efficacious treatment interventions and
to identify effective treatment programs for adolescents with serious alcohol

This RFA invites applications to conduct preclinical or clinical research that
leads to identification of efficacious treatments and treatment processes for
adolescents with primary alcohol-related problems, abuse or dependence.  This
criterion does not exclude recruitment of subjects with co-occurring conditions
and problems as long as outcome measures attend adequately to alcohol-specific
behaviors and consequences.  The ultimate goal is to identify which types of
treatment approaches are most efficacious or effective for which subgroups of
adolescents with a primary alcohol-related problem.

Areas of Research Interest

The objective of applications funded under this RFA is to conduct research that
contributes to  the efficacy of treatment interventions and the effectiveness of
treatment programs for alcohol abuse and dependence in adolescents.  These
objectives can be met through preliminary observational or experimental studies
or secondary analyses of existing data sets as well as through clinical trials
designed to determine the efficacy/effectiveness of particular interventions or
combinations of interventions.  Applicants who propose to assess the impact of 
interventions not previously tested among adolescents are encouraged to initiate
their project with pilot studies that develop formal measures and treatment
manuals.  In addition, they should  assess feasibility of the proposed research
design and recruitment plan.

Although exploratory or purely empirical studies may be appropriate in some
phases of  treatment research, clinical trials to test specific interventions
should be theory-driven whenever possible.  Formal theories postulating
mechanisms of action for a particular intervention may be drawn from
multidisciplinary sources such as the behavioral, biomedical, developmental,
and/or social sciences (Petraitis et al. 1995); for example, Jessor's (1985)
problem behavior theory, Bandura's (1986) social learning theory, Flay &
Petraitisþs (1996) theory of triadic influences, or family interactional theory
(Brook et al. 1990).  In studies that evaluate the effectiveness of one or more
currently available adolescent treatments, program theory may be formalized to
make explicit and testable providersþ assumptions regarding factors leading to
favorable treatment outcomes (Moos, Finney, and Cronkite, Chapter 12, 1990).  The
following discussion offers examples of  research topics.

Screening and Assessment

Background.  Over the past decade, a variety of standardized instruments have
been developed specifically to evaluate adolescents in need of alcohol or drug
abuse treatment  (McLellan and Dembo, 1993; Winters & Stinchfield, 1995). These
instruments include an array of screening and diagnostic tools, comprehensive
multiscale assessment inventories and interviews, and assessment systems that
combine instruments into a unified clinical process for screening, diagnosis,
treatment planning, and referral (Rahdert, 1991; Winters and Henly 1994). 
Standardized instruments have also been developed that assess post-treatment
outcomes such as coping responses to chronic life stressors and high risk
situations (Moos, 1993; Myers and Brown, 1996; Timko et al., 1993).

Examples of research areas:

o  An important process will be to evaluate the relative reliability,
sensitivity, specificity, and validity of the array of available instruments in
different settings (e.g., primary care or pediatric clinics, schools or other
community settings, alcohol/drug treatment programs, referral systems) and among
different subgroups of  adolescents (e.g., children of alcoholics, polydrug
abusers, adolescents with conduct disorder, delinquents, minority group members,
teenage parents).

o Equally important will be to determine which instruments yield adequate
predictive validity and measurement sensitivity for predicting behaviors such as
response to treatment, treatment compliance, and treatment outcome. The ultimate
goal should be to identify minimal batteries of standardized instruments both for
clinical and research applications.

o NIAAA also encourages development of new instruments to assess theoretically
relevant areas for which adequate standardized measures do not yet exist.

Treatment Interventions

Background.  A variety of interventions have been developed to reduce serious
alcohol and alcohol-drug problems among adolescents (Adger, 1991; Wilkinson &
Martin, 1991).  These are available, for example, in schools through counseling
and student assistance programs; in juvenile justice systems through family
education, adolescent diversion, and post-adjudication programs;  in health
systems through emergency room interventions; and in national Outward Bound
wilderness programs that target high risk youth (Klitzner et al., 1992).  In
addition, there are many tertiary care programs designed specifically to treat
adolescent substance abusers (e.g., Brown et al. 1992; DelBoca et al., 1995). 
Despite the proliferation of treatment interventions, their efficacy is largely
untested.  The recently developed instruments for adolescent screening and
assessment (McLellan & Dembo, 1993; Klitzner et al., 1992; Rahdert, 1991; Wagner
& Kassel, 1995; Winters & Stinchfield, 1995) provide tools to initiate clinical
trials designed to determine the short- and long-term benefits of treatments for
adolescentsþ alcohol or alcohol-drug abuse.

Three types of randomized clinical trials are encouraged: (1) efficacy or
effectiveness clinical trials which standardize and evaluate components currently
used in treatment programs for adolescents; (2) efficacy trials which develop and
test new interventions, or new combinations of interventions, through
experimental clinical trials; (3) efficacy or effectiveness trials which
introduce into existing treatment programs interventions determined to be
efficacious in previous clinical trials of adults.  Cost effectiveness studies
that assess the relative social and economic costs of comparison conditions in
clinical trials (types 1 and 3 above) are welcome under this RFA.  For those
applicants considering the inclusion of a cost-effectiveness component, it is
advisable to seek the collaboration (not just consultation) of a health
economist.  Also welcome under this RFA are projects that investigate the
relative effectiveness of competing treatment strategies for specific forms of
disorders and affected populations.

Examples of research areas:

o In the absence of tested adolescent-specific interventions, adult treatment
approaches have been widely adopted  in adolescent treatment.  There is a need
to develop and test interventions tailored to the developmental and social needs
of adolescents.  These may be either novel approaches (as long as theoretically
or empirically justified and assessed in an initial pilot study) or may modify
common adult interventions including: motivation enhancement therapy, stress
management, cognitive-behavioral therapy (e.g., social skills training,
behavioral family therapy, behavioral self-control training, coping skills
training), and the 12-step Minnesota Model approach (Wagner & Kassel, 1995).

o Initial research funded by the National Institute on Drug Abuse has
demonstrated that family-based intervention is effective in treating adolescent
drug use (Liddle & Dakof, 1995).  "Integrative" models in particular have proven
superior to traditional adolescent substance abuse treatment.  These
multidimensional, multicontextual family-based approaches intervene with several
people in the adolescentþs social networks and intervene with problem behaviors
in addition to substance abuse.  It will be important to determine which family
therapy approaches are most efficacious/effective for adolescents with a primary
diagnosis of alcohol abuse or dependence and whether any of these are more
effective than other single intervention therapeutic strategies.

o Adolescents in substance abuse treatment constitute a remarkably  heterogeneous
population.  Not only do they vary from adults in demographics, lifestyle,
developmental issues, and patterns of abuse, they differ significantly among
themselves in severity of alcohol abuse and co-occurring conditions such as
polydrug use, affective, and conduct disorders (Brown et al., 1996; Sher, 1991;
Wilkinson & Martin, 1991; Zucker, 1994).  Applicants are encouraged to measure
variables that represent significant subgroups.  Such variables not only may
identify subgroups that vary in response to treatment but also can serve as
covariates in analyses of alcohol-specific outcomes.  Further, such variables may
be used to assess the impact of an alcohol-specific intervention on concurrent
conditions or behaviors.  Examples of these variables include family history of
alcoholism and related conditions, developmental social and biological problems,
concurrent or previous psychiatric disorders, and concurrent or previous
addictions, including eating disorders.  Studies are welcomed that focus on
targeting treatments to subtypes of adolescents such as those with alcohol
problems only, those who are children of alcoholics, or those with primary
alcohol problems who also have concurrent or previous depression, eating
disorders, behavior disorders, and/or other substance abuse disorders.  More
severely affected adolescents may benefit from concurrent treatment that targets
specific problems such as severe alcohol dependence, depression, or conduct
disorder.  Pilot studies that assess the efficacy and safety of promising
combined pharmacological-behavioral therapies in adolescent treatment also are


It is NIH policy that women and members of minority groups and their
subpopulations must be included in all NIH supported biomedical and behavioral
research projects involving human subjects, unless a clear and compelling
rationale and justification is provided 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
"NIH Guidelines for Inclusion of Women and Minorities as Subjects in Clinical
Research," which have been published in the Federal Register of  March 28, 1994
(FR 59 14508-14513) and in the NIH Guide for Grants and Contracts, Volume 23,
Number 11, March 18, 1994.

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


Prospective applicants are asked to submit, by May 8, 1998, a letter of intent
that includes a descriptive title of the proposed research, the name, address,
and telephone number of the Principal Investigator, the identities of other key
personnel and participating institutions, and the number and title of the RFA in
response to which the application may be submitted.  Although a letter of intent
is not required, is not binding, and does not enter into the review of a
subsequent application, the information that it contains allows NIAAA staff to
estimate the potential review workload, identify potential reviewers, and avoid
conflict of interest in the review.

The letter of intent is to be sent to:

RFA: AA-98-003
Office of Scientific Affairs
National Institute on Alcohol Abuse and Alcoholism
Willco Building, Suite 409
6000 Executive Boulevard MSC 7003
Bethesda, MD  20892-7003
FAX: (301) 443-6077


The research grant application form PHS 398 (rev. 5/95) is to be used in applying
for these grants.  These forms are available at most institutional offices of
sponsored research and 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:

The RFA label available in the PHS 398 (rev. 5/95) application form must be
affixed to the bottom of the face page of the application.  Failure to use this
label could result in delayed processing of the application such that it may not
reach the review committee in time for review.  In addition, the RFA title and
number must be typed on line 2 of the face page of the application form and the
YES box must be marked. Applications for support mechanisms other than R01 must
cite the relevant program announcement on line 2 in addition to listing the
current RFA. Page limits and limits on size of type are strictly enforced.

Applicants from institutions that have a General Clinical Research Center (GCRC),
funded by the NIH National Center for Research Resources, may wish to identify
the Center as a resource for conducting the proposed research.  If so, a letter
of agreement from either the GCRC program director or principal investigator
should be included in the application material.

Submit a signed, typewritten original of the application, including the checklist
and three signed photo copies in one package to:

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

At the time of submission, two additional copies of the application must also be
sent to:

Office of Scientific Affairs
National Institute on Alcohol Abuse and Alcoholism
Willco Building, Room 409
6000 Executive Boulevard MSC 7003
Bethesda, MD  20892-7003
Rockville, MD  20852 (for express/courier service)

Applications must be received by June 12, 1998.  If an application is received
after that date, it will be returned to the applicant without review.  The Center
for Scientific Review (CSR) will not accept any application in response to this
RFA that is essentially the same as one currently pending initial review, unless
the applicant withdraws the pending application.  The CSR will not accept any
application that is essentially the same as one already reviewed.  This does not
preclude the submission of substantial revisions of applications already
reviewed, but such applications must include an introduction addressing the
previous critique and must be prepared in the format of a revised application.


Upon receipt, applications will be reviewed for completeness by CSR and for
responsiveness by the Institute.  Incomplete applications will be returned to the
applicant without further consideration.  If the application is not responsive
to the RFA, CSR staff may contact the applicant to determine whether to return
the application to the applicant or submit it for review in competition with
unsolicited applications at the next review cycle.

Applications that are complete and responsive to the RFA will be evaluated for
scientific and technical merit by an appropriate peer review group convened by
the Institute in accordance with the review criteria stated below. As part of the
initial merit review, a streamlined review process may be used by the initial
review group in which applications may or may not be discussed based on their
scientific merit relative to other applications received in response to the RFA. 
Applications which are fully discussed and judged to be highly scientifically
meritorious will be assigned a priority score.  Applications which are not scored
will be withdrawn from funding consideration.  The second level of review for
scored applications will be provided by the National Advisory Council on Alcohol
Abuse and Alcoholism.

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 review, comments on the following aspects of the application will be made
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 the assignment of the overall score.

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?

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?
Will proposed subjects manifest symptoms of alcohol abuse/dependence?  Do outcome
measures assess alcohol-specific behavior and consequences?  (Note: Inclusion of
polydrug users or non-alcohol-specific outcome measures are allowed as long as
the focus of the study is alcohol.)

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?  If the project is a replication,
does it contribute to confirming efficacy of an intervention? Does it assess the
generalizability of an intervention? Does the project enhance or extend the
original theory and/or method?

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)?

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 support?

Budget.  Is the requested budget and estimation of time and staff to complete the
project appropriate for the proposed research?

Where applicable, the adequacy of procedures to protect or minimize effects on
human subjects and the environment will be assessed.

Plans for the recruitment and retention of subjects also will be evaluated as
will the adequacy of plans to include both genders and minorities and their
subgroups as appropriate for the scientific goal of the research.


Applications recommended for approval by the National Advisory Council on Alcohol
Abuse and Alcoholism will be considered for funding on the basis of the overall
scientific and technical merit of the proposal as determined by peer review,
NIAAA programmatic needs and balance, and the availability of funds.


Inquiries concerning this RFA are encouraged.  The opportunity to clarify any
issues of questions from potential applicants is welcome.

Direct inquiries regarding programmatic issues to:

Cherry Lowman, Ph.D.
Division of Clinical and Prevention Research
National Institute on Alcohol Abuse and Alcoholism
6000 Executive Boulevard, Suite 505, MSC 7003
Bethesda, MD 20892-7003
Telephone:  (301) 443-0637
FAX:  (301) 443-8774

Karen Urbany
Division of Practice and Systems Development
Center for Substance Abuse Treatment
5600 Fishers Lane, Room 7A-134
Rockville, MD  20857
Telephone:  (301) 443-9678
FAX:  (301) 443-3543

Direct inquiries regarding fiscal matters to:

Edward Ellis
Office of Planning and Resource Management
National Institute on Alcohol Abuse and Alcoholism
6000 Executive Boulevard, Suite 504, MSC 7003
Bethesda, MD  20892-7003
Telephone:  (301) 44304703
FAX:  (301) 443-3891


This program is described in the Catalog of Federal Domestic Assistance, No.
93.273.  Awards are made under the authorization of the Public Health Service
Act, Sections 301 and 464H, and administered under the PHS policies and Federal
Regulations at Title 42 CFR Part 52 and 45 CFR Part 74.  This program is not
subject to intergovernmental review requirement 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, any portion of a facility) in which regular or
routing 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.


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to risk.  In Zucker, R.A., Boyd, G., & Howard, J., ed.s.,  The Development of
Alcohol Problems: Exploring the Biopsychosocial Matrix of Risk.  NIAAA Research
Monograph 26, Rockville, MD: National Institutes of Health, pp. 255-289.

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