The Addiction Psychologist

Dr. Kirsten Smith joined us in June 2022 for a wonderful discussion about Kratom. In this episode, she updates us on the volatile changes that have occurred since our last discussion. Dr. Kirsten Smith is an Assistant Professor of Psychiatry and Behavioral Sciences in the Behavioral Pharmacology Research Unit at Johns Hopkins University. 

If you haven't heard the first episode, make sure to have a listen to get caught up to speed on Kratom!

People attempting recovery face formidable challenges to successful sustained remission. Return to use depends upon the individual's access to recovery capital, or the collection of resources available that can bolster or improve recovery. In this episode, Dr. Emily Hennessy discusses the science of recovery capital and how improving recovery capital can enhance recovery and save lives. Dr. Emily Hennessy is the Associate Director of Biostatistics at the Recovery Research Institute and an Associate Director at the National Center on Youth Prevention, Treatment, and Recovery at Massachusetts General Hospital, as well as an Assistant Professor at Harvard Medical School.

People range in their readiness to make changes to different behaviors. Processes occurring naturally in each stage differ across the spectrum of readiness to for behavior change. In this episode, we talk with Dr. Carlo DiClemente about the origins and development of the Transtheoretical Model of Behavior Change. This model has become a standard and common language for a generation of behavior change specialists working with people experiencing addiction, in addition to many other health-related behavior changes. Dr. DiClemente is an Emeritus Professor of Psychology the the University of Maryland Baltimore County and a former President of the the Society of Addiction Psychology.

People attempting recovery from addiction are best served when recovery can be achieved through multiple, diverse, pathways that fit their needs and recovery goals. Although the most commonly used recovery support service is Alcoholics Anonymous (or a similar Anonymous affiliated group), some object to core tenets or cultural elements and may benefit from alternative options. SMART Recovery is one example of an alternative mutual help group that was created to meet the needs of those who may benefit from a different pathway to recovery. In this episode, Dr. Horvath discusses the history, core tenets, structure, and evidence base for SMART Recovery. Dr. Horvath is a licensed clinical psychologist and President of Practical Recovery. Dr. Horvath was a founding board member and served as the president of SMART Recovery for 20 years. He has facilitated approximately 1000 SMART meetings and has supported San Diego to become the locality with the greatest concentration of SMART meetings at approximately 40. Dr. Horvath is also a past president of Div 50 (1999-2000).

In the past few years, a novel adulterant, Xylazine, has emerged in the illicit opioid drug supply. Between 2020 and 2021, there was a more than 1000% increase in xylazine-positive overdose mortalities in the United States from 2020 to 2021. What is Xylazine? How does it work? Why has it emerged in the supply? Dr. Cassandra Gipson-Reichardt discusses emerging literature on Xylazine and answers our questions on this episode of the Addiction Psychologist podcast. Dr. Gipson is an associate professor in the department of pharmacology and nutritional sciences at the University of Kentucky.

Many with substance use disorders make recovery attempts, whether through abstinence or reduction goals. However, some level of return to previous levels of use are relatively common, and treatments developed over the past four decades have typically included elements focused on relapse prevention. However, this was not always the case. Dr. Katie Witkiewitz discusses the history of relapse prevention and her work in the space of mindfulness-based relapse prevention. She also discusses recent conversations about the phrase "relapse": what does it mean, and how is it captured in scientific studies? Dr. Witkiewitz is the Director of the Center on Alcohol, Substance Use, And Addictions (CASAA) and a Distinguished Professor in the Department of Psychology at the University of New Mexico.

In general, most people have some degree of ambivalence towards behavior change. Whether reducing television in the evenings, eating less chocolate, or deciding to limit or abstain from alcohol, most people can identify reasons they would prefer to maintain the status quo and reasons to make a change. How can one move from ambivalence to action? Dr. Bill Miller discusses the origins and key tenets of Motivational Interviewing, an approach grounded in Humanistic psychology to help create a safe space for people to explore their ambivalence and consider change. Dr. Bill Miller is an Emeritus Distinguished Professor of Psychology and Psychiatry at The University of New Mexico.

Chronic pain commonly co-occurs with substance use disorder and may get in the way of recovery goals and valued living. Despite this, chronic pain can go untreated and unmanaged in treatment settings, and many people with substance use disorders struggle to get treatment for pain due to addiction stigma. Dr. Jeff Boissoneault provides an overview of the intersection between pain and substance use and makes the case for why scientists and clinicians should prioritize measuring and treating chronic pain. Dr. Boissoneault is an associate professor in the department of anesthesiology at the University of Minnesota Medical School.

Despite some consequences, substances can provide immediate and certain reward in the different forms, including but not limited to euphoria, pain relief, energy, alleviation of emotional suffering, and social connection. These rewards can compete with non-substance activities that are enjoyable and rewarding, and understanding changes in reward processing over the course of substance use disorder severity may provide critical insights into how to bolster recovery. Dr. Stacey Daughters provides an overview of reward processing in substance use disorders, and explores ways in which neuroscience treatment techniques may complement existing evidence-based psychotherapy treatments to bolster outcomes for people recovering from substance use disorders. Dr. Daughters is a professor in the Department of Psychology and Neuroscience at the University of North Carolina, at Chapel Hill.

Epidemiological surveys suggest that prevalence of harmful patterns of substance use is greatest among Multiracial populations relative to other racial demographic groups. Yet, most studies either do not report full racial demographics or under-sample people who identify as multiracial. In this episode, Tessa Nalven illuminates the importance of studying multiracial populations, discusses theoretical mechanisms for disparities, and provides recommendations for research with multiracial populations. Tessa Nalven is a currently finishing her doctoral degree in clinical psychology at the University of Rhode Island. She is completing her clinical internship year at the Boston VA. Tessa was the recipient of the 2022 Division 50 DEI Student Recognition Award.

For many, the onset of substance use occurs in adolescence. A subset of adolescents who use substances develop substance use disorders later in life, and some even develop harmful patterns of drinking while still in the developmental stage of adolescence. Why is substance use initiation likely in this age group, and what is the developmental function of substance use behavior? What are the interpersonal processes that influence substance use, and how do relationships with friends and family change during this critical developmental stage? Is it possible to leverage these interpersonal processes to bolster treatment initiation and success? Dr. Sam Meisel answers these questions and more as he discusses the complex social environment of the adolescent and it's pertinence to understanding substance use. Dr. Sam Meisel is a Research Scientist at Bradley Hospital and the Center for Alcohol and Addiction Studies in the Brown University School of Public Health.

Dr. Bill Stoops provides an overview of the pharmacology, effects, and prevalence of cocaine, in addition to treatments for cocaine use disorder. Dr. Bill Stoops is an Associate Director for Clinical Science in the Substance Use Priority Research Area, and a Professor in the Departments of Behavioral Science, Psychiatry, and Psychology, and in the Center for Drug and Alcohol Research, at the University of Kentucky.

Sexual assault is a massive problem on college campuses, and alcohol is involved in some form or another in more than half of cases reported. Dr. Jen Read talks about her work to understand the complex social environment within which sexual assault often takes place, and her work to design interventions to reduce the rate of sexual assault. Unfortunately, the evidence suggests that intervention and prevention approaches targeting the perpetrators do not work. However, sexual assaults often take place in complex social environments, and interventions may be able to leverage friendships to create more explicit conversations about how to protect one another during a night out. Dr. Jen Read is a renowned scientist known for her work illuminating harms and developing intervention approaches to reduce drinking among college students. Dr. Read is a Professor and Chair in the Department of Psychology at the University at Buffalo.

Regular exercise confers many benefits: It will increase your mood, decrease fatigue, and increase the quality of your sleep, among others. But how can exercise impact substance use? Is exercise an effective adjunct to treatment? If so, how do we encourage a behavior that, for many, is so hard to maintain? Dr. Ana Abrantes discusses the research on exercise and substance use treatment, with a particular focus on making exercise accessible. Dr. Ana Abrantes is a Professor of Psychiatry and Human Behavior in the Alpert Medical School of Brown University, and the Co-Director of Behavioral Medicine and Addictions Research at Butler Hospital.

Have you ever passed a sign on the road advertising for something called "Kratom"? or, perhaps, a friend or family member has mentioned trying it. What is it? An herbal supplement, or pharmacological drug? As addiction scientists, epidemiologists, and clinicians, do we have anything to be concerned about? In this episode, Dr. Kirsten Smith catches us up on what is known about Kratom, including the pharmacology, effects, and prevalence of this emerging substance. Dr. Kirsten Smith is a Post-doctoral Fellow in the Real-world Assessment, Prediction, and Treatment Unit at the National Institute on Drug Abuse Intramural Research Program, and an incoming Assistant Professor at Johns Hopkins University. 

ARE YOU READY FOR CPA 2022? 

The first in-person CPA conference since 2019 is happening this weekend, April 7-9, in Portland, OR. In addition to amazing networking opportunities, there will be incredible sessions and posters presented by experts ranging from early to late career, studying addiction and related topics. On this episode, we highlight the award-winning work of five early career scholars who will be presenting their research in Portland. Tune in for a sneak preview, and get hyped for CPA! Timestamps and presentation titles below. 

1:34 - 10:44: Dr. Jevon Rice - Training in Substance Use Disorders Among Black Emerging Adults for Psychologists

10:44 - 19:27: Victoria Chentsova - Internalizing Symptoms, Rumination, and Problematic Social Networking Site Use: A Cross-national Examination

19:27 - 32:01: Peter Soyster - Personalized Machine Learning Models to Predict Future Alcohol Use

32:01 - 36:30: Madison Smith - Which Types of Substance-Related Legal Problems are Most Predictive of Arrest?

36:30 - 47:51: Melissa Schick - Gender Parity and Homophily in the Drug and Alcohol Dependence Editorial Process

Sleep is a critical function that can be disrupted by substance use. In fact, the majority of people with an alcohol use disorder report insomnia or sleep disturbance. So, what is good sleep, and why does it seem that substance use disrupts it? Can you treat the sleep, even if the drinking doesn't change? Does cannabis actually help sleep? Dr. Mary Beth Miller answers these questions and more, in our latest episode on the relationship between sleep and substance use. Dr. Mary Beth Miller is an Assistant Professor in the Department of Psychiatry at the University of Missouri School of Medicine.

Persistent alcohol use can, at times, interfere with intimate relationships and create conflict. The dynamic of the couple can be a source of tension and may create a loop that can perpetuate alcohol use. However, intimate couples relationships can also be great supports in the recovery from alcohol use disorder. Dr. Barbara McCrady talks about decades of research and development of Alcohol Behavioral Couples Therapy (ABCT), which attempts to target changes in alcohol use by bolstering the couples relationship and using the partner to help work toward behavior change. Dr. Barbara McCrady Professor Emerita of Psychology and the Center on Alcohol, Substance Use, and Addictions (CASAA) at the University of New Mexico. Here she is pictured with her beloved horse, Skylark. 

Alcohol use produces changes in the cardiovascular system affecting heart rate. These systematic differences in heart rate can, in turn, function as a biological signature (i.e., biomarker) of dysfunction among those with alcohol use disorder (AUD). In addition to assessing difficulties, understanding heart rate modulation may have important treatment implications. Dr. David Eddie talks about heart rate variability as a biomarker of AUD and his work developing behavioral skills that can target heart rate using biofeedback to improve AUD treatment outcomes. Dr. Eddie is an Assistant Professor at Harvard Medical School and a Research Scientist at both Massachusetts General Hospital’s Center for Addiction Medicine and Recovery Research Institute.

Most commonly known psychedelics are considered schedule 1 substances by the controlled substances act, meaning they is no currently accepted medical use and a high potential for abuse. However, there is emerging evidence that psychedelics may have some therapeutic value. Dr. Matthew Johnson discusses the history of psychedelic research in the United States and his work on understanding abuse potential and therapeutic value of one specific psychedelic, psilocybin. Matt is the Susan Hill Ward Professor in Psychedelics and Consciousness and Professor of Psychiatry and Behavioral Sciences at Johns Hopkins.

A great deal of our research focuses on adults with substance use disorder. Yet, many who develop severe substance use disorder begin during adolescence. What types of psychosocial treatments are available for adolescents? What about pharmacological treatments? Does combining psychosocial and pharmacological treatments increase efficacy? In this episode, Dr. Robert Miranda discusses treatments available for adolescents and the complications of developing these treatments. Dr. Robert Miranda is a Professor of Psychiatry and Human Behavior in the Warren Alpert Medical School, a Professor of Behavioral and Social Sciences in the School of Public Health, and the Training Director of the NIAAA/NIDA Postdoctoral Fellowship in the Center for Alcohol and Addiction Studies at Brown University. He is also the Clinical Director of the Vista Intensive Outpatient Program at Bradley Hospital in Providence, Rhode Island.

Cannabis is becoming increasingly tolerated, both culturally and legally, across the United States and other parts of the world. Yet, there are at least 100 different psychoactive cannabinoids in any strain of cannabis. What do we know about these cannabinoids? Dr. Hollis Karoly talks about the two most common cannabinoids, THC and CBD, and what the scientific evidence suggests about their harms and benefits. She then discusses the connection between cannabinoids and alcohol use. Dr. Hollis Karoly is an Assistant Professor in the Department of Psychology at Colorado State University.

A great deal of individual's require substance use treatment that is more active than brief motivational interventions, yet are unable or unwilling to attend long-term inpatient treatment. Cognitive Behavioral Therapy (CBT) for is an effective treatment for substance use disorders. CBT for substance use disorder targets emotions, cognitions, and behaviors associated with substance use and teach skills in order to reduce use. Dr. Kate McHugh discusses CBT for substance use disorder, including her work to increase its overall impact. Kate is the Director of the Stress, Anxiety, and Substance Use Laboratory and Director of Behavioral Therapy Development, Training and Research at McLean Hospital. She is also an Associate Professor of Psychology in the Department of Psychiatry at Harvard Medical School.

College students drink at higher levels than most other groups; yet, their motivation to reduce drinking is often low because alcohol consumption provides salient social benefits. Despite these benefits, emerging adulthood is a critical developmental period that can impact the likelihood of alcohol use disorder over the lifespan. Dr. Jim Murphy talks broadly about brief motivational interventions (BMIs) for college populations, which typically deliver personalized feedback in a motivational interviewing style to increase motivation to change drinking practices among college students. Jim also discusses the limitations to BMIs and discusses his work to try to extend their efficacy. Dr. Jim Murphy is the Dunavant Professor in the Department of Psychology in the University of Memphis. 

This is the first episode in a three part series on intervention and treatment, which will be followed by episodes on Cognitive Behavioral Therapy and Contingency Management.  

Across substances, rates of use are high in indigenous populations across North America. Melissa Schick discusses the historical and ongoing trauma experienced by these populations and why it might be related to higher rates of substance use. Melissa also discusses combining strength-based approaches, from the perspective of positive psychology with community participatory research to provide culturally humble treatment and interventions. Melissa Schick is a Doctoral candidate in Clinical Psychology at the University of Rhode Island and the Senior Student Representative to the executive committee for the Society for Addiction Psychology.

Posttraumatic Stress Disorder (PTSD) and Alcohol Use Disorder (AUD) often co-occur. A great deal of research has attempted to understand the nature of this relationship. Is PTSD a risk factor for AUD? Is high risk drinking a risk factor for PTSD? These questions can help us understand which of the two disorders to target first. Dr. Debra Kaysen talks about her research on treatments for co-occurring PTSD and AUD, focusing special attention toward state of the art science on ordering effects. Dr. Debra Kaysen is a clinical psychologist and Professor in the Department of Psychiatry and Behavioral Sciences at Stanford University. Dr. Kaysen’s area of specialty both in research and clinical work is in treatment of those who have experienced traumatic events including PTSD, mood and substance-use disorders. Debra is one of the leading researchers in adaptation of evidence-based PTSD treatments to increase access to evidence based treatments for diverse populations (Iraq, Democratic Republic of Congo, Native Americans), comorbidities (alcohol use disorders, HIV risk behavior), and for use in non-specialty care settings (digital health, telepsychology and primary care settings). Debra is currently the Immediate Past President of the International Society for Traumatic Stress Studies (ISTSS).

Biomarkers are objective signs or indications of a clinical state which can be measured reliably and accurately. Biomarkers are important because they can reveal mechanisms of behavior and help inform treatments. Laura Lesnewich talks about Biomarkers for Alcohol Use Disorder and her work identifying Biomarkers related to executive functioning deficits. Laura is a Doctoral candidate in Clinical Psychology at Rutgers and a Predoctoral intern at the Coatesville VA Medical Center. 

A great deal of the literature delineating the experience of addiction uses cross-sectional survey data or longitudinal data separated by wide gaps of time. Although this research is critical and is useful for answer certain questions, these research designs are unable to answer certain questions, such as about proximal contextual factors associated with within-person differences in substance use, or about psychological processes that shift moment to moment that may increase risk of substance engagement. Dr. Lorraine Collins talks about her seminal work applying ecological momentary assessment methodologies to alcohol and cannabis. Dr. Lorraine Collins is the Associate Dean for Research in the School of Public Health and Health Professions, and a Professor in the Department of Community Health and Health Behavior at the University at Buffalo.

Alleviation of pain, whether emotional or physical, is among the most common reasons for substance use. Despite this, very little experimental work has been done to delineate a causal effect of pain. Dezarie Moskal talks about her experimental work on the effect of pain on substance use and a recent meta-analysis on the effect of endocannabinoids on the alleviation of pain. Finally, she discusses the role of psychotherapy in alleviating pain. Dez is a doctoral candidate in clinical psychology at Syracuse University and a predoctoral internship at the VA Maryland Health Care System/University of Maryland School of Medicine Psychology Internship Consortium. Dez is also a proud Division 50 student member. 

In December of 2020, the US House of Representatives passed the Marijuana Opportunities Reinvestment and Expungement (MORE) act, which removes marijuana from the list of scheduled substances under the Controlled Substances Act and eliminates criminal penalties for an individual who manufactures, distributes, or possesses marijuana. Although the bill is unlikely to survive the Senate, it seems to be a matter of time before some version of this bill does pass. There has been growing interest in decriminalizing and legalizing cannabis in on the state level in the United States and in many countries around the world, and many around the country support the action. It is increasingly important to understand the impact of cannabis legalization. How will the impact of federal legislation be different from that of state legislation? How will cannabis legislation impact the epidemiological harm of cannabis use? How can psychologists contribute to this legislation to minimize costs and maximize benefits oft he legislation? Dr. Alan Budney discusses the likely effects of cannabis legislation and outlines what we still do not know about cannabis. Dr. Alan Budney is a Professor of Psychiatry in the Geisel School of Medicine at Dartmouth College.

Self control is thought to be closely associated with the ability to abstain or regulate substance use and is just one aspect of self-regulation, or the ability to organize behavior toward a goal. Many have suggested that self-regulation is damaged in those with chronic patterns of harmful substance use. However, it has also been noted that substance use itself is a highly goal directed behavior and requires self-regulation. Kyle Walters discusses his work on the interaction between self-regulation and the environment and suggests that this relationship may not be as simple as we once thought. Kyle also briefly discusses his forays into Network Analysis as an alternative approach to traditional conceptualizations of psychopathology.  Kyle Walters is a doctoral candidate in the Department of Psychology at the University of South Dakota.

There are two competing paradigms attempting to explain the phenomena of addiction: Addiction as compulsion and addiction as choice.  The compulsion model describes addiction as a brain disease in which alcohol and drug use cause neuroadaptations, resulting in uncontrolled drug seeking behavior. The choice model describes addiction as pathology of reinforcement that is contextually dependent upon the availability of meaningful and rewarding alternatives in the choice environment. Dr. Matt Field describes each model and their respective bodies of research.  Dr. Matt Field is a Professor in the Department of Psychology at University of Sheffield.