Dr. Noah Emery and Samuel Acuff interview researchers, clinicians, and policymakers in the field of addiction psychology with the hopes of enhancing recovery. Official podcast of the Society for Addiction Psychology.
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.
Research and theory have led to the development of empirically-supported options for SUD treatment, both psychosocial and pharmacological. However, these treatments only have moderate efficacy/effectiveness, and some aspects of treatments may be more implicated for some than others. Tori Votaw talks about precision medicine, which is determining which treatments work best for subgroups of individuals. Specifically, Tori discusses her work in understanding phenotypes of addiction such as negative emotionality and executive functioning that may help classify individuals into different specific treatment approaches. Tori Votaw is a graduate student and T32 predoctoral fellow in the Department of Psychology at the University of New Mexico.
E-cigarettes have increased in prevalence over the past decade and provided a powerful alternative to tobacco products like cigarettes. E-cigarettes have the potential to be addictive in part because qualities that are typically inherent to a substance (e.g., flavor, "harshness") can actually be modified to increase the reinforcing efficacy of the nicotine from the e-cigarettes. However, the full picture of both acute and chronic consequences are yet to be understood. Dr. Adam Leventhal provides an overview of the science of e-cigarettes and vaping, including what we now about it's harm and addictive potential. He also discusses his work regarding the regulation "sweet spot": making it appealing enough for cigarette smokers to want to start using e-cigarettes, but aversive enough to prevent uptake among at-risk groups, such as adolescents. He also discusses how to develop a research career that has a focus on public health impact. Dr. Adam Leventhal is a Professor in the Department of Preventive Medicine and Psychology in the Keck School of Medicine at the University of Southern California. He is also the Director of the USC Institute for Addiction Science and Health, Emotion & Addiction Laboratory; a new Fellows Chair in the APA Division on Psychopharmacology and Substance Abuse (Division 28); and a recently appointed member of the Tobacco Products Scientific Advisory Committee for the Food and Drug Administration.
Alcohol use is a burden on the healthcare system and is among the leading causes of preventable deaths in the United States. There are eleven possible Alcohol use Disorder (AUD) symptoms and only two are required, resulting in a wide range of possible combinations of symptoms and thus widely divergent profiles of individuals with AUD. Further, not all of the AUD symptoms are equally severe, and two individuals with two symptoms each may have completely different levels of severity. Despite these issues, many of our research and clinical decisions are made based on AUD clinical cutoffs. Cassie Boness talks about her work in understanding the diagnostic issues with AUD, including how she has used cognitive interviewing to better understand how people are understanding the symptoms of AUD. Cassie Boness is an intern at Western Psychiatric Hospital at the University of Pittsburgh Medical Center.
Racial disparities in prevalence rates of harmful substance use can largely be attributed to social determinants of health, which are perpetuated by racist policies that have been implemented over the past century. The clearest example can be found in the policies related to Nixon's War on Drugs, which criminalized drug use, increased drug enforcement forces across the nation, and specifically targeted Black communities. More generally, the definition of addiction and its recovery has been determined by white scientists, religious figures, and politicians without regard to the Black community or other groups. Dr. Ayana Jordan discusses racist drug policy and the problems facing individuals in the Black community who struggle with addiction. She then discusses her work that seeks to eliminate disparities: first, by creating scaffolding for those going through white-centric treatment; and second, by creating treatments designed for Black individuals. Dr. Ayana Jordan is an Assistant Professor and the Associate Residency Program Director in the Department of Psychiatry at Yale University School of Medicine. She is also an Addiction Psychiatrist and Attending Physician at Connecticut Mental Health Center.
The academy systematically excludes members of certain groups, leading to underrepresentation of those who identify as of Black, indigenous, and people of color. Keanan Joyner discusses the leaky pipeline and provides specific actionable steps that can help increase representation in your academic department. Keanan Joyner is a doctoral student at Florida State University and a Ford Fellow.
Some research demonstrates that rats will self-administer dangerously high levels of drugs under certain schedules of reinforcement. However, much of this research has been done under conditions of depravity, in which the rat does not have any access to alternatives. Humans almost always make choices between a menu of options, suggesting a different, more dynamic choice context with competing reinforcers. Keanan discusses his work in this area, in addition to the importance of confirming self-report findings by using multimethod approaches, such as psychophysiology. Keanan Joyner is a doctoral student at Florida State University and a Ford Fellow.
Most definitions of recovery from addiction require abstinence from the problem substance. Dr. Katie Witkiewitz discusses the limitations of abstinence-based models of recovery and describe why non-abstinent models may have a positive public health impact. Namely, Katie's research suggests that many people regain functioning in interpersonal, occupational, and health domains without achieving full abstinence, and that these definitions actually prevent people from seeking treatment. Katie outlines the benefits of incorporating non-abstinent recovery options alongside the dominant abstinent model, and also shares NIAAA's preliminary definition of recovery from alcohol. Dr. Katie Witkiewitz is the Regent's Professor in the Department of Psychology at the University of New Mexico. She is also a Scientist at the Center on Alcoholism, Substance Abuse & Addictions (CASAA), and the Technology Committee Chair for the Society of Addiction Psychology.
Systematic barriers can prevent educational and occupational attainment for those with substantive substance use or incarceration histories. For example, the Violent Crime Control and Law Enforcement Act of 1994 prevents those with a felony from receiving a Pell grant, effectively preventing college entry for most. Further, reporting that you have been arrested and/or convicted of a crime on college applications prevents many from applying, even though applications are rarely rejected for this purpose. Dr. Noel Vest talks about his lived experience through substance use, prison, and his journey into the academy, which has resulted in two primary areas of passionate engagement. First, Noel pushes for policy-level change to ensure that those with lived experience have an opportunity for continued education and opportunity. Second, Noel engages in research to enhance recovery for those already in college in the form of collegiate recovery programs. Dr. Noel Vest is a postdoctoral fellow working with Dr. Keith Humphreys at Stanford University School of Medicine.
Abstinence models have historically dominated definitions of recovery. However, research suggests that there is not necessarily a 1:1 ratio of substance use to problems, highlighting the importance of targeting harm rather than consumption. In recent decades, harm reduction models of recovery and policy have increasingly gained traction. Drs. Seema Clifasefi & Susan Collins talk about the history and definition of harm reduction, and about how a harm reduction approach informs their research and policy application. They also discuss diversity initiatives being implemented in Division 50. Dr. Seema Clifasefi is an Associate Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington, and the chair of the Diversity, Equity, and Inclusion Committee of Division 50. Dr. Susan Collins is a Professor in the Department of Psychology at Washington State University, and the Division 50 APA convention chair and chair of the membership committee for Division 50. Together, they are co-Directors of the Harm Reduction Research & Treatment Center.
Listen to the future voices of addiction research. Ten students/ECRs discuss their excellent work which will also be presented live, along with 23 others, on August 7, 2020 during the NIAAA/NIDA student/ECR poster session. Content ranges from psychometric analyses of new measures to policy-level decision making about harm reduction approaches, and everything in between. Primary presenters, poster titles, and timestamps for posters below.
Silvi Goldstein (3:44-8:44) - Cross-cultural validity of the SIP-2R for Indigenous and Black adults experiencing homelessness with alcohol use disorders
Rachelle Kromash (8:44-13:33) - Psychometric properties of the Illness Attitudes Scale among people with substance use disorders
Katie Lindstrom (13:33-19:05) - Social network feedback and drinking outcomes in community-dwelling emerging adults recruited by peer referral
Shelbi Fisher, Tyron Slack, and Alan Crutchfield (19:05-24:36) - Positive psychology in alcoholics anonymous literature
Stephanie Coronado-Montoya (24:36-29:02) - SPICE: Intervention preference survey for people with early psychosis using cannabis
Dr. Lourah Kelly (29:02-33:33) - Interactive effect of adverse child experiences and suicidality on adolescent alcohol and marijuana use frequency
Dr. Alejandra Fernandez (33:33-37:21) - Screening for family functioning in primary care: Preliminary evidence
Kate Bartley (37:21-42:44) - Health risk perceptions and secondhand exposure behaviors related to vaping among student veterans
Kathleen Giarrantano (42:44-46:50) - Assessing support for safe injection sites among adult constituents in New York
Jacob Daheim (46:50-52:37) - The Pain Medication Attitudes Questionnaire and conformity to masculine norms on men’s risk of abusing opioids in chronic pain
Although in-person treatment is beneficial, many clients need to use skills in moments (e.g., under conditions of emotional distress or craving) that can make effective skill utilization difficult. Dr. Tyler Wray talks about harnessing technology for just-in-time interventions to help "nudge" clients people towards effective behavior change. Importantly during the COVID-19 era, Tyler discusses remote enrollment and data collection related to these studies, which helps his team gain access to vulnerable and hard-to-reach populations. Dr. Tyler Wray is the Edens Family Chair in Healthcare Communications & Technology at the Brown University School of Public Health and leads the School's academic programs in digital health and behavior. His research explores various ways technology can be used to help people make healthier decisions and lead healthier lifestyles.
Dr. Brandon Bergman continues his discussion about recovery support services and communities available through the Internet. Dr. Brandon Bergman is an Assistant Professor at Harvard Medical School and the Associate Director of the Recovery Research Institute, which is housed in the Center for Addiction Medicine at Massachusetts General Hospital. Learn more about their mission at recoveryanswers.org.
Physical distancing recommendations from the COVID-19 pandemic has complicated addiction recovery, forcing many addiction recovery support services online for the foreseeable future. In the first half of our interview with Brandon Bergman, he discusses the difference between addiction treatment and recovery-support services, setting the stage for a discussion about online recovery support communities (Episode 1 Part 2). Dr. Brandon Bergman is an Assistant Professor at Harvard Medical School and the Associate Director of the Recovery Research Institute, which is housed in the Center for Addiction Medicine at Massachusetts General Hospital. Learn more about their mission at recoveryanswers.org.