Substance Use Disorders
Frances Levin, MD
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The mission of this research area is to develop innovative treatment interventions to ameliorate the personal suffering and negative public health consequences of substance use disorders. Our faculty are dedicated to conducting a broad range of translational research, disseminating and implementing evidence-based interventions within the Columbia community and throughout the country, and providing state-of-the-art training to the next generation of addiction investigators. As one of the leading addiction medicine programs in the nation (and routinely in the top five university drug and alcohol abuse programs as ranked by U.S. World and News Report), we are at the forefront of addressing the critical addiction challenges facing New York City, New York state, and the nation.
Led by Frances Levin, MD, Substance Use Disorders has an administrative structure consisting of an executive committee (Drs. Foltin, Evans, Nunes, Comer, Haney, Martinez, Bisaga, and Kleber), and a senior administrator (Mr. David Hurst). The division has had continuous NIH and industry funding for over 25 years, including 37 active federal grants and subawards, training awards, and industry contracts. The area is comprised of 25 faculty members, of which 16 have independent funding.
The main areas of research and research training include: Preclinical and Laboratory Research Programs, National Drug Abuse Clinical Trials Network, Substance Treatment and Research Service and Education, and Training. Developing areas include: 1) Device-Based Diagnostics and Interventions, 2) Enhanced Clinical Services, 3) Substance Use Data Science, and 4) Implementation Science and Quality of Care. Contributing to each of these Subdivisions is a U54 Medications Development Center.
- Pursue novel pharmacologic interventions for substance use disorders. Novel medications can be evaluated across the translational spectrum from preclinical work in non-human primates to human laboratory proof of concept and safety studies to clinical trials and, finally, implementation.
- Develop partnerships with pharmaceutical companies and basic scientists to develop novel compounds that may have promise for substance use disorders.
- Expand understanding of the neurobiological correlates of substance use disorders via neuroimaging and other novel approaches.
- Explore device-based treatments of substance use disorders and other digital therapeutics, including opportunities available via SBIR funding mechanisms or industry-supported funding.
- Expand and improve substance use disorder training within the Department of Psychiatry and Columbia University Irving Medical Center (CUIMC).
- Increase national training initiatives to encourage implementation of evidence-based treatments.
- Grow new collaborative research within the Department of Psychiatry and CUIMC.
- Expand our national influence on policy initiatives critical to the treatment of substance use disorders.
Of the area's 37 funded grants, approximately 75% are funded by NIDA. We have 14 R01s, 4 R21s, 1 R34, 3 K23s, 3 senior K awards, a U54 Center, other U mechanisms, an FDA contract, and pilot funding for non-federal sources, such as Smithers Foundation. Our research encompasses a wide spectrum of study methods and designs including preclinical research, human laboratory research, genetics, neuroimaging, and randomized clinical trials. In most of these areas, we have ongoing research with the major drugs of abuse including opioids, cannabis, cocaine, and alcohol. In addition to traditional research studies, an important aspect of our area is training and implementation science. With respect to training, Dr. Levin has a NIDA-funded T32 Fellowship primarily to train physicians to conduct clinical addiction research and Drs. Campbell and Hien have an R25 to train racial/ethnic minorities in translational addiction research. Lastly, our group is currently collaborating on several high-profile, national SAMHSA-funded initiatives to provide training and technical assistance to medical and allied health professionals throughout the United States, with an emphasis on medication-assisted treatment for substance use disorders, and, in particular, opioid use disorders.
Programs, Centers, Laboratories
Substance Treatment and Research Service (STARS)
The Division supports a host of clinical treatment research studies targeting tobacco, cocaine, alcohol, cannabis, and opioid use disorders at STARS. Dr. John Mariani, the STARS Medical Director, coordinates recruitment and clinical oversight for this consortium of 8 Principal Investigators. Our Division has had long-standing expertise and interest in improving induction onto medication-assisted treatments and enhancing medication adherence for opioid use disorders. Novel interventions currently being studied include ketamine for opioid and cocaine use disorders (Dr. Dakwar), an investigative sequenced computerized behavioral treatment approach to understand the cognitive mechanisms associated with change between those needing/not needing a medication-enhanced treatment strategy (Drs. Carpenter and Levin), and translational studies combining fMRI with clinical methods to understand the neural mechanisms by which behavioral treatments for alcohol use disorder change behavior (Dr. Naqvi). Industry trials include assessing the utility of extended release formulations of buprenorphine to enhance adherence and reduce diversion (Dr. Nunes). Notably, our Division was one of the first groups to conduct outpatient pharmacologic treatment trials targeting cannabis use disorders. Another area of developing interest is harnessing technology, including ecological momentary assessments using smart phones, to assess outcome measures relevant to substance use disorder treatment trials.
Preclinical and Laboratory Research Programs
Research conducted at the Substance Use Research Center focuses on behavioral and biological factors affecting 1) vulnerability to drug use, 2) patterns of drug use, and 3) the response to putative treatment interventions with respect to cannabis, opioid, cocaine and alcohol use and misuse. The Women’s Research Center (Dr. Evans) places these research questions in the context of sex differences that affect alcohol and cannabis misuse. Currently, Drs. Evans and Bedi have a grant to examine neurobiological mechanisms, using fMRI, of decision making in cannabis smokers. The focus of the Cannabis Research Laboratory (Dr. Haney) is to conduct placebo-controlled, human laboratory studies to develop novel treatments for cannabis use disorder by assessing medication effects on cannabis intoxication, withdrawal and relapse, and to test the potential therapeutic effects of cannabinoids. The Cocaine Research Laboratory (Dr. Foltin) is conducting a series of studies examining the relationship between impulsivity and patterns of cocaine use, impulsivity and treatment outcome, and the neural correlates of decision making in cocaine users. Research conducted in the Opioid Research Laboratory (Dr. Comer) targets approaches for training people who use opioids on how to respond to an overdose emergency, tests novel medication approaches for treating co-morbid opioid and alcohol use disorders, evaluates the abuse potential of novel pain medications, and uses pharmacogenetics to improve treatment outcomes. Preclinical research with laboratory animals focuses on investigating the mechanisms of the reinforcing effects of drugs in laboratory animals.
National Drug Abuse Clinical Trials Network (CTN)
Under the direction of Dr. Nunes, the Greater NY Research Node of the NIDA-funded CTN has been continuously funded since 2000. In addition to contributing individual sites to national multi-site trials, the Node has led four large multi-site effectiveness trials, including the first multisite trial of a behavioral treatment for combined PSTD and substance use disorder, the first multisite trial of a web-delivered behavioral intervention for substance use disorders, and the first comparative effectiveness trial of buprenorphine vs. injection naltrexone for treatment of opioid use disorder. A data analytic core serves as a resource to the Division supporting both trainees and faculty in conducting secondary analyses of CTN datasets.
U54 Medications Development Center
The Division has a U54 Center grant (5U54DA037842) entitled “Shared Pharmacotherapeutic Strategies for Cannabinoid & Opioid Use Disorders” that is directed by Dr. Levin and co-directed by Dr. Evans. The overarching theme of the Center is to test medications for their ability to improve clinical sequelae common to both cannabinoid and opioid use disorders (i.e., abstinence-induced withdrawal and relapse), in part due to their shared common neurobiologic underpinnings. Unifying and supporting three Center research projects are the Administrative Core, the Pilot Project Core, and the Training and Education Core. The Administrative Core (Director Dr. Levin), provides infrastructure to ensure the efficient running of the Center. The Training and Education Core (Director Dr. Bisaga) provides support for all training and educational activities (including a NIDA-funded T32 Substance Abuse Fellowship) and creates opportunities to develop new integrative educational programs and initiatives.
Gambling Disorders Clinic
Funded by the Office of Alcoholism and Substance Abuse Services (OASAS) and directed by Dr. Okudabenavidas, this clinic offers free, intensive, evidence-based outpatient treatment for gambling addiction and concerned significant others (CSOs).
Additional Programmatic Initiatives
1) Device-based Interventions: This research program has been a progressive division-wide endeavor with several investigators and fellows engaged in innovative, novel assessments and research initiatives. Led by Dr. Martinez, investigations include deep brain stimulation targeting alcohol self-administration in nonhuman primates and transcranial magnetic stimulation (TMS) on cocaine and nicotine use disorders. Novel computerized treatment applications (“APPs”) are currently being evaluated. Finally, working with industry, faculty are consulting on a recently-funded SBIR to develop a phrenic nerve intervention to prompt breathing during an overdose event. 2) Implementation Science and Quality of Care: Dr. Campbell is currently involved in a number of federally-funded implementation studies. Dr. Williams recently received a K23 to assess barriers that thwart effective opioid use disorder treatment.