Suchitra Krishnan-Sarin PhD
Associate Professor of Psychiatry; Vice-Chair, Human Investigations Committee II & IV
Substance use; Alcohol; Tobacco; Marijuana; Adolescent; Developmental; Prevention; Cessation; Biobehavioral
- To examine the effects of glutamatergic and opiodergic agents on alcohol drinking behaviors including craving.
- To develop a novel high school based tobacco cessation intervention for adolescent smokers using behavioral techniques and pharmacotherapy.
- To develop a novel incentive based smoking cessation and prevention program for high school and middle school students.
- To develop novel marijuana prevention and cessation for adolescents
- To use a developmental perspective to understand the prevalence, interactions and biobehavioral underpinnings of high risk behaviors among adolescents.
My research is focused on developing a biobehavioral understanding of the underpinnings of alcohol, tobacco (nicotine) and marijuana use, in adolescent and adult populations, and developing new pharmacological and behavioral interventions to reduce and prevent use of these substances.
Extensive Research Description
Developing a better understanding of the neurobiological and behavioral adaptations produced by substance use is crucial to developing optimal behavioral relapse prevention and pharmacological strategies to help initiate and maintain abstinence. To this end, my research focuses on understanding a a host of factors that mediate the intensity, content and duration of abstinence such as sex/gender, age, concurrent substance use and depression.
From a treatment development perspective, we are primarily focusing on two separate areas. In the first, we have developed and are using an alcohol self-administration paradigm in alcohol dependence drinkers to screen new medications that could reduce drinking behavior. In the area of tobacco dependence, we are developing innovative school-based prevention and cessation programs for adolescent smokers.
In the area of alcohol drinking, we are interested in understanding alcohol drinking behavior and evaluating the efficacy of new medications in reducing drinking behavior. This research is conducted using a human laboratory alcohol drinking paradigm for adult heavy drinkers developed by our group at Yale. Laboratory paradigms provide researchers with the opportunity to manipulate factors that may have predictive utility in treatment outcome in a controlled environment. Using this paradigm to evaluate naltrexone, one of two FDA approved medications for alcoholism, we recently demonstrated that naltrexone reduced drinking only in drinkers with a positive family history of alcoholism. Thus, the efficacy of naltrexone, while modest in unselected samples, may be maximized by targeting the treatment to those with a genetic risk for alcoholism. Currently, we are using these laboratory paradigms to evaluate the influence of glutamatergic agents on alcohol drinking behaviors.
Use of many substances, particularly tobacco, alcohol and marijuana is established during adolescence. Unfortunately, we know little about what maintains substance use behaviors in adolescents and there are few empirically validated treatments for this population. We have shown for the first time that while adolescent smokers show minimal symptoms on traditional withdrawal measures during abstinence from cigarettes, there are clinically significant gender-related changes in stress responses and cognition. These findings suggest that adolescents may be smoking to modulate stress reactivity and cognitive performance and emphasize the need for gender-specific treatments addressing tobacco-abstinence induced changes. We have used surveys to examine the relationships between a number of high risk behaviors including substance use, gambling, stealing among high school and middle school students, as well as to examine adolescents perceptions and attitudes towards school-based prevention and cessation programs. We have also used behavioral and neuroimaging techniques to evaluate the role of personality factors like impulsivity and risk taking behaviors in predicting both initiation and cessation of substance use in adolescents.
In the area of adolescent tobacco use, we are developing unique prevention and cessation programs that use behavioral reinforcement techniques. For example, we have developed a unique school based cessation program for adolescent smokers that uses Contingency Management (CM) based techniques to reinforce tobacco abstinence in combination with cognitive behavioral smoking cessation therapy. CM is an approach that reinforces target behaviors (such as abstinence) and has had a profound effect on the field of behavioral therapies for substance use in adults. We have adapted this approach to the unique needs of adolescent smokers and initial results from this program are extremely promising and suggest that CM could be used to initiate abstinence in this high risk population of smokers. We are now working on methods to enhance the efficacy of this program by understanding predictors of treatment outcome, and including pharmacotherapies and other behavioral interventions to address the influence of these of predictors.
More recently, we have focused our efforts on developing a school wide “Tobacco free and Win” program designed to motivate high school smokers to not use tobacco products. This unique program is being developed using input and feedback from students and administrators and will be designed to motivate a school-wide tobacco-free lifestyle. Finally, we are conducting developmental work on marijuana education, prevention and cessation programs in high school students and are also extending our research to examine biobehavioral correlates of initiation of substance use, and develop interventions for middle school students.