Overall, my research focuses on improving the accessibility, effectiveness, and efficiency of treatment for mental health and addictive disorders.
My specific areas of research include:
1. Extending the Reach of Mindfulness to Underserved Populations via Pragmatic Adaptions and Technology
2. Using Person-Centered Analyses to Advance Precision Addiction Treatment (matching treatments to patients)
3. Applying Contextual Models to Understand Self-Regulation as a Mechanism of Change in Addiction Recovery
4. Identifying Clinically Meaningful Reductions in Substance Use
Extensive Research Description
Extending the Reach of Mindfulness to Underserved Populations via Pragmatic Adaptions and Technology
Mindfulness in general is rapidly growing in popularity, yet mindfulness practice and treatment can be misunderstood. Mindfulness is not simply about relaxation or concentrating on one thing and blocking others things out. Rather, mindfulness and mindfulness-based therapy approaches are all about learning and systematically practicing mindfulness meditation and on-the-go daily mindful skills for enhancing several core interrelated self-regulation abilities: 1) acting with awareness, 2) distress tolerance, 3) cognitive distancing, and 4) attentional shifting, and 5) internal cue awareness.
- Acting with Awareness - pausing and responding with awareness (not reacting), especially when triggered
- Distress Tolerance - tolerating and making space for emotional and physical discomfort
- Cognitive Distancing - "stepping back" and observing thoughts as thoughts, not commands or truths
- Attentional Shifting - redirecting one's attention to particular aspects of present moment experience
- Internal Cue Awareness - recognizing internal emotional or physiological cues (e.g., sadness, hunger, craving)
My colleagues and I have conducted research focused on developing flexible adaptions of MBTs for real-world community-based addiction treatment settings (e.g., rolling admission groups) and identifying which types of patients with substance use disorders benefit most from MBT. My research has shown that MBT for substance use disorder actually demonstrates particularly strong treatment effects in clinical trials among racial/ethnic minorities and vulnerable patients with high dependence severity and co-occurring depression and anxiety. Unfortunately, the uptake of MBT in clinical practice is low due to limited or expensive clinician trainings, impractical program designs (e.g., closed-groups, 2-hours sessions), and an overall lack of a sustainable model for training frontline clinicians and rolling out MBTs in real-world clinical settings. Novel strategies are needed to expand the overall reach and accessibility of MBTs, especially among vulnerable and underserved populations. I believe that technology-based tools (apps and websites) have the potential to reduce health disparities and increase the reach and accessibility of MBT. In fact, 77% of Americans own a smartphone, with similar rates across Whites, Blacks, and Hispanics. Therefore, the next core focus of my research on mindfulness is developing and evaluating accessible and easy-to-use mindfulness-based web tools and apps to that expand the reach and accessibility of MBTs to a more diverse range of individuals and settings.
Using Person-Centered Analyses to Advance Precision Addiction Treatment
My colleagues and I have conducted many secondary analyses of clinical trial data aimed at informing the refinement and optimal delivery of both behavioral and pharmacotherapy addiction treatments. For example, one key question is whether certain types medications or behavioral therapies for addiction are more beneficial for certain kinds of patients than others. The approach of matching precise treatments to certain patients is often referred to as Precision Medicine or Precision Treatment. I specialize in utilizing person-centered analyses (finite mixture modeling) to identify patient subgroups that respond optimally certain treatments. My research has shown that naltrexone may be particularly effective among reward drinkers (those whose drinking is driven primarily by positive reinforcement) and acamprosate may be particularly effective among relief drinker (those who drinking is driven primarily by negative reinforcement). In regards to behavioral treatments, my research has shown that mindfulness-based relapse prevention may be particularly effective for racial/ethnic minorities who use drugs and vulnerable patients characterized by high dependence severity and co-occurring depression and anxiety. My colleagues and I are currently planning projects to identify subgroups or "phenotypes" of individuals with opioid use disorder who may respond optimally to specific treatments.
Applying Contextual Models to Understand Self-Regulation as a Mechanism of Change in Addiction Recovery
With the guidance of my colleague and mentor, Dr. Katie Witkiewitz, I recently developed the contextual model of self-regulation change mechanisms, which is a conceptual model to guide research on better understanding how exactly treatment providers can intervene with different approaches to enhance self-regulation abilities (e.g., coping, emotion regulation) among different types of patients and under varying contextual conditions. The model emphasizes the critical importance of understanding different contextual conditions, including those in the immediate situational context (e.g., fluctuating internal and external cues) and in the broader context (e.g., major life stressors, environment conditions, traits, disorder severity). As an example, one key hypothesis is that more severe contextual demands warrant greater need for coping skills to avoid or reduce addictive behavior, and in turn coping skills may be more likely to be a mechanism of change among patients with higher dependence severity. My research has supported this hypothesis by showing that cognitive-behavioral therapy for alcohol use disorder appears to help people reduce their alcohol use by improving alcohol-specific coping skills (e.g., avoiding alcohol triggers, alternative activities etc.), but only among patients with high alcohol dependence severity. I plan to conduct further secondary data analyses that apply the contextual model towards better understanding improvements in coping and emotion regulation as mechanisms of addiction recovery.
Identifying Clinically Meaningful Reductions in Substance Use
In the addiction treatment field, abstinence from substances is generally considered the best outcome. In fact, abstinence is the only clinical trial efficacy endpoint accepted by the FDA for approving new pharmacotherapies for illicit drug use disorders, and "no heavy drinking" (never exceeding 4/5 drinks a day for women/men) is the endpoint accepted by the FDA for approving pharmacotherapies for alcohol use disorders. However, given addiction is considered a chronic relapsing condition and changing substance use behavior often takes time, complete abstinence from drugs and "never exceeding 4/5 drinks" may be too stringent criteria for evaluating treatment success in clinical trials, as well as stringent expectations for clinicians to uniformly have for patients at all times during treatment. My colleagues and I have conducted secondary data analyses of clinical trials aimed at improving our understanding of what constitutes clinically meaningful reductions in substance use over time and expanding the notion of what is considered "success" in addiction recovery. Much of our research to date has focused on individuals with alcohol use disorder and we our published papers supported two key findings: 1) "no heavy drinking" is not a sensitive indicator of success in alcohol recovery - many patients who have some heavy drinking episodes demonstrate substantial improvements in functioning equivalent to those who are completely abstinent, and 2) a large proportion of patients who regain high level functioning show clinically meaningful reductions in alcohol use during the course of treatment and go through a "process of change over time" that involves gradually increasing periods of abstinence and decreasing the quantity/frequency of drinking. In other words, our research shows there are many paths to recovery and gradually reducing alcohol use over time is actually the norm and is indeed possible. My colleagues and I are currently working on secondary analyses to better understand clinically meaningful reductions in cocaine use and opioid use during treatment.