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I investigate pharmacological and behavioral treatments for addictions and co-occurring psychiatric disorders. My research has encompassed a broad segment of the translational spectrum, including early-phase clinical research on the neurobiological mechanisms and clinical effects of investigational drugs, larger-scale efficacy trials, repurposing of existing medications to target new indications or new populations, effectiveness studies conducted in real-world clinical settings, and identification of patient characteristics that predict response to a particular treatment (precision medicine).

Over the past decade I have investigated the therapeutic potential of serotonergic psychedelic drugs such as psilocybin and MDMA. Much of the current work in my lab focuses on the neurobiological and clinical effects of psilocybin in patients with addiction, including alcohol use disorder (AUD) and opioid use disorder (OUD). In patients with alcohol use disorder (AUD), we are using fMRI and objective tasks as well as self-report questionnaires to elucidate the effects of psilocybin on core domains of the AUD phenotype including incentive salience, negative affect, and executive functioning. We will evaluate the extent to which these effects account for clinical outcomes. We are also conducting a multi-site trial of the effects of psilocybin in patients with OUD who are receiving methadone but continue to use illicit opioids (e.g., fentanyl and heroin). Both of these studies recruit patients who are already receiving treatment in community-based treatment programs, which enhances the generalizability of the clinical results. In all of our research with psychedelic treatments, we are working to improve clinical trial methodology, aiming to improve our ability manage and account for the effects of unblinding, patient expectancies, and non-pharmacologic aspects of treatment.

Since the beginning of my career I have developed and studied treatments for patients who have substance use disorders as well as other co-occurring psychiatric disorders. I am particularly interested in identifying treatments that can work across diagnostic boundaries by acting on dimensional traits that underlie multiple diagnoses. In the psilocybin trials mentioned above, we are including many patients with mood and anxiety disorders in order to explore such transdiagnostic effects. Also, I am currently working with colleagues in the department of psychiatry on a trial of topiramate used to treat patients with AUD and co-occurring post-traumatic stress disorder (PTSD), evaluating the effects of the study drug on each of the two disorders. 

Finally, we are applying advanced machine learning approaches to identify likely responders to pharmacologic treatments. Currently we are using these approaches re-analyze data from completed alcohol use disorder trials. On completion of the studies mentioned above, we will also apply these methods to identify likely responders to topiramate used to treat co-occurring alcohol use disorder and PTSD,  psilocybin used to treat AUD, and psilocybin used to treat OUD.