People with psychosis are admitted more frequently to inpatient psychiatric units and have a longer length of stay once admitted compared to those with other psychiatric conditions. Cognitive Behavioral Therapy for psychosis (CBTp) reduces hospital admissions when delivered in outpatient settings and facilitates quicker symptom improvement when delivered in inpatient settings. Despite this, implementation of CBTp is exceedingly rare in practice. The purpose of this study is to test the feasibility and acceptability of a conjoint single-session CBTp intervention + FOCUS digital mental health intervention for people with psychosis admitted to inpatient psychiatry units.
Patient Population: Adults
Immune changes with neuropsychiatric symptoms in dementia
Though the focus of most research on dementia is the pathogenesis of cognitive deficits, neuropsychiatric symptoms (NPS) are identified in >90% of those afflicted, resulting in hastened cognitive decline, worsened general health, reduced patient and caregiver quality of life, sooner institutionalization, and increased mortality. Affective symptoms, including depression, are the most common NPS in Alzheimer’s Disease (AD), and are present in over half of patients. Using the in-depth clinical phenotyping of participants in the National Alzheimer’s Coordinating Center (NACC) with matched plasma samples, we propose to determine the correlation between select cytokines/chemokines and T-cell differentiation with depression in dementia.
THRIVE Study
This is a study of an app intended to support recent sexual assault survivors, called THRIVE. In a prior grant, we pilot tested THRIVE and found that it reduced risk for alcohol misuse and posttraumatic stress. In the first year of this grant, we aim to revise the app to increase usability and inclusivity. In the second through fifth years of the grant, we will conduct a larger randomized controlled trial of multiple versions of the app among college students who have experienced sexual assault in the past 12 weeks. This will allow us to identify the most effective and low-burden version of THRIVE. If we are successful in identifying a highly effective and efficient version of THRIVE, this intervention would represent a highly-scalable strategy to reduce the substantial burden of posttraumatic stress and alcohol misuse on student survivors and campus service systems.
Machine learning methods for identifying person-level mechanisms of alcohol use among sexual and gender minority intersections
The goals of the proposed research are to 1) distinguish sexual and gender minoritized (SGM) subgroups and intersections at heightened risk for alcohol use (AU; e.g., bisexuals and trans persons, SGM young women of color), 2) assess the role of state policies in moderating AU risk, and 3) delineate moderators and mechanisms of heightened AU across SGM populations within and beyond the coronavirus pandemic. Aim 1 will identify heterogeneity in substance use behaviors among SGM communities. It will then test race/ethnicity and age as intersectional moderators of SGM inequities and state-level policies impacting SGM communities that further differentiate AU risk among SGM groups. Findings will then be extended to address mediators and moderators of AU in the monthly AURP COVID-19 Participant Experience Survey (Aim 2) as well as the longitudinal, biennial data that extends beyond the pandemic into 2027 (Aim 3).
Implementing Contingency Management in Oregon-based Health Settings to Address Stimulant Misuse
The project supports delivery of an empirically-supported technical assistance package for implementing contingency management to improve treatment adherence among persons with stimulant use disorders.
Peer Engagement in Methamphetamine Harm Reduction with Contingency Management
This five-year trial tests a peer-led contingency management intervention as means of decreasing overdose and improving harm reduction behavior among people who use methamphetamine.
A multisite study of prenatal alcohol exposure: effects of inflammation and endocrine dysfunction in adulthood
Using a “whole body, whole lifespan” approach, we will investigate how alterations in the immune and endocrine systems induced by prenatal alcohol exposure may be key drivers of early-onset health and functional deficits in adults with fetal alcohol spectrum disorders.
Guiding opioid therapy University of Southern California (USC) / National Institute on Aging (NIA)
Patients on long-term opioid therapy are aging and now face magnified risk of harm with continued high-dose opioid use. These increased risks are due to age-related changes in drug metabolism, multi-morbidity, and polypharmacy. The dominant approach to mitigate these risks is to screen for aberrant patient opioid behaviors, with assessments like the Current Opioid Misuse Measure (COMM), so that clinicians can pre-empt misuse early through review of contractual opioid agreements or by lowering patient dosages. By focusing on opioid misuse alone, this strategy encourages forced opioid tapering that is associated with opioid overdose and mental health crisis. Many persons have mental health, trauma-related or polysubstance use disorders that need to be addressed. Directing clinician attention to the comorbid conditions associated with opioid misuse may promote safer and more effective care. Such an approach provides a broader understanding of the pain experience and may help address the reasons why patients use or misuse opioids.
The specific aims are: (1) to develop a simple experimental approach for the collection of clinical pain data and for assessing, preventing, and managing pain in later life through the electronic health record; and (2) to assess the comparative effectiveness of PainTracker, a set of questions that targets a broad range of problems associated with pain, in a randomized controlled trial.
Needs Assessment for Supporting Technology use and Harm Reduction (STaHR Study)
The proposed study entails a needs assessment to develop a program for Supporting Technology use and Harm Reduction (STaHR) among HF residents with lived experience of homelessness and substance use. This study will qualitatively explore HF residents’ technology literacy as well as their perspectives on barriers and facilitators to the use of technology, broadly, and for harm-reduction service provision. Then, with a community advisory board (CAB) made up of HF residents, staff, and management, we will inform and provide recommendations to HF management and leadership ways to improve HF resident technology use and engagement with online harm-reduction services.
eHaRT-A: adapting an in-person harm reduction for alcohol intervention into a telehealth platform
The unprecedented global pandemic has highlighted the digital divide and limited access to alcohol-related treatments among marginalized communities, specifically individuals with lived experience of homelessness. In line with the NIAAA health initiative seeking to integrate technology-based interventions among vulnerable populations, this study directly addresses this mission by proposing innovative methods (i.e., user-centered design + a community based participatory research framework) to adapt an in-person harm reduction for alcohol (HaRT-A) intervention into a telehealth platform (eHaRT-A) that can then be tested and successfully implemented into low-barrier Housing First settings. As healthcare continues to move more services online, it is essential to understand ways to successfully adapt and implement rigorously tested telehealth treatment services for marginalized communities to ameliorate alcohol-related harms.
