Substance use disorder and addiction are complex public health problems, vividly evidenced by the ongoing opioid epidemic throughout the country. Also, New Mexico has the highest alcohol-related mortality rate and currently races to address this as well as opioid and methamphetamine addiction rates. Few people understand the complexities of these issues better than Dr. Katie Witkiewitz, Regents' Professor in the UNM Department of Psychology.
“I love Albuquerque. I came to UNM to study these disorders. CASAA is internationally renowned for research and treatment of addiction” says Witkiewitz, who is originally from rural western New York. “I’m excited about the enthusiasm the University has shown for our passion on these topics.”
Witkiewitz is the co-lead convener, along with Dr. Brandi Fink an assistant professor in the Department of Psychiatry and Behavioral Sciences, under President Stokes’ Grand Challenges initiative on Substance Use Disorders. In addition, her colleagues at the Center on Alcoholism, Substance Abuse, and Addictions (CASAA) have secured further NIH funding as a result of partnerships made through the Grand Challenge. All told, these projects bring in over $7.4 million for research at UNM.
Interdisciplinary cooperation as well as partnerships between main campus and the UNM Health Sciences Center (HSC) are central to these projects. Witkiewitz emphasizes the importance of the freedom that the Grand Challenge provides to implement innovative pilot projects and is thrilled with the response of 90 researchers and clinicians across UNM who are eager to address the challenge of substance use disorders in New Mexico.
“Taking a whole-team collaborative approach to address a complex problem is incredibly challenging and is likely to be highly rewarding by directly impacting patients’ lives,” she says. “We look at addiction science from all angles, from brain research to treatment, cells to society, and prevention to policy.”
One of the funded projects wouldn’t have happened without the collaborative expertise among UNM faculty in Departments of Family and Community Medicine, Psychology, Psychiatry and Behavioral Sciences, and Emergency Medicine. This particular project, “Patient-Centered Team-Based Primary Care to Treat Opioid Use Disorder, Depression, and Other Conditions”, has far-reaching implications if successful. The project, awarded to Dr. Robert Rhyne at the UNM HSC with Witkiewitz as a co-investigator, will test a groundbreaking model of care management: providing people with depression and an opioid-use disorder with regular direct contact with a nurse over the telephone for a 12-month period.
The team, which is led by Kaiser Permanente Washington Health Research Institute and also includes collaborators at the University of Washington, will look at whether patients who receive nurse care management are more likely to receive medication treatment for their opioid-use disorder, and more likely to have significant reduction in symptoms of depression. This proactive approach may help patients stay engaged with their treatment options when compared to those who do not have this type of personal outreach from a nurse. If successful, this program could be implemented by federally funded, community-based health care providers in underserved areas.
A second grant led by Witkiewitz and Dr. Kevin Vowles at Queens University in Belfast, “Integrated Treatment for Veterans with Co-Occurring Chronic Pain and Opioid Use Disorder,” directly resulted from the Grand Challenges initiative and includes investigators from UNM HSC as well as the New Mexico Veterans Administration (VA) Health Care System, and the Puget Sound VA Health Care System.
The project brings together experts to test an innovative behavioral treatment for patients with chronic pain and opioid use disorder. When veterans come home from war with trauma and injuries, they are often treated with opioid pain medication, yet mounting evidence has shown opioids are not effective for the long-term management of pain. Indeed, long-term opioid use for pain often leads to addiction.
“Veterans are suffering a second injury of developing an opioid-use disorder from medications. We have effective behavioral treatments that can target pain and distress, as well as opioid use disorder,” explains Witkiewitz. “This trial will be the first of its kind to test an integrated behavioral treatment at multiple sites. As the wife and granddaughter of veterans, I am proud to serve our veterans in implementing and supporting this project.”
If successful in reducing opioid use disorder while reducing chronic pain symptoms, the integrated behavioral therapy will roll out nationwide to all VA health care systems.
In addition to these projects, the Substance Use Disorders Grand Challenge initiative have led to other new grants by CASAA investigators. Dr. Kamilla Venner, Assistant Professor in the Psychology Department, and Dr. Aimee Campbell, Associate Professor of Clinical Psychiatric Social Work (in Psychiatry) at Columbia University Irving Medical Center, co-lead the project “Culturally Centering Medications for Opioid Use Disorder with American Indian and Alaska Native Communities.”
The opioid overdose epidemic has disproportionately impacted Tribal communities and this project will develop a program-level intervention to support four clinical sites primarily serving American Indians and Alaska Natives to initiate or enhance delivery of medication treatment for opioid use disorder.
By working with the collaborative board, comprised of a diverse group of Native experts and stakeholders, the project centers treatment around the culture of the community viewing addiction within a holistic wellbeing framework. Community participation allows innovative solutions to take shape that will be aligned with American Indian Alaska Native perspectives and thus may increase uptake of the first-line treatment of medications for OUD to help decrease the health inequities.
“We have a collaborative board to help guide the development of the intervention to include cultural centering of medication treatment and implementation strategies,” says Venner. “Interacting with and learning from the collaborative board has been meaningful and productive, as well as a real joy of this work; we look forward to our ongoing partnership.”
In the state, there remains a continued need for more knowledge on how best to treat alcohol use disorders. Drs. J. Scott Tonigan and Matthew Pearson, investigators in the UNM Psychology Department and CASAA, also recently began their project, “Development of a Comprehensive and Dynamic Alcoholics Anonymous (AA) Model: One Day at a Time.” They hope to provide insight into activities, interactions, traditions, and other practices in AA programs and how these practices account for alcohol abstinence.
“This study adds significant value to the mission of the Grand Challenge initiative by documenting and disseminating information about how to optimize benefit from the most popular community-based approach for reducing alcohol problems in New Mexico and the United States,” says Tonigan.
With these research projects ongoing, Witkiewitz is well on her way to helping UNM achieve the Substance Use Disorders Grand Challenges goal to unite prevention, treatment, and policy in order to address the high social costs and human suffering brought on by substance use disorders.