The Addiction Psychologist

In December of 2020, the US House of Representatives passed the Marijuana Opportunities Reinvestment and Expungement (MORE) act, which removes marijuana from the list of scheduled substances under the Controlled Substances Act and eliminates criminal penalties for an individual who manufactures, distributes, or possesses marijuana. Although the bill is unlikely to survive the Senate, it seems to be a matter of time before some version of this bill does pass. There has been growing interest in decriminalizing and legalizing cannabis in on the state level in the United States and in many countries around the world, and many around the country support the action. It is increasingly important to understand the impact of cannabis legalization. How will the impact of federal legislation be different from that of state legislation? How will cannabis legislation impact the epidemiological harm of cannabis use? How can psychologists contribute to this legislation to minimize costs and maximize benefits oft he legislation? Dr. Alan Budney discusses the likely effects of cannabis legislation and outlines what we still do not know about cannabis. Dr. Alan Budney is a Professor of Psychiatry in the Geisel School of Medicine at Dartmouth College.

Self control is thought to be closely associated with the ability to abstain or regulate substance use and is just one aspect of self-regulation, or the ability to organize behavior toward a goal. Many have suggested that self-regulation is damaged in those with chronic patterns of harmful substance use. However, it has also been noted that substance use itself is a highly goal directed behavior and requires self-regulation. Kyle Walters discusses his work on the interaction between self-regulation and the environment and suggests that this relationship may not be as simple as we once thought. Kyle also briefly discusses his forays into Network Analysis as an alternative approach to traditional conceptualizations of psychopathology.  Kyle Walters is a doctoral candidate in the Department of Psychology at the University of South Dakota.

There are two competing paradigms attempting to explain the phenomena of addiction: Addiction as compulsion and addiction as choice.  The compulsion model describes addiction as a brain disease in which alcohol and drug use cause neuroadaptations, resulting in uncontrolled drug seeking behavior. The choice model describes addiction as pathology of reinforcement that is contextually dependent upon the availability of meaningful and rewarding alternatives in the choice environment. Dr. Matt Field describes each model and their respective bodies of research.  Dr. Matt Field is a Professor in the Department of Psychology at University of Sheffield.

Research and theory have led to the development of empirically-supported options for SUD treatment, both psychosocial and pharmacological. However, these treatments only have moderate efficacy/effectiveness, and some aspects of treatments may be more implicated for some than others. Tori Votaw talks about precision medicine, which is determining which treatments work best for subgroups of individuals. Specifically, Tori discusses her work in understanding phenotypes of addiction such as negative emotionality and executive functioning that may help classify individuals into different specific treatment approaches.  Tori Votaw is a graduate student and T32 predoctoral fellow in the Department of Psychology at the University of New Mexico.

E-cigarettes have increased in prevalence over the past decade and provided a powerful alternative to tobacco products like cigarettes. E-cigarettes have the potential to be addictive in part because qualities that are typically inherent to a substance (e.g., flavor, "harshness") can actually be modified to increase the reinforcing efficacy of the nicotine from the e-cigarettes. However, the full picture of both acute and chronic consequences are yet to be understood.  Dr. Adam Leventhal provides an overview of the science of e-cigarettes and vaping, including what we now about it's harm and addictive potential. He also discusses his work regarding the regulation "sweet spot": making it appealing enough for cigarette smokers to want to start using e-cigarettes, but aversive enough to prevent uptake among at-risk groups, such as adolescents. He also discusses how to develop a research career that has a focus on public health impact. Dr. Adam Leventhal is a Professor in the Department of Preventive Medicine and Psychology in the Keck School of Medicine at the University of Southern California. He is also the Director of the USC Institute for Addiction Science and Health, Emotion & Addiction Laboratory; a new Fellows Chair in the APA Division on Psychopharmacology and Substance Abuse (Division 28); and a recently appointed member of the Tobacco Products Scientific Advisory Committee for the Food and Drug Administration.

Alcohol use is a burden on the healthcare system and is among the leading causes of preventable deaths in the United States. There are eleven possible Alcohol use Disorder (AUD) symptoms and only two are required, resulting in a wide range of possible combinations of symptoms and thus widely divergent profiles of individuals with AUD. Further,  not all of the AUD symptoms are equally severe, and two individuals with two symptoms each may have completely different levels of severity. Despite these issues, many of our research and clinical decisions are made based on AUD clinical cutoffs. Cassie Boness talks about her work in understanding the diagnostic issues with AUD, including how she has used cognitive interviewing to better understand how people are understanding the symptoms of AUD. Cassie Boness is an intern at Western Psychiatric Hospital at the University of Pittsburgh Medical Center. 

Racial disparities in prevalence rates of harmful substance use can largely be attributed to social determinants of health, which are perpetuated by racist policies that have been implemented over the past century. The clearest example can be found in the policies related to Nixon's War on Drugs, which criminalized drug use, increased drug enforcement forces across the nation, and specifically targeted Black communities. More generally, the definition of addiction and its recovery has been determined by white scientists, religious figures, and politicians without regard to the Black community or other groups. Dr. Ayana Jordan discusses racist drug policy and the problems facing individuals in the Black community who struggle with addiction. She then discusses her work that seeks to eliminate disparities: first, by creating scaffolding for those going through white-centric treatment; and second, by creating treatments designed for Black individuals. Dr. Ayana Jordan is an Assistant Professor and the Associate Residency Program Director in the Department of Psychiatry at Yale University School of Medicine. She is also an Addiction Psychiatrist and Attending Physician at Connecticut Mental Health Center.

The academy systematically excludes members of certain groups, leading to underrepresentation of those who identify as of Black, indigenous, and people of color. Keanan Joyner discusses the leaky pipeline and provides specific actionable steps that can help increase representation in your academic department. Keanan Joyner is a doctoral student at Florida State University and a Ford Fellow.

Some research demonstrates that rats will self-administer dangerously high levels of drugs under certain schedules of reinforcement. However, much of this research has been done under conditions of depravity, in which the rat does not have any access to alternatives. Humans almost always make choices between a menu of options, suggesting a different, more dynamic choice context with competing reinforcers. Keanan discusses his work in this area, in addition to the importance of confirming self-report findings by using multimethod approaches, such as psychophysiology. Keanan Joyner is a doctoral student at Florida State University and a Ford Fellow. 

Most definitions of recovery from addiction require abstinence from the problem substance. Dr. Katie Witkiewitz discusses the limitations of abstinence-based models of recovery and describe why non-abstinent models may have a positive public health impact. Namely, Katie's research suggests that many people regain functioning in interpersonal, occupational, and health domains without achieving full abstinence, and that these definitions actually prevent people from seeking treatment. Katie outlines the benefits of incorporating non-abstinent recovery options alongside the dominant abstinent model, and also shares NIAAA's preliminary definition of recovery from alcohol. Dr. Katie Witkiewitz is the Regent's Professor in the Department of Psychology at the University of New Mexico. She is also a Scientist at the Center on Alcoholism, Substance Abuse & Addictions (CASAA), and the Technology Committee Chair for the Society of Addiction Psychology.