Synopsis of Research and Related Activities
The UCLA Integrated Substance Abuse Programs (ISAP) conducts research, provides research training and clinical training, and arranges treatment for substance use disorders in coordination with the UCLA Department of Psychiatry and Biobehavioral Sciences and in affiliation with community-based treatment providers. ISAP efforts range from epidemiological and policy studies to basic science and human laboratory research to clinical trials of innovative behavioral therapies and pharmacotherapies. ISAP activities are briefly summarized below:
An extensive program of brain imaging research is coordinated with a program of cognitive and neuropsychological assessment, using imaging approaches (e.g., PET and fMRI) to study brain changes and physiologic responses to nicotine, methamphetamine, cocaine, and other substances.
Clinical Trials of Treatments for Substance Use Disorders
ISAP directs the Pacific Region Node of the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN). The Node includes a geographically and clinically diverse group of community treatment programs throughout California and Hawaii. In concert with other CTN nodes across the country, the Pacific Region Node conducts research on innovative treatments for substance use disorders. ISAP investigators are conducting clinical trials on behavioral approaches, including contingency management (in the United States and China), mindful meditation, aerobic exercise, technology-supported cognitive behavioral therapy, and traditional Native American healing approaches.
Consistent with NIDA’s increased emphasis on developing effective medications for substance use disorders, ISAP investigators have been instrumental in the development and implementation of several medications for opioid dependence, including buprenorphine for opioid dependence. Recent ISAP research on Probuphine®, the long-acting, implant formulation of buprenorphine, confirmed clinical utility of this new and important pharmacotherapy. A long-acting depot form of naltrexone (Vivitrol®) for opioid dependence was recently approved based on research involving ISAP Director Walter Ling, M.D. ISAP’s innovative development of pharmacotherapies for stimulant dependence includes buprenorphine for cocaine dependence as well as methylphenidate and a combination of bupropion and naltrexone for methamphetamine dependence.
Criminal Justice Populations
ISAP researchers have conducted comprehensive reviews of drug treatment in the criminal justice system and have examined treatment programs focused on women offenders and ethnic minorities under criminal justice supervision. Other work has investigated the differential effects of incarceration, parole, and methadone maintenance on drug use and criminal behavior, and has documented the effects of civil commitment and other forms of compulsory treatment. ISAP investigators have explored the relationship between drug use and crime, including outcomes of treatment for drug-using offenders and the role of drug use in perpetuating the cycle of crime among offenders. ISAP’s Pacific Coast Research Center is a component of the NIDA Criminal Justice Drug Abuse Treatment Services Research System, a nationwide effort to optimize treatment for drug-using individuals under criminal justice supervision.
Health Care Reform & Integration of SUD Treatment with Primary Care
As a result of the Affordable Care Act of 2010 (ACA), the substance use disorder (SUD) treatment field now faces the most significant and sweeping changes that it has experienced in decades. Access to SUD services is expected to expand dramatically through integration with primary care, particularly in settings such as federally qualified health centers. A growing body of literature suggests that patients receiving SUD services that are integrated with primary care have better outcomes and reduced costs relative to patients receiving non-integrated care. Through multiple contracts and grants ISAP is both studying the evolution of integration throughout the state and facilitating it through training and technical assistance activities.
Studies by M. Douglas Anglin (one of the ISAP founders) and William McGlothlin in the 1970s on the impact of methadone treatment initiated the UCLA tradition of studying how addiction treatment services impact the community and how the methods of delivering these services influence their effectiveness. Recently, ISAP researchers have been leading an extensive array of efforts on the integration of substance use disorder services into the broader primary care system. For example, screening, brief intervention, and referral to treatment (SBIRT) is an efficient approach that will improve identification and treatment of substance use disorders in the U.S. healthcare system.
Since the early 1980s, ISAP researchers have investigated HIV/AIDS among drug users and have participated in community-based interventions to combat HIV, including tracking long-term trends in risk behaviors among drug-using arrestees. A series of studies testing psychosocial predictors of HIV risk reduction led to the development of a culturally congruent HIV education program serving drug users in Los Angeles. Several NIDA-funded projects have evaluated the effectiveness of a variety of behavioral and pharmaceutical interventions designed to reduce risk of HIV infection among drug users. In addition, ISAP’s Health Risk Reduction Projects (HRRP) conducts HIV/AIDS behavioral research on children, adolescents, adults, and families. HRRP has examined the impact of maternal HIV/AIDS on children in an ongoing 15-year longitudinal study.
Implementation Science and Practice Improvement
A major focus of ISAP efforts is increasing the real-world application of research-proven treatment techniques, often termed “implementation science” or “research to practice.” Several ISAP projects have formed and supported networks of community-based treatment providers and researchers committed to improving the quality of interaction among service providers, policymakers, researchers, and members of the community. These efforts continue to provide educational activities, assist community programs with the use of evidence-based screening and treatment practices, and foster new collaborative projects in the community.
International Research and Training
ISAP personnel conduct extensive training throughout the world, disseminating research methods and proven clinical practices through their direct efforts and by hosting conferences. ISAP investigators carry out ongoing collaborative research and training efforts in Australia, China, Egypt, Iraq, Israel, Palestine, United Arab Emirates, South Africa, and Vietnam. ISAP coordinated the worldwide “Treatnet” capacity-building effort by the United Nations Office on Drugs and Crime to train clinical professionals in best practices regarding assessment and treatment of substance use disorders and related consequences. In addition, ISAP directors have contributed to United Nations/World Health Organization policymaking efforts to address global drug problems. ISAP also continues to offer training through the NIDA INVEST program for addiction medicine researchers and clinicians who engage in year-long fellowships at ISAP.
Natural History, Treatment Process, and Outcomes
ISAP is the lead organization or a participating member in major treatment outcome evaluations at the national level, across California, and in the Los Angeles area. Specific research projects focus on treatment effectiveness for dually diagnosed patient populations and development of enhanced strategies for engaging difficult-to-treat and special populations. These research efforts involve ISAP researchers who are expert in the design and application of advanced analysis techniques such as structural equation models, hierarchical linear models, latent curve models, and latent transition models. Incorporation of these techniques into ISAP investigations ensures rigorous research and reliable findings. Several publications produced by ISAP researchers have been used as guides for the application of statistical methods to social science research. Based on ISAP’s standing as the leading repository of expertise in longitudinal research on drug abuse, ISAP hosts the NIDA-funded Center for Advancing Longitudinal Drug Abuse Research.
A full array of evaluation and consultant services is provided by ISAP’s Program Evaluation Services, including needs assessment, culturally competent evaluation planning and study design, methods for improving priority scores of funding applications for projects with evaluation components, performance and outcomes monitoring, and evaluation data collection and analysis (including GPRA). ISAP assists in program evaluation at any stage, including helping programs secure grant funding and improve their programs during the proposal development stage. ISAP has evaluated numerous projects conducted locally by Los Angeles agencies, as well as around the nation, including a number of projects funded by state and federal grants. The numbers of sample participants in these projects range from 40 to 10,000. The evaluations vary in scope from outcome reports involving a small number of variables, such as retention and engagement in treatment, to complex analyses of multiple measures of performance and outcomes collected longitudinally.
Special Populations and Topics
ISAP researchers have examined patterns of substance use disorders and associated behaviors as they relate to individual/demographic characteristics, with recent work examining genetic-based variations. Research has shown that treatment can be more effective when designed to accommodate the unique needs of special populations, such as individuals who are dually diagnosed (with substance use disorders and mental health disorders), adolescents, the homeless, welfare recipients, the disabled, or gay, bisexual, and/or transgender populations. In addition, the engagement and retention of such persons in treatment require targeted efforts informed by research.
Substance Use Epidemiology
ISAP participates in several ongoing studies of substance use epidemiology and associated behaviors, including analyses of national representative databases (e.g., National Household Survey on Drug Use and Health, National Epidemiologic Survey on Alcohol and Related Conditions), and conducts analyses of statewide and local household survey and treatment utilization data. ISAP investigators participate (representing Los Angeles) in the NIDA-supported Community Epidemiologic Workgroup (CEWG), which meets biannually to report on continuing and emergent drug use trends using multiple sources of data, as well as in the biannual Substance Abuse Research Consortium (SARC), which reports on emerging drug-use trends and their policy-related implications for the State of California. ISAP investigators also conduct qualitative studies of emergent drug use trends and subpopulations, using focus groups, site visit observations, and in-depth interviewing.
Drug Policy Issues
Serving in an advisory capacity, senior members of ISAP have supported efforts of the U.S. Attorney General’s office, the White House Office of National Drug Control Policy, four directors of NIDA, the director of the Center for Substance Abuse Treatment (CSAT), and agencies and organizations in many states and counties. Senior ISAP scientists have provided expert testimony before Congress, state legislatures, the Food and Drug Administration, and the United Nations.
Training and Dissemination
Many ISAP professionals contribute to the UCLA education mission by providing coursework and lectures within the University. ISAP personnel also provide training in treatment protocols and research processes, delivering hundreds of workshops and presentations in the United States and abroad. ISAP’s NIH/NIDA-funded Drug Abuse Research Training Center supports annual fellowships for predoctoral and postdoctoral fellows. In addition, ISAP is the administrative home of the Pacific Southwest Addiction Technology Transfer Center (Pacific Southwest ATTC), one of 10 regional centers supported by the Center for Substance Abuse Treatment. The Pacific Southwest ATTC provides training, technical assistance, and collaborative promotion of empirically proven substance use disorders treatment practices. Like the CTN, the Pacific Southwest ATTC increases knowledge about and improves the delivery of effective treatments for substance use disorders. Recently, the Pacific Southwest ATTC has provided training on healthcare reform; integration of primary care and behavioral health services; screening, brief intervention, and referral to treatment (SBIRT); medication-assisted treatment for opioid and alcohol use disorders; and motivational interviewing. For the past five years, ISAP has partnered with the Los Angeles Department of Mental Health to provide comprehensive training and technical assistance to the local mental health clinical workforce on co-occurring substance use and mental health disorder screening and treatment intervention. ISAP researchers annually produce approximately 100 publications in peer-reviewed journals and present research findings at scientific meetings throughout the world.
The UCLA Alcoholism and Addiction Medicine Service, based at the Resnick Neuropsychiatric Hospital at UCLA, provides comprehensive, evidence-based assessment and treatment in a caring and confidential environment. The program is directed by ISAP’s Karen Miotto, M.D., and Larissa Mooney, M.D., and offers partial hospitalization and inpatient/detoxification services for patients with co-occurring substance abuse and major psychiatric illnesses, as well as an outpatient clinic. The program coordinates outpatient treatment with aftercare, which occurs at the ISAP-affiliated network of community-based outpatient clinics: Matrix Institute clinics, Tarzana Treatment Clinic, Friends Research Institute sites, and others. This clinical system supports patient care, teaching, research training, clinical training, and research activities.
Women's Substance Use Disorder IssuesISAP researchers are making significant contributions to the growing body of research on the particular needs of women substance users. These include studies of women in gender-specific treatment programs (e.g., the organizational characteristics of these programs, the evidence basis for treatment models, and treatment outcomes); outcomes of women and their children who come into contact with child welfare services; evaluations of programs developed for women offenders, both in correctional programs and community settings that involve innovative arrangements between corrections and treatment; and longitudinal examinations of gender differences in drug use, treatment, other service system interactions, and recovery over the life course. ISAP researchers also participate in numerous advisory boards for state and national policymakers on applying research findings to improve the delivery and outcomes of treatment for women with substance abuse disorders.