The UCLA Integrated Substance Abuse Programs (ISAP), organized within the Department of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA, works to:
The UCLA Integrated Substance Abuse Programs (ISAP) conducts research, provides research training and clinical training, and arranges treatment for substance use disorders (SUDs) in coordination with the UCLA Department of Psychiatry and Biobehavioral Sciences and in affiliation with community-based treatment providers. ISAP efforts range from clinical trials of innovative behavioral therapies and pharmacotherapies to epidemiological studies, as briefly summarized below:
ISAP directed the Pacific Region Node of the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) from 1999 to 2015. The Node included 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 conducted research on innovative treatments for SUDs. ISAP investigators have conducted 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 SUDs, ISAP investigators have been instrumental in the development and implementation of several medications for opioid addiction, including buprenorphine for opioid dependence. Recent ISAP research on the long-acting, implant formulation of buprenorphine confirmed clinical utility of this new and important pharmacotherapy. A long-acting injectable form of naltrexone for opioid addiction was approved based on research involving ISAP founding director Walter Ling, M.D. ISAP's innovative development of pharmacotherapies for stimulant use disorders includes buprenorphine in combination with depot naltrexone for cocaine dependence, as well as methylphenidate and a combination of bupropion plus depot naltrexone for methamphetamine dependence.
To provide a dedicated community-based setting for NIH-funded clinical trials, in 2005 ISAP created the UCLA ISAP Outpatient Clinical Research Center (OCRC), which was fully equipped and staffed for conduct of Phase II, III, and IV research on pharmacotherapies, including innovative new medications in development by pharmaceutical companies. The facility, which was in operation for 10 years, uniquely blended academically affiliated research capacity in a community setting, fostering real-world research that increased relevance and utility of findings.
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, and have examined the feasibility and clinical utility of providing depot naltrexone to released prisoners who have a history of opioid use disorder to inhibit relapse.
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.
As a result of the Affordable Care Act of 2010 (ACA), the SUD treatment field faces increasingly significant changes. 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 has studied the evolution of integration throughout the state and facilitated service integration through training and technical assistance activities.
Studies on the impact of methadone treatment conducted in the 1970s by ISAP co-founder M. Douglas Anglin initiated the UCLA tradition of exploring how addiction treatment services impact the community and how the methods of delivering these services influence their effectiveness. Recently, ISAP researchers have led an array of efforts on the integration of SUD services into the broader primary care system. For example, screening, brief intervention, and referral to treatment (SBIRT) is an efficient approach that seeks to improve identification and treatment of SUDs 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 20-year longitudinal study. ISAP research and training has promoted the integration of HIV pharmacotherapy and opioid agonist pharmacotherapy (buprenorphine and methadone) for addicts in many regions of the United States, and new projects in China and Vietnam are taking these advanced approaches to areas with high prevalence of HIV and addiction.
ISAP personnel conduct extensive training throughout the world, disseminating research methods and proven clinical practices through their direct efforts and by hosting conferences where clinical trainings take place and research-proven practices are disseminated. ISAP investigators carry out ongoing collaborative research and training efforts in Australia, China, Egypt, Iraq, Israel, Palestine, United Arab Emirates, South Africa, Taiwan, 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 SUDs 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.
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 in social science research. Based on ISAP's standing as the leading repository of expertise in longitudinal research on drug abuse, ISAP hosted the NIDA-funded Center for Advancing Longitudinal Drug Abuse Research (CALDAR). CALDAR work has extended to China, Taiwan, and other parts of Asia and Pacific Island regions in the form of conferences and special trainings provided by CALDAR investigators and technical experts.
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 in the NIDA-supported Community Epidemiologic Workgroup, 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.
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 pre-doctoral and postdoctoral fellows. In addition, ISAP is the administrative home of the Pacific Southwest Addiction Technology Transfer Center (PSATTC), one of 10 regional centers supported by the Center for Substance Abuse Treatment. The PSATTC provides training, technical assistance, and collaborative promotion of empirically proven substance use disorders treatment practices. Like the CTN, the PSATTC increases knowledge about and improves the delivery of effective treatments for substance use disorders. Recently, the PSATTC 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 several 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 SUD 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 Addiction Medicine Clinic, based at the Resnick Neuropsychiatric Hospital at UCLA, provides comprehensive, evidence-based assessment and treatment in a caring and confidential environment. The program, which is directed by ISAP's Larissa Mooney, M.D., offers partial hospitalization and inpatient/detoxification services for patients with co-occurring substance abuse and major psychiatric illnesses, as well as intensive outpatient programs. The program coordinates outpatient treatment with aftercare, which has occurred 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.