Addictions are an expanding and vital area of research here at Duke. In 2012, Duke Psychiatry instituted a new division specifically focused on Addictions Research and Treatment. More recently, the Duke Institute for Brain Science (DIBS) launched the first university-based addiction center to offer basic and translational neurobiological research toward the prevention, early intervention and treatment of addiction. The Center for Addiction and Behavior Change (CABC) will position Duke as a national and global leader in the field of addiction and behavior change scholarship, research and practice. We are proud to have many faculty members who study and treat addictions.
Our featured expert, Joe McClernon, PhD, specializes in understanding the neurobiological basis of drug craving and reward and developing new smoking cessation treatments. Dr. McClernon is an Associate Professor in Psychiatry and Behavioral Sciences and is the first Director of the Addictions Division. He also directs Triangle Smoking Studies and the Health Behavior Neuroscience Research Program and is a member of DIBS and the Duke/UNC Brain Imaging and Analysis Center.
I was a psychology major in college and honestly didn’t have much of a career plan beyond graduation. The first job I had was as a research assistant at Midwest Research Institute in Kansas City, MO working with a group that conducted research on tobacco use. I quickly developed a passion for research and liked the focus on a behavior with significant public health consequences. Smoking was particularly interesting given that 100% all smokers I talked to knew that smoking was killing them but at the same time had difficulty quitting. This made it seem like such an interesting problem—one that we still grapple with as a field to this day.
I think it’s changed tremendously over the last couple decades, due in large part to work that’s been done here at Duke. Overall, we have gained tremendous new knowledge of the neurobiology of addiction. This has happened both through work with animal models, but also in the field of human neuroimaging. Work in my own lab has explored how smoking withdrawal changes brain function and how this leads to relapse. Other investigators at Duke have investigated the neurobiology that underlies adolescent drug use and sex differences in drug use outcomes. We’ve seen similar advances in our understanding of the genetic basis of addiction. More than anything, we’ve seen an evolving recognition that addictions is more than simply physiological dependence—there are numerous factors that maintain addiction and lead to lapse and relapse including psychological, sensory and even cultural factors. Duke investigators have led the way in much of this new understanding. My own recent work is focusing more and more on how the environment influences addictive behaviors—at the neural and behavioral levels—and how we can use mobile technologies to deliver interventions to patients in the real-world.
On the research side, I want to see additional and increased focus on understanding the co-occurrence of addiction with other forms of psychiatric disease. Comorbidity between addiction and mental illness is the rule rather than the exception and takes a tremendous toll on health. At the same time comorbidity is less frequently addressed in our research and treatment. Duke has historically been a leading center for research focused on comorbidity and I hope to strengthen our work in this area with a new postdoctoral training program and targeted faculty recruitments. In addition, we’ve always been an international leader in tobacco research and I want that to continue. At the same time, we are exploring ways to ‘diversity our portfolio’ by building research programs focused on other drugs of abuse including stimulants, opiates and marijuana. Finally, I want to maintain and strengthen our ability to take what we know from behavioral, genetics and brain research and translate that work into novel and more effective treatments.
On the treatment side, we have a number of initiatives in the works. One big goal is to increase awareness of our addiction programs and to increase community access to these resources. We will be working with the director of the Duke Addictions Program, Dr. Ashwin Patkar, on this initiative. We are also actively collaborating with the Child and Family Division to increase and integrate our services to adolescents struggling with substance abuse problems and their families. Finally, this year we are starting to reach out to local addiction treatment programs in an effort to discuss common challenges and opportunities and how we can work together to better serve our community.
Future advances in addictions research and treatment will almost certainly be born from collaboration—and there are few other institutions in the world that provide such rich opportunities for, and support of, collaboration across disciplines. Our institutes: the Duke Institute for Brain Science, the Duke Global Health Institute and the Social Science Research Institute, just to name a few, are a tremedous resource. They provide the forums for cross-disciplinary discussions to occur as well as the resources, including pilot funds, to get new interdisciplinary efforts off the ground. One part of what attracted me to Duke and has kept me here for 12 years has been the opportunities to collaborate across disciplines. Most of my early mentors, Jed Rose, PhD and Jeannie Beckham, PhD, were engaged in this type of work and still are to this day. I want to continue that tradition by creating training and mentoring programs in the Addictions Division that focus heavily on developing the skills early career scientists need to successfully collaborate.