Anxiety is a risk factor for the use of opioids and anxiety disorders are highly prevalent among individuals with opioid dependence. Moreover, individuals with co-occurring opioid dependence and anxiety disorders often experience poorer drug use, anxiety, and functional outcomes following treatment. Despite the links between opioid dependence and anxiety disorders and the risk associated with their co-occurrence, very little is known about this common dual diagnosis, and efficacious treatment options have yet to be established. Dr. Rebecca Kathryn McHugh's career goal is to conduct patient-oriented research focused on the co-occurrence of substance dependence and anxiety disorders. The integrated training and research plans proposed in this application will provide Dr. McHugh with advanced training in several critical areas needed to enhance her program of research toward this career goal. Under the mentorship of internationally renowned leaders in the field of substance dependence, training is targeted to the following domains: (1) clinical research in co- occurring disorders (Dr. Roger Weiss), (2) the nature and treatment of opioid dependence (Dr. Weiss), (3) behavioral treatment development and testing (Dr. Shelly Greenfield), (4) the role of stress in substance dependence (Dr. Rajita Sinha), and (5) longitudinal data analytic techniques (Dr. Garrett Fitzmaurice). These training objectives will be achieved through a combination of didactic and applied activities and through the application of these skills in a Stage 1 behavioral treatment development trial involving the development and pilot testing of a novel integrated cognitive behavioral treatment for co-occurring opioid dependence and anxiety (I-CBT). Target areas for learning in each training domain are directly linked to the specific aims of this researc study, which include (1) the development of an integrated cognitive behavioral treatment manual for opioid dependence and anxiety disorders (I-CBT), (2) pilot testing the efficacy of I-CBT for reducing opioid use and anxiety symptoms compared to standard CBT for opioid dependence, (3a) the examination of the association between pre-treatment reactivity to stress and opioid use outcomes following treatment, and (3b) the examination of changes in stress reactivity following treatment. McLean Hospital and Harvard Medical School provide an ideal environment for the attainment of these training and research objectives, including clinical units supportive o patient-oriented research, seminars and courses in designating training areas, and a highly active Clinical and Translational Science Center with a wide array of resources for career development and training. This K23 Award would provide Dr. McHugh with a repertoire of advanced skills designed to complement her prior training and to provide an essential bridge between her prior experience and her career goal to conduct an active program of patient-oriented research as an independent scientist, toward the ultimate goal of reducing the public health burden of substance dependence and anxiety disorders.

Public Health Relevance

Anxiety disorders are highly prevalent among individuals with opioid dependence and confer greater risk for continued drug use and poor treatment outcomes. However, there are currently no efficacious treatments available for co-occurring opioid dependence and anxiety disorders. Enhanced understanding of the underlying mechanisms and optimal treatment strategies for co-occurring opioid dependence and anxiety disorders will help to reduce the burden of this significant public health problem on individuals, families, and societies.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Mentored Patient-Oriented Research Career Development Award (K23)
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Risk, Prevention and Intervention for Addictions Study Section (RPIA)
Program Officer
Aklin, Will
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Mclean Hospital
United States
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McHugh, R Kathryn; Votaw, Victoria R; Sugarman, Dawn E et al. (2018) Sex and gender differences in substance use disorders. Clin Psychol Rev 66:12-23
Mackie, Susan E; McHugh, R Kathryn; McDermott, Katherine et al. (2017) Prevalence of restless legs syndrome during detoxification from alcohol and opioids. J Subst Abuse Treat 73:35-39
Votaw, Victoria R; Wittenauer, Justine; Connery, Hilary S et al. (2017) Perceived risk of heroin use among nonmedical prescription opioid users. Addict Behav 65:218-223
Medlock, Morgan M; Rosmarin, David H; Connery, Hilary S et al. (2017) Religious coping in patients with severe substance use disorders receiving acute inpatient detoxification. Am J Addict 26:744-750
McHugh, R Kathryn; Gratz, Kim L; Tull, Matthew T (2017) The role of anxiety sensitivity in reactivity to trauma cues in treatment-seeking adults with substance use disorders. Compr Psychiatry 78:107-114
McHugh, R Kathryn; Votaw, Victoria R; Barlow, David H et al. (2017) Development of an integrated cognitive behavioral therapy for anxiety and opioid use disorder: Study protocol and methods. Contemp Clin Trials 60:105-112
McHugh, R Kathryn; Votaw, Victoria R; Fulciniti, Francesca et al. (2017) Perceived barriers to smoking cessation among adults with substance use disorders. J Subst Abuse Treat 74:48-53
McHugh, R Kathryn; Votaw, Victoria R; Bogunovic, Olivera et al. (2017) Anxiety sensitivity and nonmedical benzodiazepine use among adults with opioid use disorder. Addict Behav 65:283-288
Griffin, Margaret L; McDermott, Katherine A; McHugh, R Kathryn et al. (2016) Longitudinal association between pain severity and subsequent opioid use in prescription opioid dependent patients with chronic pain. Drug Alcohol Depend 163:216-21
Marcovitz, David E; McHugh, R Kathryn; Volpe, Julie et al. (2016) Predictors of early dropout in outpatient buprenorphine/naloxone treatment. Am J Addict 25:472-7

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