Addictions; Internal Medicine
I work full- time in Addiction Medicine. My patient clientele are those with Addiction related issues (Alcohol, opiates, benzodiazepines, etc) that need Medically Assisted Treatment. I am a Buprenorphine prescriber, and I also work at a Methadone clinic. For patients requesting help, please call the 716 – 247 -5281 number.
Addictions; Drug abuse; Behavioral pharmacology; Gene therapy; Molecular and Cellular Biology; Neurobiology; Gene Expression; Neuropharmacology
My laboratory seeks to understand the neurobiology of motivation and how these systems can be "highjacked" by abused substances. Substance abuse and addiction are wide-spread problems that have an enormous economic and emotional toll. Reports indicate that it costs the US upwards to $600 billion a year to deal with the health and criminal consequences and loss of productivity from substance abuse. Despite this, there are few effective treatments to combat this illness. The brain has natural systems responsible for motivating an organism to participate in behaviors that are necessary for survival, such as eating, exercise and reproduction. These same brain regions are highly sensitive to drugs of abuse, including cocaine, heroin and marijuana. My laboratory seeks to understand how these brain regions are affected by exposure to abused drugs, and in particular how the motivation to take drugs is altered by various molecular mediators in the neurons on these regions. The two basic questions we are interested in are 1) how projections from the cortex to the striatum influence drug seeking behaviors, and 2) how neurotransmitter receptors, particularly dopamine and cannbinoid receptors in these regions influence drug seeking. Our technical approaches include a number of basic behavioral models including measurements of locomotor activity, catalepsy, conditioned place preference and drug self-administration. In order to probe the circuitry of these brain regions, we use a number of advanced molecular techniques to activate and inactivate neuronal populations including optogenetics and artificial receptors. We probe the molecular pathways within the neurons by over expressing genes or knocking down expression using RNA interference. Gene delivery is accomplished using recombinant adeno-associated virus (rAAV) and several projects in the laboratory focus on improving this approach and exploring potential gene therapy applications for these vectors. The ultimate goal is to understand the basic neurobiology and molecular biology of addiction in order to develop more effective treatments for addiction.
Addictions; Family Medicine
I care for patients admitted to Erie County Medical Center (ECMC) and the Terrace House residence at Horizon Health Services as they withdraw and stabilize from drug and/or alcohol addiction. I also see patients at the UBMD addiction medicine ambulatory care office on Sweet Home Rd. There, I care for patients addicted to prescription opiate medications, alcohol or heroin and for patients with chronic pain syndromes who are addicted to prescription drugs. In addition, I am a consultant at the student health center on the Buffalo State College campus, seeing patients who are referred to me for evaluation of a possible or previously diagnosed substance use disorder. I have an active research portfolio and focus on three main areas of study. I investigate clinical protocols for patients who have a chronic pain disorder that coexists with a prescription drug addiction. I aim to find ways to control pain in these patients while keeping them engaged in treatment for their addiction. In collaboration with the Center for Development of Human Services (CDHS) at Buffalo State College, I investigate clinical management strategies for pregnant women who have a prescription drug addiction. I seek solutions that will help ensure effective treatment—and help ensure these patients stay in treatment—toward the goal of successful newborn deliveries. I also conduct educational research related to the best practices for training physicians on addiction medicine topics, coordinating this work with the American Board of Addiction Medicine (ABAM). Our objective is to ensure that addiction medicine physicians receive appropriate training, particularly as it relates to their role in preventing alcohol and drug addiction and identifying the beginning stages of substance problems. I teach medical students, family medicine residents and psychiatry and addiction medicine fellows. During the summer, I mentor medical students conducting clinical research. Under a contract with ABAM, I work with UB colleagues to coordinate the national effort to develop addiction medicine fellowship programs and to standardize the curriculum offered in these programs. I conduct training sessions for Buffalo State College nurse practitioners, athletic directors and counselors to help them identify and intervene with students at risk for, or who manifest the early signs of substance use problems.
Addictions; Drug abuse; Public Health and General Preventive Medicine
Dr. Dermen’s research agenda comprises two overarching goals. The first is to improve understanding of factors and processes that influence health-related behavior. In this area, his primary focus has been on testing theoretical models of health-related behavior, including alcohol and other drug use, risky sexual behavior and sexual aggression. The second goal of his research program is to improve behavioral methods and technologies for health promotion, prevention and treatment. In this domain, his primary focus has been on developing, evaluating and disseminating motivational and behavioral interventions for treatment of substance use disorders and for health risk reduction and health promotion in substance-using populations. His efforts have involved testing methods to facilitate AA involvement in treatment for alcohol use disorders, identifying factors that affect dissemination of an empirically-supported treatment innovation, developing and piloting a brief motivational intervention to promote oral health in the context of inpatient treatment for alcohol use disorder, and testing the impact of a protocol for tailoring treatment for alcohol use disorder on the basis of clients’ pretreatment drinking trajectories. Most recently, he has begun work on creating a web-delivered, motivational interviewing-based intervention to promote oral health.
Addictions; Drug abuse; Behavioral pharmacology; Cytoskeleton and cell motility; Gene Expression; Gene therapy; Neurobiology; Neuropharmacology; Signal Transduction; Transcription and Translation
Drug addiction is a disabling psychiatric disease leading to enormous burdens for those afflicted, their friends and family, as well as society as a whole. Indeed, the addict will seek out and use illicit substances even in the face of severe negative financial, family and health consequences. It is believed that drugs of abuse ultimately “hijack” the reward circuitry of the CNS leading to cellular adaptations that facilitate the transition to the “addicted” state As is the case with both rodent models of drug taking, and well as throughout the global human population, not all individuals exposed to drugs of abuse will meet the classical definition of being truly “addicted”. We are looking at how molecular and behavioral plasticity mediates susceptibility to drug abuse and relapse like behaviors.
Research in our lab has largely focused on the bidirectional relationships between alcohol and social/interpersonal relationships. One of the specific questions that we have addressed is whether excessive alcohol use is a factor in bar violence, intimate partner violence, parenting behavior, and child outcomes. We have conducted this research on experimental, marital and parent-child interaction, event-based, and longitudinal studies and have made important theoretical and empirical contributions to our understanding of alcohol and adverse social outcomes. A second question that we have addressed is the individual difference, intimate partner, and social relationships that influenced alcohol and substance use among young adults. Our research has shown that over the transition to marriage, marital satisfaction plays a pivotal role in the reduction of heavy drinking, both directly as well as indirectly by leading to changes in the social network. Moreover, our research has demonstrated the importance of discrepant substance use patterns as predictors of marital disruptions.
Addictions; Gastroenterology; Internal Medicine; Liver (Hepatology); Infectious Disease
I care for patients with liver disease and addiction disorders, including opiate dependency, viral hepatitis, alcoholic and fatty liver disease, in an outpatient setting at Erie County Medical Center where I am the medical director of hepatology. In collaboration with the division of infectious diseases, I also evaluate and treat patients with hepatitis C virus (HCV) and HIV co-infection. I also treat veterans with opiate dependency at the Buffalo VA Medical Center, in the addiction medicine unit. My patient-care efforts include digital outreach: I co-authored an article for the inaugural issue of the patient-oriented online magazine “HCV Next.” My research involves improving hepatitis C treatments in populations disproportionately affected by HCV but with limited access to health care (including many American veterans, ethnic minority groups, injection drug users, and patients with psychological disorders) as well as developing novel modalities to deliver care. The goal of my research is to expand HCV treatment services to a wide-ranging group of patients, especially those without immediate access to care, in an effort to reduce global disease burden. This may include training primary care or other providers to treat HCV and using telemedicine and co-localization as a way to increase treatment uptake in areas such as rural primary care clinics and methadone clinics. My team is also investigating barriers to hepatitis C screening and treatment. Using the data we collect (e.g., patients’ knowledge of the disease, their perceptions regarding treatment, their willingness to be treated), we can design initiatives to improve patient-based HCV education and work toward the goal of increasing treatment uptake. This component of my research also looks at the same issues on the provider side: provider HCV knowledge and screening, referral and treatment practices. These data will help us understand what the provider-level barriers are to disease control, and we can design provider-based HCV educational initiatives to improve screening and referral for care. I am also a co-investigator on numerous clinical trials related to new therapeutic agents for hepatitis C and fatty liver disease, including a study funded by the Centers for Disease Control and Prevention (CDC) to evaluate the use of telemedicine to treat HCV in methadone maintenance clinics. I present and lecture nationally about hepatitis C with an emphasis on opiate dependence and special populations. I am a member of the New York State Hepatitis C Demonstration Project expert panel. I teach medical students in small group settings in the area of gastroenterology and hepatology. I also precept internal medicine residents and gastroenterology fellows in the outpatient clinics.
Addictions; Public Health and General Preventive Medicine; Behavioral Medicine
I was trained as an experimental social psychologist but my research has involved the use of multiple methodologies including laboratory studies, longitudinal survey studies, and daily diary studies. My primary research interests are in the area of behavioral health, in particular (1) the relationship of substance use and misuse to aggression, relationship conflict, and social functioning and (2) psychological and social variables that influence quality of life among people with chronic medical disorders (IBS, cardiac arrhythmia etc).