Addictions; Family Medicine
Board Certified in Addiction Medicine by the American Board of Addiction Medicine Board Certified in Family Medicine by the American Board of Family Medicine
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; 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.
Addictions; Family Medicine
My practice at UBMD Family Medicine is focused on treating patients with substance dependency and on preventing addiction. My responsibilities with UBMD include collaborating with Horizon Health Services and Renaissance Addiction Services, Inc. (RASI) as medical director for these Western New York organizations. Both provide rehabilitation services in supportive residential environments to help patients stabilize from drug and/or alcohol withdrawal. I take an interdisciplinary approach in my work and collaborate with expert colleagues in social work, psychiatry and pain management to arrive at the best possible care for my adolescent and adult patients. Prior to expanding my training to specialize in addiction medicine, I practiced medicine as a primary care physician trained in both functional medicine and medical acupuncture, which I incorporated into a holistic practice. My motivation to concentrate in the addictions field was in part driven by my own personal and family history. I realized that my experience and insights are valuable assets to recognizing and treating the common, often fatal, yet treatable disease of addiction. Using my background in functional medicine, I take a comprehensive, patient-centered approach to address the underlying causes of addiction, looking at the interactions among genetic, environmental and lifestyle factors that can influence the long-term health of individuals with this complex and chronic disease. I spend time with my patients in a comfortable setting, listening to their histories and engaging them in a therapeutic partnership that addresses their needs. The science behind understanding addictions and related behavioral disorders is fascinating and rapidly expanding. Addiction affects individuals and families and has far-reaching societal effects. As such, preventing addiction is also an important part of my work. I collaborate with UB’s Department of Pediatrics to educate children and adolescents in order to prevent addiction—an approach that is more successful than focusing on end-stage disease, the treatment modality that has been the norm for decades. As a faculty member in the Department of Family Medicine, I am dedicated to educating others and to contributing to the field through research and community involvement. I teach medical students and residents: I coordinate the curriculum for the Addiction Medicine elective for them and enjoy having them on site with me for rotations. And as program director for the department’s Addiction Medicine Fellowship, I work with the Buffalo-based National Center for Addiction Training to advance this discipline and maintain high standards for educating and preparing future fellows for American Board of Addiction Medicine (ABAM) certification. The center’s mission helps equip future physicians with the best knowledge to identify signs and symptoms of addiction in its earliest stages--or possibly prevent it altogether.
Addictions; Family Medicine
As a family medicine physician, I am committed to the primary care of patients of all ages. My practice is focused on preventive care and the care of patients with chronic conditions such as diabetes, hypertension, heart and lung diseases and endocrinological issues. I also care for patients with addictions to alcohol, opioids and benzodiazepine use. I care as well for patients admitted to the Erie County Medical Center (ECMC), to the hospital’s family medicine service and its inpatient detoxification and rehabilitation units. As the medical director of ECMC’s family health center, a patient-centered medical home, I work to ensure patient care safety and quality. I teach and train medical students and residents at all levels of learning. I teach medical students in small group settings within the Jacobs School and in clinic and inpatient settings. I supervise residents in the outpatient clinic and during inpatient rotations. I involve residents in practice transformation activities through journal clubs, case conferences and readmission reviews on patients in high-risk categories. I share individual feedback with my residents so that they can learn to improve their performance and get ready for their future practices. In addition to daily teaching, I participate in lectures during group and site-specific teaching sessions. I am involved as well in learning about personalized medicine, an evolving field of medicine in which patient data related to genetics, microbiome and environmental factors are used to develop diagnostic and treatment strategies for a patient. As a primary care physician and teacher, I am learning all I can about this developing area of medicine. I am also sharing my experience with my residents and medical students so that they can learn as well.
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.