For our training program, research on co-occurring disorders (COD) is broadly defined as systematic studies focused on (a) behavioral, environmental, and neurobiological mechanisms related to understanding etiology and phenomenology of disorders of addiction and commonly co-occurring mental, behavioral or medical disorders, (b) development and evaluation of interventions of disorders that comprise COD, and (c) the study of health services systems that impact the implementation of interventions for disorders that comprise COD. Trainees are exposed to a broad, transdisciplinary agenda because we believe this is required if we are to expect our next generation of scientists and policymakers to bring more substantive enhancement to a system of care that fails many individuals with CODs. Our T32 program exposes trainees to research with humans and systems that range from studies that inform the development of innovative treatments to those that determine how to best impact health care systems and policy that can advance the implementation of such interventions in our communities.
The program directs these research efforts toward the challenges associated with COD by engaging multiple research groups at Dartmouth. The expertise of longstanding and new faculty spans behavioral and neurobiological mechanisms, development and proof of concept testing of innovative behavioral and pharmacological treatments, development of digital health applications to enhance access, outcomes and implementation, applied research on implementation of evidence-based practices, and analysis of health service systems. Knowledge of clinical approaches, their efficacy and limitations, and an understanding of the operations of the healthcare system provide invaluable information for determining the salience of the questions asked in our laboratory and clinical research studies. The structure of the program facilitates exposure to and integration of more than one discipline and more than one topic area. Creating such experiences is necessary, in our opinion, to develop a perspective that can most effectively address problems related to substance use and other commonly occurring disorders. We strive to develop young scientists with greater awareness of the depth of issues that science must address to effectively impact addiction and COD, who also develop broader areas of expertise seeking always to collaborate and include multi-disciplinary approaches to address their questions of interest.
More recently, our training program has become more focused on digital health research approaches to substance use and COD. The field of digital technology and health is rapidly evolving across the globe and our primary T32 faculty, who are all affiliated with the Center for Technology and Behavioral Health (CTBH: c4tbh.org), are positioned to lead the field of scientific research focused on leveraging digital technologies to advance our understanding of, prevention, assessment, and intervention for SUDs and behavioral health. Digital therapeutics can provide on-demand access to therapeutic support to help individuals learn new skills and access tools to help prevent or change unhealthy behavior or manage a medical condition in their daily lives. They also have the potential to ensure the delivery of evidence-based practices for SUD, MH or COD care with fidelity, while transcending geographic boundaries and providing on-demand support in a manner that does not require synchronous communication with a clinician. Harnessing digital technology in the treatment of COD can increase the quality, reach, and personalization of care. Further, the anonymity afforded by digital interventions may be appealing to individuals when addressing sensitive topics such as substance use, mental health issues, and other risk behavior. Last, offering interventions on mobile platforms has potential to overcome the disparities endemic to many traditional care models. And, digital therapeutics are arguably more timely and significant than ever, given the marked shift to remote models of SUD, COD and many other types of health care as a result of the COVID-19 pandemic.
In addition to bringing rigorous science to digital therapeutic research, our T32 faculty have expanded research on the measurement of drug use events (and other health behavior) and contextual factors surrounding these events using data captured via digital technology (e.g., digital phenotyping; passive mobile sensing). Smartphones and smartwatches are used to conduct passive, unobtrusive ecological sensing that provides continuous measurement of individuals’ behavior and physiology, such as sleep, social interactions, physical activity, electrodermal activity, and/or cardiac activity. This type of data provides rich information about an individual’s context (e.g., mood, behavior, pain, sleep, stress) that can then be used to support just in time digital interventions. Our faculty leverage social media data collection to enable a richer understanding of social networks, communications, and behavior, including drug use and mental health risk. Our faculty also seek to accelerate research on transdiagnostic digital treatments related to COD. These interventions demonstrate the transformative potential impact of digital health across many health domains (HIV, depression, anxiety, schizophrenia, PTSD, pain, binge eating, diabetes, or medical regimen adherence).
Training the next generation of researchers in digital health has become an important priority for advancement of public health and potentially addressing health disparities. Our T32 program embraces this mission and will provide high quality, comprehensive training in digital research methods for studies focused on substance use and COD. As mentioned above, our primary training faculty conduct much of their research in the digital health space. Our faculty and the CTBH’s growing international reputation in this area of science has been attracting high quality predoctoral and postdoctoral trainees with strong interests in digital assessment, therapeutics, and data analytics related to substance use and COD prevention, intervention, and health services research.