Robert Ross MacLean

Yale University | YU · Department of Psychiatry

Medication assisted treatment (MAT) is highly effective in reducing illicit opioid use and preventing overdose in individuals with opioid use disorder (OUD); however, treatment retention of patients engaged in MAT is a significant clinical concern. The experience of stress may contribute to a decision to drop out of treatment. The current study is...

Introduction: Although cigarettes and alcohol are frequently used together, few studies have evaluated evidence of attentional bias to both smoking and alcohol cues. Attentional bias (AB) is defined as preferential attention to drug-specific cues and is most often studied in a laboratory with one cue type. AB may be an important mechanism associat...

Objective: To evaluate measurement and associations between pain severity and opioid craving in individuals with chronic pain on long-term opioid therapy and/or with opioid use disorder. Study design: . Systematic review of randomized controlled trials and observational studies. Methods: . The PubMed, EMBASE, and PsycINFO databases were search...

Menthol is the only available flavor in combusted tobacco cigarettes; however, e-cigarettes are available in thousands of flavors. Research on flavors and rewarding properties of nicotine is limited. The present study sought to examine the acute rewarding effects of flavors inhaled from an e-cigarette, in combination with intravenous (IV) nicotine...

Purpose of Review Chronic pain among individuals diagnosed with opioid use disorder (OUD) receiving opioid agonist treatment (OAT) is common. We review extant literature on the impact of chronic pain on OAT outcomes (i.e., illicit opioid use and OAT retention). Recent Findings We found 13 manuscripts using 9 datasets. The relationship between chro...

Background: Chronic pain and problematic substance use are commonly co-occurring and highly detrimental issues that are especially prevalent in U.S. veteran populations. Although COVID-19 made clinical management of these conditions potentially difficult, some research suggests that certain veterans with these conditions did not experience this pe...

Background: Despite high co-occurrence, chronic pain is often unaddressed in treatment for opioid use disorder (OUD) and little is known about mechanisms that may underlie associations between pain and opioid use. Using an attentional bias (AB) task with both pain and opioid cues, we evaluated a cognitive bias modification (CBM) task administered...

Objective: Cognitive behavioral therapy for chronic pain (CBT-CP) is an evidence-based treatment for improving functioning and pain intensity for people with chronic pain with extensive evidence of effectiveness. However, there has been relatively little investigation of the factors associated with successful implementation and uptake of CBT-CP, p...

Unlabelled: Cognitive behavioral therapy for chronic pain (CBT-CP) has a strong evidence base, but little is known about when treatment benefits are achieved. The current study is a secondary analysis of individuals with chronic back pain recruited for a non-inferiority trial comparing interactive voice response (IVR) CBT-CP versus in-person CBT-C...

Cocaine use disorder (CUD) is a devastating disorder, impacting both individuals and society. Individuals with CUD face many barriers in accessing treatment for CUD, and most individuals with CUD never receive treatment. In this review, we provide an overview of CUD, including risk factors for CUD, common co-occurring disorders, acute and chronic e...

Due to concerns about the safety and efficacy of long-term opioid treatment, non-pharmacological interventions for chronic pain such as cognitive-behavioral therapy for chronic pain (CBT-CP) are being promoted as first-line treatments. Telehealth delivery is designed to increase access and reduce barriers to CBT-CP with comparable effectiveness rel...

This secondary analysis sought to determine if plasma menthol glucuronide (MG) concentrations predict changes in three outcomes, subjective drug effects, urges to smoke, and heart rate, following concurrent inhaled menthol and intravenous nicotine. A total of 45 menthol and non-menthol cigarettes smokers (36 male, nine female, 20 Black, and 23 Whit...

The development and dissemination of multicultural competence in the field of clinical psychology is garnering increased attention. Providing multicultural supervision enhances multicultural competence and benefits the supervisor, supervisee, and client. However, there is little research on how multicultural supervision is provided and how it could...

A recent study demonstrated that during a single sampling period, 0.1 mg of intravenous (IV) nicotine (vs. placebo) was found to be the threshold for subjective and physiological drug effects. The present study is a secondary analysis evaluating whether the threshold for subjective and physiological effects is similar when the subject has repeated...

Background: Understanding how stress dynamically associates with alcohol use could provide a finer-grain resolution of drinking behavior, facilitating development of more effective and personalized interventions. The primary aim of this systematic review was to examine research using Intensive Longitudinal Designs (ILDs) to determine if greater nat...

Faster delivery rate enhances the abuse potential of drugs of abuse, yet systematic studies on the impact of delivery rate on the acute effects of nicotine in humans are lacking. Using an intravenous (IV) nicotine infusion procedure that allows precise control of rate of delivery, we examined the impact of nicotine delivery rate on the positive sub...

Little is known about how individuals with chronic pain use tailored internet-based interventions. This study is the first to compare self-reported skill module use to observed module access and to examine each of these in relationship to tailored recommendations to access specific content. Participants (N = 58) enrolled in a 10-week trial of the P...

To address the ongoing opioid epidemic, there has been an increased focus on the treatment and evaluation of opioid use disorder (OUD). OUD and chronic pain (CP) frequently co-occur; however, little is known about the additional comorbidities that present when they occur together as compared to when either condition presents alone. Using data from...

RationaleReducing nicotine content of inhaled tobacco products may prevent nicotine addiction, but the threshold for nicotine reinforcement has not been systematically evaluated in controlled human laboratory studies.Objectives The current study uses a novel double-blind placebo-controlled intravenous (IV) nicotine self-administration (NSA) model t...

Objectives An estimated 50 million adults in the US have chronic pain, and is one of the most cited reasons for seeking medical treatment. There are well-established associations between dietary patterns, nutrient intake, and musculoskeletal health. Dietary habits can influence inflammation and inflammatory markers, both of which can contribute to...

Objectives: Opioid use disorder (OUD) is a public health emergency. Evidence suggests that posttraumatic stress disorder (PTSD) is common among individuals with OUD; however, few studies evaluate whether concurrent diagnoses affect treatment outcomes. This review examines the impact of concurrent diagnoses of OUD and PTSD on treatment outcomes. M...

Quitting smoking is notoriously difficult. Models of nicotine dependence posit that strength of cognitive control contributes to maintaining smoking abstinence during smoking cessation attempts. We examine the role for large‐scale functional brain systems associated with cognitive control in smoking lapse using a novel adaption of a well‐validated...

Background Given access barriers to cognitive behavioral therapy for chronic pain (CBT-CP), this pragmatic superiority trial will determine whether a remotely delivered CBT-CP intervention that addresses these barriers outperforms in-person and other synchronous forms of CBT-CP for veterans with musculoskeletal pain. Design This pragmatic trial co...

The multitude of treatments available for tens of millions of US adults with moderate/severe chronic pain have limited efficacy. Long-term opioid therapy (LTOT) is a widely available option for controlling pain among patients with chronic pain refractory to other treatments. The recent recognition of LTOT inefficacy and complications has led to mor...

Internet-based interventions for chronic pain have demonstrated efficacy and may address access barriers to care. Participant characteristics have been shown to affect engagement with these programs; however, limited information is available about the relationship between participant characteristics and engagement with internet-based programs for s...

Purpose of Review Many psychosocial interventions for substance use disorders (SUDs) focus on teaching self-regulation strategies. Research using intensive longitudinal methods (ILM), such as ecological momentary assessment and daily diaries, is critical for elucidating if and how these strategies function as mechanisms of change among individuals...

Quitting smoking is notoriously difficult. Models of nicotine dependence posit that deficits in cognitive control contribute to failures to maintain smoking abstinence during smoking cessation attempts. We examine the role for large-scale functional brain systems associated with cognitive control in smoking lapse. We use data from 70, five-minute f...

Rationale Minocycline, a tetracycline antibiotic, inhibits activation of microglia. In preclinical studies, minocycline prevented development of opioid tolerance and opioid-induced hyperalgesia (OIH). The goal of this study was to determine if minocycline changes pain threshold and tolerance in individuals with opioid use disorder who are maintaine...

Purpose To review the epidemiology, diagnosis, and treatment of co-occurring mood disorders (bipolar disorder and major depression) and stimulant use disorders (SUD), which includes cocaine and methamphetamine use disorders. Recent Findings Epidemiological studies support frequent co-occurrence between mood and SUD. Multiple studies support a bidi...

Background: Opioid use in the United States is a national public health emergency. The primary treatment for opioid use disorder (OUD) is medication assisted treatment (MAT). Although effective in improving treatment outcomes in OUD, there is a need to develop behavioral treatments adjunctive to MAT. The current study investigates attentional bias...

Objective Drugs that enhance cholinergic transmission have demonstrated promise treating addictive disorders. Galantamine, an acetylcholinesterase inhibitor, may reduce cigarette smoking in otherwise healthy treatment‐seeking smokers. Methods The current study is a double‐blind, placebo‐controlled, study that randomized daily smokers (n = 60) to r...

Background: Given the current prevalence of both cigarette use and obesity in the United States, identification of dietary patterns that reduce mortality risk are important public health priorities. The objective of the present study was to evaluate the correlation between cigarette use and dietary energy density, a marker for diet quality, in a p...

The Balloon Analogue Risk Task (BART) is a behavioral measure that is commonly used to assess risk taking propensity. The primary goal of the present study was to introduce a mobile version of the BART (mBART) that can be included within ambulatory assessment protocols to assess risk taking in daily life. Study 1 compared common BART indices (i.e.,...

There is growing interest in applying the multimorbidity model for mental health disorders - i.e. the interactive effects of co-occurring diagnoses. Alcohol use disorder (AUD) and tobacco use disorder (TUD) often occur together, but distinctive correlates of their co-occurrence have not been studied. Veterans treated by the Veterans Health Administ...

Introduction: Research suggests that a blunted response to nondrug rewards, especially under conditions associated with strong cigarette cravings, is associated with reduced abstinence motivation in daily smokers. One limitation of previous studies is that they have largely focused on monetary rewards as broad representative of nondrug rewards. It...

- Greater risk-taking on the mBART (adjusted average pumps, number of balloon explosions, and coefficient of variability) is associated with greater sensitivity to incentives. - The coefficient of variability on the mBART uniquely conveys information about risk-taking and substance use as well as nicotine dependence in nondaily smokers. - The coeff...

Decades of alcohol research have established the health risks and pharmacodynamic profile of oral alcohol consumption. Despite isolated periods of public health concern, comparatively less research has evaluated exposure to alcohol vapor. Inhaled alcohol initially bypasses first-pass metabolism and rapidly reaches the arterial circulation and the b...

Smoking cessation failures are frequently thought to reflect poor top-down regulatory control over behavior. Previous studies have suggested that smoking cues occupy limited working memory resources, an effect that may contribute to difficulty achieving abstinence. Few studies have evaluated the effects of cognitive load on the ability to actively...

Risky sexual behavior is associated with multiple negative health outcomes including increased risk for sexually transmitted diseases, unplanned pregnancy, as well as adverse psychological consequences. Young adults in a university environment are particularly susceptible to high-risk sexual behavior and other disinhibited behaviors such as alcohol...

As a group, cigarette smokers exhibit blunted subjective, behavioral, and neurobiological responses to nondrug incentives and rewards, relative to nonsmokers. Findings from recent studies suggest, however, that there are large individual differences in the devaluation of nondrug rewards among smokers. Moreover, this variability appears to have sign...

Digital interactions are an increasingly common communication method among young adults, but little is known about whether such remote exchanges influence riskiness. The current study examined whether observing and interacting with, versus simply observing, a digital peer affect risk taking in young adults aged 18–25. Participants who remotely view...

Ecological momentary assessment (EMA) and related methods typically entail repeatedly and intensively sampling behavior as it occurs over time and under naturalistic conditions. Although the methodological features of EMA make it a highly valuable research technique in its own right, EMA can also be a potent counterpart to other approaches. One met...

Networks of brain regions having synchronized fluctuations of the blood oxygen level-dependent functional magnetic resonance imaging (BOLD fMRI) time-series at rest, or "resting state networks" (RSNs), are emerging as a basis for understanding intrinsic brain activity. RSNs are topographically consistent with activity-related networks subserving se...

Self-control plays an important role in several health-related behaviors, including cigarette smoking. There is some evidence that individual differences in self-control are negatively associated with overall levels of nicotine dependence but, to our knowledge, finer-grained relationships between these constructs have not been explored. This is an...

Transcutaneous electric acupoint stimulation (TEAS) avoids the use of needles, and instead delivers a mild electric current at traditional acupoints. This technique has been used for treating heroin addiction, but has not been systematically tested for other drugs of abuse. This study aims to investigate the effects of TEAS on drug addiction. Volun...

Supplemental tables

According to ancient Chinese medicine, kudzu root has been used as an ingredient to treat alcohol intoxication for centuries. Kudzu root extract is effective at reducing alcohol intake in animals and in humans, both in a natural-settings laboratory environment and on an outpatient basis. In dependent populations, withdrawal from alcohol is associat...

Cocaine use is associated with poorer HIV clinical outcomes and may contribute to neurobiological impairments associated with impulsive decision making. This study examined the effect of cocaine dependence on brain activation during a delay discounting task involving choices between smaller immediate rewards and larger delayed ones. Participants we...

Zolpidem is a short-acting imidazopyridine hypnotic that binds at the benzodiazepine binding site on specific GABA(A) receptors to enhance fast inhibitory neurotransmission. The behavioral and receptor pharmacology of zolpidem has been studied extensively, but little is known about its neuronal substrates in vivo. In the present within-subject, dou...

Background: Isoflavone administration in the form of a purified extract from the herbal medication kudzu root has been shown to reduce, but not eliminate, alcohol consumption in alcohol-abusing and alcohol-dependent men. The precise mechanism of this action is unknown, but 1 possible explanation for these results is that the isoflavones in kudzu m...

Recent case reports suggest that the short-acting benzodiazepine-like hypnotic, zolpidem, may have abuse potential among individuals who have no personal history of abusing drugs or alcohol, particularly at doses higher than those recommended for treating insomnia. This study recruited drug-naive volunteers to assess the subjective effects of multi...

Several popularly abused drugs, such as nicotine (tobacco) and THC (?9-tetrahydrocannabinol) (marihuana) are commonly selfadministered by the smoked route. Although the neuronal substrates mediating the effect of smoked drugs are of interest, studies of their acute actions in living human brain has been difficult due to the unique constraints impos...

Disturbed sleep is a common subjective complaint among individuals diagnosed with anxiety disorders. In rodents, sleep is often recorded after exposure to various foot-shock paradigms designed to induce an anxiety state. Although differences in sleep-wake architecture are noted, the relationship to specific level of anxiety is often assumed or abse...

At its most basic level, the function of mammalian sleep can be described as a restorative process of the brain and body; recently, however, progressive research has revealed a host of vital functions to which sleep is essential. Although many excellent reviews on sleep behavior have been published, none have incorporated contemporary studies exami...