Researcher Seeks to Identify Best Medications to Treat Drug Abuse
Craig Rush is devoted to improving the lives of people who struggle with drug abuse by identifying treatments that allow them to stop or reduce their drug use. Since joining the University of Kentucky in 1999, he has come to wear several hats. He is the director of UK’s Laboratory of Human Behavioral Pharmacology, serves as assistant vice president for research, and holds professorships in the departments of behavioral health, psychiatry and psychology so that he can help train the next generation of researchers.
But it was a combination of choice and chance that led him to the field of human behavioral pharmacology and drug abuse.
“I can remember as a little boy, talking to my mother and saying ‘I think I want to do something with drug abuse,’” he said. “I was six or seven. I remember it clearly — we were in the car. I thought I would be a drug cop, something to help people make their lives a little better.”
He later came to the field of human behavioral pharmacology “purely by accident.” He finished his Masters degree in psychology at Bowling Green State University in Ohio and taught at a community college for three years. “But I didn’t want to teach intro to psychology for the rest of my life,” he said. “Everything I read about drug abuse was saying ‘We don’t know much about this, there needs to be more research’. And I thought, ‘I could do that research.’”
With that motivation, Rush applied to a doctoral program at University of Vermont to work with a researcher who studied drug abuse through rodent experiments. “I knew I wanted to study drug abuse, but I had always thought about doing it in a lab, not with people,” said Rush. But, by chance, his application was forwarded to a researcher who studied human behavioral pharmacology. “We really hit it off,” said Rush.
Some 20 years later, Rush is a leader in the field of human behavioral pharmacology, with a postdoc at Johns Hopkins University, more than 100 peer-reviewed publications to his credit and over $35 million of competitively awarded research funding through his various roles and collaborations.
Specifically, he is committed to determining what medications, or combinations of medications, can help people stop or reduce their use of stimulants like cocaine and methamphetamine. “I’m engaged in treatment identification,” he said. “We only want to push forward medications with the most promise.”
Rush and his team are currently running four studies funded by the National Institutes of Health (NIH). Rush’s work also depends on the research infrastructure at UK, particularly the in-patient research unit that is supported by UK’s Center for Clinical and Translational Science.In that unit, Rush and his team run the Laboratory of Human Behavioral Pharmacology to screen medications that can possibly block the effects of drugs so that people will become less dependent on them and/or stop using them altogether. Rush examines if some medications help drug abusers become abstinent, and if the same or different medications can help them remain abstinent.
“If we want to think about addiction as a disease, we need to bring the disease research mentality to our work.” He said. “If it’s a medical condition, let’s think about medically.”
Just like researchers must study cancer medications in patients with cancer, the medical approach necessitates that Rush and his team study addiction medications in persons who are addicted to drugs. That’s right: study participants must be currently addicted to drugs, specifically stimulants. Potential participants are thoroughly screened for a huge number of criteria, including active addiction, and undergo a battery of psychological testing, a full physical exam, lab work, and an ECG before they are cleared to participate. “We are conservative about inclusion. We’re really careful on the front end in order to avoid problems on the back end,” Rush said.
In the course of the studies, participants spend two to four weeks in the in-patient research unit. During that time, they are alternated on and off the medication being studied, or given a placebo, to gauge the effectiveness of the medication in reducing their desire for and willingness to work for the drug. A physician sees the participants every day in the in-patient research unit. At the end of their participation, they are offered a referral for drug abuse treatment.
“What we are finding is that there are some medications that work,” said Rush. “They’re not as effective as we’d like them to be, but they give clinicians something to use while we look for other drugs that are better.”
Rush knows that one therapy that appears to be the most effective is also the most controversial: substitution therapy for harm reduction. This involves substituting the drug to which a person is addicted with a less harmful alternative, under the safe and monitored clinical supervision of doctors. For example, this is the approach by which clinically supervised methadone maintenance is used to as an anti-addictive maintenance medication for people addicted to opioids.
“Substitution therapy is better because it’s under the control of a healthcare provider – it’s safer for the patient, reduces chances of overdose or contracting a disease, and is ultimately better for the healthcare system,” said Rush.
He also wants to see more creative, medical approaches and mentalities in treating drug abuse. “I think we need to start thinking outside the box about how to treat drug abuse and what our goal is. Is it abstinence? Is it decreased drug use for a healthier life?” he said.
He uses an analogy about obesity to demonstrate that, as in other medical conditions, any improvement with drug addiction is worthwhile. “If someone is morbidly obese and weighs 300 pounds, and you can get them to lose 25 pounds, they’re still obese but it’s better than where they started at 300. Maybe their blood pressure is a little lower, maybe their knees hurt a little less,” he said. He sees a parallel with drug abuse. “Abstinence might be an unrealistic goal for some people. So even reductions in use are good. If we can reduce drug use, and by association, the health consequences and the harm that people are causing themselves, that’s good. That’s good for the person and it’s going to translate into significant savings in the health care system.”
Rush acknowledges that the best treatment for drug abuse is a combination of medication and behavioral interventions. “There’s not a magic bullet that’s going to fix an addiction,” he said. “There’s a lot of behavior that needs to change.” He is currently writing a grant to study if cognitive retraining, which has been shown to have some effect in treating alcohol abuse, can reduce cocaine use.
He also understands the broader social factors that are inextricably related to drug abuse. Just as education and socioeconomic status are predictors of many health problems like smoking and obesity, they are often a predictor of drug abuse. “And we aren’t going to be able to fix someone’s socioeconomic status with a drug,” he said. “It would be nice if we could, but we can’t.”
Rush sees a long road ahead in working toward better approaches and treatments for drug abuse. That’s part of why he is so committed to training and mentoring the next generation of researchers.
“My favorite part of my job is training graduate students,” he said. “It’s what I’m most proud of. They’re young and excited about their research, which makes me excited.”
Similarly, his role as associate vice president of research stems from his desire to impact the broader UK research community at a higher level than just his own work. “I could just sit here and do my research,” he said. “But I also want to help move the university forward in this way.”
He particularly enjoys conducting grant writing workshops for researchers. “The grant funding situation is so difficult right now. Senior folks like me need to take some time to help the young folks learn to write grants.”
When asked about the future of his work, Rush is clear that he has no intentions of leaving UK or his field. He remembers that during his first visit to UK, he went to a restaurant with his wife. She pointed out that most people in the restaurant were wearing something with UK or Kentucky on it. “The community and statewide support of this institution is wonderful,” he said. “The integrated medical and academic parts of campus create a great collaborative environment. There is so much support for our research here.”
And he knows that his work can be of great benefit in Kentucky, which, according to the 2007 – 2008 National Survey on Drug Use and Health, is one of the top 10 states for rates in several drug-use categories among persons age 12 and older: past-year non-medical use of pain relievers; past-month use of illicit drugs other than marijuana; and illicit drug dependence. Drug induced deaths in Kentucky exceed the national average, according to the same survey.
“It’s hard to watch the news without hearing about a meth bust somewhere in the state. There’s a high incidence of drug abuse in Kentucky, and we’d like to impact health here at home, in our state,” he said. “And we know that medication development for drug abuse has to get creative.”
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