The Addiction Institute of Mount Sinai (AIMS) is the largest institute in the nation that combines clinical services; clinical, basic, and translational research; and education and training to advance treatments for addiction to alcohol, opioids, compulsive eating, and gambling.
Yasmin Hurd, PhD, Director of the Addiction Institute of Mount Sinai, is investigating the effectiveness of nonaddictive medications such as cannabidiol (CBD), and has launched innovative fellowship training programs in addiction medicine and addiction psychiatry.
“Addiction treatment for opioid disorders, in particular, has been extremely regimented—essentially stuck in place,” said Dr. Hurd, a member of the National Academy of Medicine. “The 50-year-old model of using methadone and, more recently, buprenorphine, is well validated and has saved millions of lives, but the need for new therapies has never been greater for patients and their families.” Methadone and buprenorphine are opioid substitution therapies that work on the same opioid receptors (mu receptors) as heroin and other potential opioid agonists. These workhorse medicines are effective but carry an undeniable stigma, as well as their own addiction risk, and are subject to tight government regulations. For those reasons, many people diagnosed with opioid-use disorder avoid using them.
CBD could be one such therapy. Dr. Hurd’s lab has found that CBD significantly reduces cue-induced craving and anxiety in individuals with a history of heroin abuse, which suggests a potential role for the therapy in breaking the cycle of addiction. “The fact that CBD is nonaddictive and doesn’t have the adverse side effects of many other medicines makes it an important therapy for us to pursue,” she said.
Her research team has two new CBD studies underway. One is a major clinical trial that could lead to the development of unique CBD formulations to be part of the medical arsenal available to address the opioid epidemic. The other is a neuroimaging study that examines neural activity and levels of chemicals such as glutamate in the human brain. This study will help identify neurobiological mechanisms related to CBD’s impact in reducing drug craving and anxiety. “I believe we’re at a turning point,” said Dr. Hurd. “We’re asking the hard questions and doing the necessary research that can lead the rest of the country to new treatment options for opioid addiction.”
She also recently published study results in Nature Communications showing that people with heroin addiction have unique molecular alterations to the brain that resemble brain disturbances seen in neurodegenerative disorders such as Alzheimer’s disease. Moreover, blocking these alterations reduced heroin intake. “Direct molecular insights into the heroin-addicted human brain are critical to guide future therapies,” said Dr. Hurd. “Our new study findings clearly open up new lines of treatment opportunities for opioid use disorder, which could benefit and potentially save the lives of so many.”
This drumbeat of research supports the evidence-based treatments that AIMS provides to thousands of patients each year. These range from treating those in need of crisis management or hospital-based detoxification services to those requiring monthly check-ins with a counselor or clinician. “A lot of addiction treatment is based on anecdote—ours is very much married to science,” said Timothy Brennan, MD, MPH, Director of AIMS at Mount Sinai West and Mount Sinai Morningside.
At AIMS, an emphasis on evidence-based treatments led to the creation of the Crystal Clear Project, which addresses the growing problem of crystal methamphetamine use and its connection to unsafe sexual practices among a population of gay and bisexual men. According to Dr. Brennan, AIMS has been the only program in the nation to treat both issues together. “The Crystal Clear Project has become a model by serving as a humane place where people are treated with dignity,” he said.
Fellowship Training for Addiction Clinicians: AIMS offers two fellowships in addiction psychiatry for physicians who have completed a residency in any specialty with an option to add a second year focusing on mentored research. One fellowship is located at Mount Sinai Beth Israel, and the other is at Mount Sinai West and the James J. Peters VA Medical Center in the Bronx, New York.
A third fellowship in addiction medicine is led by Dr. Brennan at Mount Sinai West. Fellows train in behavior modification techniques, motivational interviewing, 12-step facilitation, and psychopharmacology specifically designed for this patient population.
Care for Teens: AIMS also provides integrated care for teenagers struggling with mental health or substance abuse through its Comprehensive Adolescent Rehabilitation and Education Service (CARES) program. CARES provides mental health and substance-use treatment along with a New York City Department of Education high school curriculum. The program has been virtual during the pandemic, with students attending school, socializing with peers, and participating in group and individual counseling online. The continuous delivery of these services has been essential in providing much-needed support to vulnerable patients and their families.
CARES has also provided patients with onsite, in-person support and crisis management during the pandemic. The goal has been to provide such vulnerable adolescents with a safe space where they can receive comprehensive treatment on a daily basis.
“It is critical that all efforts to combat addiction and related psychiatric disorders include focused strategies for teens and young adults, who are our immediate future,” said Dr. Hurd. “We can change the trajectory of a lifetime chronic disorder by paying significant attention to this particularly vulnerable population.”
To refer a patient, please call 212-256-2623 for Mount Sinai Beth Israel or 212-523-6491 for Mount Sinai Morningside and Mount Sinai West.
Mount Sinai Has Offered Pioneering Addiction Treatment Programs in New York City Since 1961
Harold Trigg, MD, launched the Drug Addiction Service, a detoxification inpatient program at Manhattan General Hospital in 1961, a program that was later absorbed by Beth Israel Medical Center, which is now Mount Sinai Beth Israel. Within a year of its founding, the program became the largest addiction service in the country. It is still thriving today.
In 1965, Dr. Trigg, Marie Nyswander, MD, and Vincent Dole, MD, opened the outpatient Methadone Maintenance Treatment Program, a pioneering program now called the Opioid Treatment Program, which is operated by the Addiction Institute of Mount Sinai, with locations throughout New York City.
Yasmin Hurd, PhD
Ward-Coleman Chair in Translational Research and Director of the Addiction Institute of Mount Sinai
Timothy Brennan, MD, MPH
Director of the Addiction Institute of Mount Sinai at Mount Sinai West and Mount Sinai Morningside